Medical tourism isn’t all faulty breast implants and NHS fraud

Holidays: sun, sea, surf and surgery? Gerard Stolk, CC BY-NC

Medical tourism is often associated with an image of sun, sand and surgery; patients travelling mostly from rich countries in the global North to exotic destinations for medical treatments at a lower cost, while enjoying sunshine and tourist activities. But the phenomenon where patients travel abroad to seek treatment is more diverse and varied than you might expect.

Medical tourism has received mixed coverage in mainstream media – it gains notoriety when patients travel and experience complications as a result of receiving treatment abroad. The PIP breast implant scandal, for example, brought issues with medical tourism to light after many women had the faulty implants as cosmetic surgery tourists.

More recently, the UK government chose to highlight so-called “health tourism” in its Immigration Bill. Health tourism in this context has been described as a kind of welfare scrounging where patients come to the UK and covertly try to access free NHS treatment that they are not entitled to.

But where does the majority of medical tourism take place around the world? Unfortunately, what we know is limited. In most cases, patients organise their own travel, often within the private sector. There is no clear industry structure, no oversight body or registration monitoring where people come from and where they travel to. Figures of global flows of patients reported in the mainstream media often rely on hearsay or reports by industry bodies where sources are unclear.

Complex global picture

Despite these limitations in what we know, there is increasing evidence of how and where medical tourists access treatment and where not. What emerges is a complex picture with many patients travelling within regions rather than long distance to access treatment.

Data also highlights South to South travel rather than the more commonly assumed travel from a rich country in the global North to a low income country in the global South – or vice versa. For example, many people from countries neighbouring South Africa, such as Mozambique, Zimbabwe, Lesotho and Swaziland travel into the country to access treatment and care.

In Thailand – a medical tourism hub – there is also a strong regional dimension, with patients from Myanmar travelling to access treatment and care, which they are unable to obtain at home. Equally, many Indonesians try and access medical care in Malaysia as services are not available at home.

Additionally, countries become known for an area of expertise. For example many patients from the UK and other EU countries travel to Hungary for dentistry services.

Medical tourism in and out of the UK

For the UK we know that a growing number of patients travel out, as well as into the UK. In 2010 an estimated 63,000 patients left the UK for treatment and 52,000 travelled there to access it. Patients leaving to access treatment abroad during the past decade often stayed within Europe, with the most popular destinations being Poland followed by France.

Map of medical travellers and their destinations from the UK, 2000–2010. Johanna Hanefeld/PLOS One, Author provided

But, as the map of travel destinations shows, India was not far behind. This may partly be because India has positioned itself as a hub for medical tourism, but also because there are a large number of first or second generation Indians living in the UK who travel home for treatment. Such diaspora tourism is common , with people often travelling “home” for treatment.

Of medical tourists coming into the UK, major source countries include Spain, Greece, Cyprus and the Middle East. In recent years there has also been an increase in patients travelling from Ireland and Nigeria. For the former, this may reflect the effects the economic crisis had on access to health care, while Nigerian patients may be indicative of the countries’ economic growth. However, the only reliable estimates available for the UK suggest that the numbers of actual patients travelling into the country are relatively small (a modest 52,000 people in 2010).

The bottom line

So, while we do not know how many patients travel globally, we do know quite a lot about where patients travel from and their destinations. Patients seem to predominantly travel within a region. They also travel to countries associated with specific treatments.

Countries in Southeast Asia that have marketed themselves as tourism destinations receive large numbers of patients from the Middle East and other emerging economies, which are likely to be quite well-off. In addition, they receive patients seeking a good deal from further afield, including the UK.

While data is still minimal in these areas it seems that many people who travel for treatment are likely not to be seeking beach life or sightseeing, or may not be particularly wealthy. Their motivation is complex, but patients are driven by a need for treatment unavailable to them at home, perceived quality of care or cost – rather than wishing to avoid payment.