Medical tourism: patients without borders

March 29, 2012

Stories by Diane Luckow

In Barbados, American investors are recruiting U.S. and Canadian physicians to buy time-share style memberships in a renovated hospital and bring their patients there for surgery.

In Chennai, India, Canadians in surprising numbers are seeking orthopaedic surgery to bypass wait lines at home or get procedures not readily available in Canada such as hip resurfacing.

Patients from more economically developed countries are flocking to developing countries to receive treatment for everything from elective cosmetic procedures to complex surgeries such as organ transplants and reproductive treatments, controversial stem-cell procedures and multiple sclerosis liberation therapy.

The medical tourism industry is booming. But there is a surprising lack of academic research into the industry’s size, the ethics and risks of medical tourism, and the effects it can have on developing countries’ local health services.

That’s why SFU health geographer Valorie Crooks established the SFU Medical Tourism Research Group (MTRG). In 2008, she was the first Canadian researcher to receive a Canadian Institutes of Health Research (CIHR) grant to study the subject.

“We found that many Canadians are relying on informal testimonies and anecdotal information from the Internet to make important decisions for surgical care,” says Crooks.

The study also sheds light on how and why Canadians are engaging in medical tourism.

“People believe Canadians are going abroad because of waiting lists and Americans are going because it’s cheaper, but our research shows that it’s more complex than that,” says Crooks. “There are issues of procedure availability and procedures not covered under Medicare, while others go because they’re concerned about the quality of care here in Canada. It’s not black and white.”

The group’s first study served as a platform for three more CIHR-funded studies outlined below that will examine a variety of issues related to medical tourism.

Valorie CrooksValorie Crooks

Health inequities?

What’s happening to local health-care services in developing countries that cater to medical tourists?

Crooks’ team is using a $520,000 CIHR operating grant to find out.

“There’s a lot of speculation that medical tourism is great for the locals because it brings in money and jobs,” says Crooks. “But on the other hand it shifts the focus to high-end surgeries and facilities for treating international patients.

“There’s very little evidence one way or the other to prove these two theories.”

In April, Crooks will travel to Mongolia with group member Jeremy Snyder, a health sciences assistant professor, and health sciences professor Craig Janes to explore the impact on local health services when affluent Mongolian citizens travel abroad for health care.

“We’ll look at the health-system challenges this poses for Mongolia to see if there are any lessons we can learn about how a lower-resource environment then deals with its patients,” explains Crooks.

They’ll meet with academics and interview facilitators who are sending Mongolians abroad for health services as well as local health officials.

Mongolian health sciences grad student Tsogtbaatar Byambaa, who inspired the research, is concerned about the growing numbers of Mongolians travelling outside of the country to receive medical care. He wants to know more about their outcomes and the long-term impact on the country’s health system.

The researchers will also travel to Mexico, Guatemala, Barbados and India over the next year to complete their research.

Jeremy SnyderJeremy Snyder

New ethical guidelines

People want to know if medical tourism is “right or wrong,” says health geographer Valorie Crooks, who heads SFU’s Medical Tourism Research Group (MTRG).

That’s why group member Jeremy Snyder is using a CIHR Catalyst grant to research and develop an ethical buying guide for Canadians thinking of travelling for medical services.

The guide will address issues such as the potentially negative impact medical tourism could have on local communities. “Medical tourism might direct resources away from low-income settings or redirect health personnel,” says Snyder.

As well, tourists undergoing procedures abroad such as a kidney transplant may return home requiring expensive on-going treatment “that burdens people in Canada waiting in queue,” he says. “We want to educate people about these concerns.”

Snyder and Crooks are working with the Michael Smith Foundation on a policy paper for B.C.’s health ministry to help articulate what the government’s responsibilities should be for patients returning home after international treatments.

“There are a number of stories of people returning home with very high care needs,” says Crooks, adding she is committed to publishing her group’s research in open access journals.

“We’re just touching the edge of the iceberg regarding issues related to medical tourism.”

Medical tourism caregivers

Valorie Crooks and her Medical Tourism Research Group team have just begun a three-year study into the roles, risks and responsibilities of caregivers who often accompany medical tourists.

“There’s no consideration for the costs of a travelling companion’s accommodation and transportation, their unpaid labour to assist the patient, their time and the risks they may be exposed to,” says Crooks, an associate professor of health geography.

“We need to think about these individuals and the role they play. They’re giving their unpaid labour to advance this industry.”

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