Medical Tourism: A guide for North Americans seeking health care abroad

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The unpaid care work they provide to medical tourists is invaluable. And I have no doubt that many patients would not even consider medical tourism without someone to accompany them on what can be a painful and challenging journey.

My collaborative research shows that one tangible action is to develop resources to help these individuals make informed decisions , become prepared travellers and caregivers and stay safe and healthy. I was recently involved, with a research team, in interviewing Canadians who had accompanied a family member or friend abroad for medical tourism.

Their stories contained very important pieces of advice for people considering taking on this role. We gathered this advice together and published it in an academic article.

Information and Planning

We also put together a simple, one-page information sheet that offers nine specific factors that I strongly urge friends and family to carefully consider before accompanying a medical tourist abroad. The information sheet we developed can be shared widely. The text can be copied and pasted freely onto the websites or promotional materials of clinics and hospitals seeking to treat medical tourists.

This sheet also serves as companion to another information sheet we developed —for Canadians thinking about participating in medical tourism. Their unpaid labour needs to be acknowledged. Their needs must be assessed. Their health and safety needs to be protected. I push for these things to happen when I meet with medical tourism sector representatives, and I call on others to push for the same. Edition: Available editions United Kingdom. This photo was taken at a resort just outside Chennai, India that caters to medical tourists following discharge from hospital.

Crooks , Author provided. Crooks , Simon Fraser University. Author Valorie A. It is therefore unsurprisingly that affordability of care is emphasized in marketing messages. Access to high-quality care is presumably mentioned as a way to reassure prospective clients that they should feel confident that they will receive professional care when they go abroad for treatment. This message is perhaps promoted as a way of allaying fears that going abroad for inexpensive care might increase risk of exposure to lower-quality care. Finally, the message of gaining access to "timely" health care might have particular resonance for Canadians wait-listed for orthopaedic procedures, ophthalmologic procedures, spinal surgery, bariatric surgery, and other interventions where there are sometimes considerable delays prior to obtaining access to publicly-funded health care at Canadian medical facilities.

For example, Speedy Surgery Global Healthcare, one defunct company mentioned in this analysis, and Timely Medical Alternatives, a company that continues sending Canadians to hospitals and clinics in the United States as well as private health care facilities in Canada, both emphasize in their company names provision of prompt access to care.

Wanting to avoid providing a reductionist, single-factor account of how medical tourism is marketed by companies based in Canada, it nonetheless seems reasonable to suggest that timely access to care abroad, in contrast to treatment delays for access to some types of care in medical procedures performed in Canada, is one marketing message likely to resonate with Canadians frustrated with wait-times for various elective procedures.

In this respect, it is possible that the marketing messages used by medical tourism companies based in Canada might differ somewhat from marketing claims used by medical tourism companies located in countries where the presence of a significant private health sector means that clients with sufficient financial assets can gain prompt access to medical procedures. Comparative studies that contrast marketing messages of medical tourism companies based in different countries should provide insight into regional and national variations in the types of marketing messages used to promote medical tourism.

Another finding that merits mention is that twenty-two of the twenty-five defunct medical tourism companies can be characterized as "generalist" medical tourism companies. This label means that these companies marketed multiple procedures, tests, and treatments rather than confining themselves to dental treatments or some other specialized domain of care.

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Even companies that offer many different services are at risk of ceasing operations. It is not known whether cessation of operations is linked to a limited client base, an overreliance on one or two health care destinations, concerns about liability, competition from other medical tourism companies, a low ratio of earnings to expenditures, or other factors. Future research will explore why some companies remain operational and other businesses cease functioning. Both of the companies that promoted "dental tourism" are no longer operational.

While this article does not address why medical tourism companies ceased operations, numerous hypotheses are worth exploring in future studies. Cost savings associated with obtaining dental care abroad might be lower than anticipated once airline tickets, ground transport, hotel accommodations, and other expenses are factored into consideration. Concerns about patient safety and quality of care might deter some Canadians from receiving dental care abroad. It is also conceivable that the practice of dentistry is not well suited to a business model that involves travel to international dental clinics.

Many forms of dental care require repeat visits rather than one-time procedures. Having multiple dental procedures at one time could put patients at increased risk of complications. Staying abroad for multiple procedures would presumably increase time away from home and also generate additional expenses.

Though this study offers no definitive insights into why both of Canada's dental tourism companies are defunct, it is worth noting that at present there appear to be no functioning companies in Canada that are based exclusively upon a business model of marketing dental care abroad. Travel abroad for the purpose of purchasing a kidney used in organ transplantation, sometimes described as "transplant tourism", receives considerable attention from both health researchers and journalists. However, of Canadian medical tourism companies no longer in operation, just one business had as its primary message the marketing of organ transplants abroad.

One other company marketed organ transplants in addition to other medical procedures. It is conceivable that other medical tourism companies did not market organ transplants abroad because of fears that they might be accused of facilitating "organ brokering" or "organ trafficking"; concerns about negative news media coverage that might harm other aspects of their business; inability to identify facilities able to provide organ transplants; ethical reservations about intentionally or unintentionally participating in organ trafficking; or concerns about legal repercussions. Whatever the reason, with the exception of one business that advertised organ transplants in Colombia and one company that claimed to be able to arrange transplants in India, most now-defunct medical tourism companies in Canada did not, while they remained operational, openly market organ transplants performed in other countries.

Another noteworthy finding is that of the twenty-five businesses with websites, fourteen of them sent their clients to just one medical facility or destination nation. In this business model, owners of medical tourism companies decide that all their clients will travel to just one location. It is conceivable that this arrangement is not an optimal business model for an industry that in many respects is built upon promoting patient choice and medical consumerism.

It is possible that medical tourism companies offer more attractive options to a larger prospective clientele when they market health care facilities at multiple international destinations. Whether or not this claim is credible, it is important to note that even businesses with multiple destinations ceased operations. One dental tourism company, for example, listed seven national destinations on its website.

In short, while limiting the number of medical destinations constrains choice and possibly acts as a deterrent to prospective clients, promoting choice in the form of multiple travel destinations does not ensure long-term success in the medical tourism marketplace. Though some researchers express reservations about the phrase "medical tourism", many now-inoperative medical tourism companies in Canada marketed travel-related services such as booking air and ground transport, organizing hotel accommodations and arranging side trips, and other tourist-like activities.

In this aspect of their business models, medical tourism companies resemble travel agencies. These activities provide some insight into how medical care can be connected to activities more typically associated with "traditional" forms of tourism. Whatever causes medical tourism companies to close, it is important to note that in Canada a substantial number of medical tourism companies have exited the marketplace.

The closure of approximately half of all medical tourism companies in Canada has not been previously examined and addressed by health researchers and journalists. Whereas medical tourism companies routinely issue press releases and attract news media coverage when they commence operations, these businesses typically do not issue press releases or receive news coverage when they close.

More and more Americans save money with foreign medical care. Is it safe?

Just one business, EcuMedical Resources International, generated news coverage as it ceased functioning [ 50 , 51 ]. In that company's case, several of its clients claimed that they paid EcuMedical for arranging medical procedures in the U. Following a police investigation the two company owners were charged with multiple counts of fraud. In this case, activity that is presumably atypical in the medical tourism industry resulted in considerable local news coverage of a medical tourism company ceasing operations.

One important benefit of studying medical tourism companies by analyzing content of medical tourism company websites is that the exercise can challenge hitherto unexamined assumptions about the industry. More fine-grained analyses that draw upon multiple research methods such as surveys, in-depth interviews, analysis of news media coverage, and participant observation should generate additional insights into medical tourism companies in Canada.

For example, quantitative studies should provide insight into how many Canadians go abroad for care, where they seek treatment, and what types of procedures they select. Identifying Canada's medical tourism companies, providing their websites, describing their operations and business models, charting where they send patients abroad, summarizing the procedures they advertise, and explicating what services they offer in addition to organizing health care packages should facilitate further studies into Canada's medical tourism industry.

It should also be of practical use to scholars interested in comparing medical tourism companies in Canada with similar businesses situated in other countries. For example, researchers in Australia, England, the United States and elsewhere might find it helpful to compare and contrast Canada's medical tourism industry with the emergence of medical tourism facilitators in their home countries. In addition, these findings should assist scholars interested in evaluating the quality of health-related information presented on the websites of medical tourism companies, and the use of YouTube, Twitter, Facebook, and various forms of social media by medical tourism companies situated in Canada.

Scholars interested in using various research methods to study medical tourism companies in Canada should now have a better sense of where to focus their attention. To facilitate research by other scholars, websites or printouts of websites analyzed in this article have been electronically archived in a publicly accessible database. This article is based upon content analysis of websites of medical tourism companies with home offices or affiliate offices in Canada.

It does not provide insight into medical tourism companies located in other nations. This study offers a set of categories or framework that can be used to study medical tourism companies in other nations. However, using content analysis to study websites of medical tourism companies based outside Canada might generate results very different from this study's findings. Internet searches, review of news reports, review of government records of federally incorporated companies in Canada, and examination of existing lists of medical tourism companies in Canada were all used in an attempt both to identify the total number of medical tourism companies established in Canada and distinguish medical tourism companies that are currently functioning from companies that are no longer involved in sending clients abroad for medical care.

However, it is possible that some medical tourism companies were not identified in these searches. Medical tourism companies use company websites, Twitter, YouTube, Facebook, and other media to market international care, and internet searches are therefore a useful tool to use when trying to find medical tourism companies. Nonetheless, it is conceivable that some medical tourism companies based in Canada do not advertise using the internet or that repeated searches overlooked some businesses.

Consultants to the medical tourism industry recommend that calls to medical tourism companies should be promptly returned within twenty-four hours and preferably within two hours [ 52 ]. However, it is possible that some medical tourism companies continue to function even though they did not reply to multiple efforts to contact them.

Establishing that businesses have ceased functioning in the absence of obvious signs such as companies losing their status as federally incorporated businesses in the end involved exercising judgement. The study is limited insofar as it analyzes content found on medical tourism company websites and does not question the veracity of various claims. For example, one medical tourism company website states that clients can select clinics from among seven different countries. Someone using the tools of investigative journalism might discover that companies do not have business relations with all the facilities that they mention as international health care destinations.

Such questions were bracketed from this study but they are worth pursuing in other studies. It is conceivable that some companies make exaggerated claims about destination facilities and advertised medical services and do not have experience coordinating particular health care packages and sending clients to advertised destinations. Content analysis, for the purpose of this article, accepted statements made by medical tourism companies. Such an approach, though it provides insight into how medical tourism companies in Canada advertise their services, would benefit from being complemented by investigative approaches that critically examine the credibility of claims made by medical tourism companies.

This article focuses upon medical tourism companies that ceased operations. Performing a content analysis of websites of defunct companies could be seen as a limitation of the study, though the point of the exercise was to investigate and analyze not only medical tourism companies that are flourishing in a highly competitive marketplace but also to analyze websites of companies that have ceased sending clients to international health care destinations.

To date, most studies of medical tourism companies have focused upon websites of medical tourism facilitators based in the United States. This paper makes a meaningful contribution to scholarship by providing content analysis of medical tourism companies with home offices or affiliate branches in Canada.

The local, regional, and national settings within which medical tourism companies are situated matters. It should not be assumed that medical tourism companies in Canada advertise the same health care packages or target the same prospective client base as businesses in Australia, the United States, and elsewhere. This article differs from previous work on medical tourism companies by identifying particular businesses, performing content analysis of their websites, and enabling readers to compare this analysis with the primary sources of medical tourism company websites.

This step, by linking content analysis to identified primary sources, promotes transparency in research and allows other scholars to corroborate or challenge findings described in this study. Identifying particular companies and providing content analysis of their websites might help other researchers use their disciplinary methods and theories to study Canada's medical tourism industry. This article can be distinguished from most prior work on medical tourism due to its emphasis on content analysis of medical tourism company websites.

Medical tourism companies conduct much of their business using the internet [ 53 — 55 ]. Reliance on the internet as a medium for communication, marketing, and interaction with clients means that much can be learned about medical tourism companies through careful analysis of their websites. Scholarly analysis of medical tourism companies should not be confined to content analysis of medical tourism company websites.

Nonetheless, this mode of research makes an important contribution to the study of transnational medical travel. Finally, to date scholarship on medical tourism companies has examined companies currently engaged in the business of sending clients to international health care destinations. This article differs from previous work by identifying medical tourism companies that have ceased functioning. Identifying medical tourism companies that are inoperative raises questions about the nature and future direction of this industry.

Many commentators assume that the medical tourism industry is in a period of unprecedented growth [ 56 ]. This article suggests that while the overall medical tourism industry might be expanding, the long-term success of individual medical tourism companies is not assured. The closure of twenty-five medical tourism companies in Canada might reflect a period of industry consolidation in which some companies flourish while others disappear or are subsumed by other companies.

It is also possible that interest within Canada for travelling abroad to international medical facilities is not as large as is commonly assumed and these companies ceased functioning because many businesses are competing for a limited client base. Another possibility is that many of the companies erred when they based their operational model on sending clients to just one medical facility or country.

It is conceivable that prospective clients want to have increased choice in where they travel for care and a business model that constrains options serves to deter clients that might otherwise consider going abroad for health care. And finally, since individuals considering going abroad for medical care can use the Internet to gain direct access to international hospitals and clinics, it is possible that medical tourism companies play a relatively minor role in the overall marketplace for medical travel. There might be less of a need for the service of medical travel facilitation than many entrepreneurs assume.

Future research will explore in greater detail why the medical tourism companies identified in this study ceased functioning. This study identifies twenty-five defunct Canadian medical tourism companies. Researchers will likely disagree concerning how to interpret some aspects of these findings.

Individuals supportive of the Canada Health Act and publicly funded access to medically necessary health services and critical of the privatized, for-profit health care marketed by medical tourism companies might argue that the failure of twenty-five medical tourism companies is a sign of limited interest within Canada for medical travel. They might claim that news media coverage of the phenomenon of medical tourism far outpaces the actual significance of the topic. In contrast, proponents of for-profit, private health care might assert that in every competitive marketplace some companies prosper while other businesses disappear.

Whatever lessons can be extracted from the closure of twenty-five medical tourism companies established in Canada, it seems reasonable to suggest that establishing a medical tourism company in Canada provides no assurance of commercial success. This study accomplishes several goals. Medical tourism companies use the internet to market health services to prospective clients. Their websites provide valuable information about where medical tourism companies are located within Canada, what countries and facilities they select as destination sites, what health services they advertise, how they position themselves in a competitive national and global marketplace, and what travel-related services they promote in addition to marketing health care.

Content analysis of medical tourism company websites permits development of a detailed account of the current state of Canada's medical tourism industry. This article reviews defunct medical tourism facilitators in Canada. Websites of operational medical travel companies based in Canada are examined elsewhere. Various research methods and theories can be used to build upon the analysis provided here. Many researchers lament the lack of empirical research into the study of medical tourism. This article addresses these concerns and opens new avenues for the study of medical tourism companies, medical travelers, and international health care destinations.

It also reveals the importance of studying medical tourism in Canada and elsewhere, and not making the error of thinking that the medical tourism industry is primarily a product of the large population of uninsured individuals in the United States. Many researchers and other interested parties will likely be surprised to learn just how many medical tourism companies have emerged in Canada, a country where residents have publicly funded access to a large basket of medically necessary health services.

They might be equally surprised to learn how many of these businesses have come and gone and no longer market transnational medical travel to Canadians. Establishing just how many residents of Canada use the services promoted by medical tourism companies based in Canada, examining what happens to medical travelers when they go abroad for care, and learning more about their experiences once they return to Canada will have to await additional studies by researchers from a variety of disciplines.

This study attempts to make a substantial contribution to the study of the Canadian medical tourism industry. It also provides sign posts that should be of practical use to health researchers and other individuals interested in exploring ethical, legal, social, cultural, economic, and public health implications of Canada's medical tourism industry.

LT is the sole author of this article. He designed the study, conducted content analysis of medical travel company websites, and wrote the manuscript. The author studies ethical and social issues related to transnational medical travel and the emergence of a global marketplace in health services. Leigh Turner. Ph Fax Analysis of Canadian medical tourism companies was also enabled by a William Dawson Scholar award and additional sources of funding provided by McGill University. I wish to express appreciation for these sources of financial support.

This article is published under license to BioMed Central Ltd. Research Open Access. Canadian medical tourism companies that have exited the marketplace: Content analysis of websites used to market transnational medical travel. Globalization and Health 7 Abstract Background Medical tourism companies play an important role in promoting transnational medical travel for elective, out-of-pocket medical procedures.

Results In total, 25 medical tourism companies that were based in Canada are now defunct. Conclusions This article provides a detailed empirical analysis of websites of medical tourism companies that were based in Canada but exited the marketplace and are now inoperative. Development of a database of medical tourism companies located in Canada Before analyzing websites of individual medical tourism companies it was first necessary to develop a database of all medical tourism companies with head offices or affiliate offices in Canada.

Comparing the database to other lists of medical tourism companies in Canada Internet searches resulted in the identification of several sources providing partial lists of medical tourism companies found in Canada. Content analysis of websites of medical tourism companies After developing the database content analysis was used to study and analyze websites of all identified medical tourism companies based in Canada. Location of medical tourism companies First, I identified the city or town and province that medical tourism company websites identified as their business address within Canada.

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