Patient care without borders: a systematic review of medical and surgical tourism

Abstract

Background Medical tourism (MT) is an increasingly utilized modality for acquiring medical treatment for patients globally. This review assimilates the current literature regarding MT, with particular focus on the applications, ethics and economics. Methods A systematic review of MEDLINE and PubMed Central databases for publications relating to MT from 2005 to 2018 yielded 43 articles for this review. Results Patients seeking elective bariatric, cosmetic and orthopedic surgery abroad are motivated by significantly lower costs, all-inclusive vacation packages and reduced wait times. Complication rates as high as 56% include infection, poor aesthetic and functional outcome and adverse cardiovascular events. Cross-border reproductive care has steadily increased due to less restrictive policies in select countries; however, the depth of research on outcomes and quality of care is abysmal. Stem cell therapy promise treatments that are often not well researched and offer minimal evidence of efficacy, yet patients are drawn to treatment through anecdotal advertisements and a last sense of hope. Transplant surgery sought to decrease wait times carries many of the similar aforementioned risks and may contribute to the practice of organ trafficking in countries with high rates of poverty. Patients and countries alike are motivated by a plethora of factors to engage in the MT industry but may be doing so without accurate knowledge of the quality, safety or potential for economic gain. Safety is of utmost importance to prevent surgical complications and the spread of treatment-resistant bacteria. Conclusions MT is growing in popularity and complexity. The lack of standardization in its definition and regulation leads to difficulty in epidemiologic and economic analysis and ethical issues of informed consent and health equity. The findings of this review may be used by the stakeholders of MT, including patients and providers, to enhance informed decision-making and quality of care.

Orthopedic Tourism and Volunteerism: Joint Effort or Disjointed Mobility?

“…There is a paucity of authoritative evidence regarding the quality of care and clinical outcomes of procedures performed on orthopedic tourists. A systematic review of surgical tourism by Foley et al reported complication rates as high as 56% including wound infection, poor functional outcome, and adverse cardiovascular events [4]. The risk of importation of antibiotic-resistant bacterial strains associated with inadequate antimicrobial stewardship represents a significant risk to surgical tourists and has public health implications in their home countries [8].…”

“…Economic, sociocultural, and technological globalization have facilitated the growth of medical tourism. The motivations of bariatric, cosmetic, transplant, fertility, and stem cell tourists vary, but the greatly reduced costs of procedures performed in developing countries, prohibitive domestic waiting lists, and accessibility of treatment are common driving factors [ 4 ]. The availability of inexpensive flights and the internet have also been instrumental.…”

“…The elective nature of many orthopedic procedures, coupled with their high cost in developed economies, account for the growing importance of orthopedic tourism [ 4 ]. Medical tourists take a consumer-led approach to their health care, and they initiate their own care by seeking out providers and tourist packages that meet their needs.…”

Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care?

“…Urgency to get access is even more important for patients with poor prognosis and those with severe disabilities. With the rise of health globalization, medical tourism is a growing phenomenon, 21 where the objective is not only to get a treatment faster or at a better price but to access what is not available within the domestic system. Systemic issues across health and social care.…”

COVID-19 will further exacerbate global antimicrobial resistance

“…5 The prevalence of resistant bacterial strains is higher in mobile populations such as travellers, migrants and refugees, who may be carriers for months after returning home. 6,7 Amongst them are groups of vulnerable people who are disproportionately at risks to COVID-19, putting them at higher risks of complications if they experience secondary bacterial infections. 8 They also carry with them the risks of spreading the resistant bacterial strains to people they would come in contact with during the treatment, such as healthcare workers.…”