A review of web-based resources for medical tourism. A call for future research.

1. November 2009
No Sandcastles: A Nip n
Tuck in the Sun
Medical Tourism: A review of web‐based sources
With Dr Mariann Hardey
Social Media Analyst & Consultant
e.mariann@mariannhardey.net
In association with University of York Management School

2. Summary Overview of Medical Tourism for eHealth
Defining medical tourism
Several organisations and individuals have tried to identify formally the term
‘medical tourism’. The conditions of the emergence of the defining principles of the
term means that medical tourism has been used to classify the range and scope of its
application from commercially led organisations, to the media as well as more
official Government agencies including the NHS. What is important to note is that
there is no standard or representative definition of the term – Generally this is
viewed as ‘something’ to do with treatment abroad and it currently holds a very
broad and open definition. The ‘tourism’ tag implies something casual or otherwise
outside conventional health seeking behaviour.
Review of web‐based resources
There is a striking range in the quality and usability of the web‐based resources
available to visitors of medical tourism websites and services. The consultation of
one source was unlikely to be an effective repository of reliable health related
information. In particular, the commercial marketing of sites was often emphasised
over the publication of easy access literature and services. This indicates an implied
active role for the visitor who directs their own selection of information as an
effective and efficient way of extracting knowledge and services. The range in the
quality of information is widespread. Some sites have a poor level of usability and
navigation, particularly when they represent organisations that are finance‐led – e.g.
offering financial services including health insurance and brokerage deals as an
addition to medical services. For the UK, the NHS website for information about
medical tourism is limited in its publication and access to professional resources.
The information and functionality was based on key public health issues rather than
advice on reliable sources of knowledge or validated services for patients. The least
useful sites have ‘dead’ links, making them hardest to navigate and give out
confusing or poor quality information. For example the site medibroker.com rather
than promoting health or medical information exhibits poor web‐design with
confusing array of links, and display of information. Much of the site is given over to
the promotion of advertising space.
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3. Table 1. Overview of the functions of medical tourism web portals
Information Connectivity Exchange Commerce Care
Search and Can include Peer‐to‐peer Based on Emphasis on
retrieve of official sources information consumer ‘self‐care’ with
information/data such as clinical sites e.g. behaviour and little
and public newsgroups ‘online’ coordination
health systems and message purchasing for with official
Offer a range of boards treatment medical
health resources treatment
Most likely to centres or
be Web‐based Most likely to The individual organisations
Pro‐active user: and search include sign‐up is seen (and ‘back home’
Based on engine led e.g. to newsletters treated as) as
informed decision Google
and registration ‘consumer’,
making to commercial rather than a Unlikely to be
sites ‘patient’. In this exchange or
Limited health way they are sharing of
service and ‘pro‐active’ health records
system both in terms
integration with of profile and
more sourcing of Little ‘shared’
commercial information clinical decision
organisations making or
treatment
management –
particularly for
‘after‐care’
following
patients return
back home
Some key points
Medical tourism refers to the recent new EU Cross‐border Health Directive that has
meant since 2007 restrictions have been lifted on patients who want to travel for
treatment to other EU countries. In the UK this means that patients are able to
reclaim from the NHS for the cost of ‘essential treatment’ and will ‘only have to pay
their travel and accommodation costs, plus any top‐up fees if charges in the foreign
hospitals are higher than the NHS cost’ (European Health & Medical Tourism
Association EHMTA, 2007). Medical tourism also has a more commercial and
consumer‐led meaning that refers to the rise in travel agencies and medical services
that offer medical treatment (usually for cosmetic procedures) abroad. Such
services are typically elective and concerned with cosmetic, dentistry and IVF
treatment. Factors that have contributed to the rise in medical travel include the
high cost of health care, the range of health care services, waiting times for
procedures, improvements in the standard of care in other countries, outbreak of
‘super bug’s’ such as MRSA in the UK as well as the relative ease and affordability of
travel within the EU. In addition, the ‘hotel service’ aspect of medical care can be a
factor in that private rooms, high patient staff ratios and so forth are possible in
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4. facilities that are located in countries where wages bills and so forth are considerably
lower than in the UK. Legislation underwrites the EU market (which is not the least
costly compared to e.g. India) because medical qualifications are recognised across
some EU States. Caution is need here (and further research) in that the situation is
complex and while UK qualifications may be well recognised the same is not true of
for example Polish. The implication is that while marketing hype might seek to paint
a different picture to consumers the qualifications of staff, health regulations etc will
be different form the UK. In other words consumers may be exposed to risks that
they would not have been in the UK.
A call for research
Statistics for medical tourism are restricted and generally limited to the United
States. A report by Deloitte Consulting published in 2008, projected that 750, 000
Americans went abroad for health‐care in 2007. The same report speculates that
medical tourism could increase ten‐fold in the next decade (Johnson, 2008). At
present there is little research in this area. In addition, the range of web related
‘health investors’ – including ‘lay’ or public users as well as those from the
commercial and professional sectors – is increasing exponentially. The latest
buzzwords ‘health 2.0’, ‘ehealth’, ‘webhealth’ emphasise the change in the
relationship from what has been the traditional top‐down, professional and patient
care, to bottom‐up, pro‐active patients and health information that may, or may not,
be related to professional bodies or individuals.
References
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Chambers, D., McIntosh, B. (2008) Using authenticity to achieve competitive
advantage in medical tourism in the English‐speaking Caribbean, Third World
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Chen, J.S., Prebensen, N., Huan, T.C. (2008) Determining the motivation of wellness
travellers, Anatolia 19 (1), pp. 103‐115.
Chinai, R. & Goswami, R. (2007) Medical visas mark growth of Indian medical
tourism. Bull World Health Organ, v. 85, n. 3 [cited 2008‐12‐08], pp. 164‐165.
Connell J. (2006) Medical tourism: Sea, sun, sand and ... surgery, Tourism
Management, 27 (6), pp. 1093‐1100.
Johnson, L.A. ‘Americans look abroad to save on health care: Medical tourism could
jump tenfold in next decade’, The San Francisco Chronicle, 3 August.
Jones CA, Keith LG. (2006) Medical tourism and reproductive outsourcing: the
dawning of a new paradigm for healthcare, Int J Fertil Womens Med. Nov‐Dec;
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Turner, L. (2008) 'Medical tourism' initiatives should exclude commercial organ
transplantation, Journal of the Royal Society of Medicine 101 (8), pp. 391‐394.
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