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Thus, the CDC said (in 2017), "It is clearer than ever now,
that MT is a worldwide multi-billion dollar phenomenon which
is expected to continue growing substantially in the next 5-10
years."
It must be noted that this MT phenomenon not only
affects the US; as stated, it is now global in extent and has
already taken root in Canada where the costs of insured MT
services purchased out-of-country have more than doubled.
Canada's provincial-based insurance plans have been taking
steps to reduce the volume of insurance-covered medical
services purchased outside their country. However, Canadians,
like their American neighbors, continue to be influenced by
many of the same factors, some of which include issues of
comparative costs, consumerism, foreign economic development
(including expanding and increasing sophistication of foreign
MT operations), increasing demand for outpatient surgery, a
drive to reduce waiting times, and increased direct-to-consumer
advertising by MT companies and foreign destinations.
A recent report by the Deloitte Center for Health Solutions
(Evolving MT in Canada: Exploring a New Frontier) stratified the
types of MT into three categories (See Figure 1).
Fig. 1. Types of Medical Tourism
TYPE

DESCRIPTION

(a) Intrabound (or internal)

Patients traveling
domestically for medical care.

(b) Inbound

Patients from other countries
traveling to a host country to
receive medica care.

(c) Outbound

Patients traveling from home to
other countries to receive medical
care.

[Source: Adapted from Deloitte, op cit supra, 2008]

here by their caregivers abroad. More recently, in certain states
such as California, a recent University of California SF report
showed that about 3 million residents remained uninsured
despite Obamacare, and that "almost 60% of those were
immigrants in the country illegally." To cover their healthcare
costs it was projected that it would require another $13 billion a
year - and that would be just for California!
The third category (outbound) is not new. Some would trace
its history back thousands of years. During the 19th century spa
towns and health resorts flourished in Europe and drew wealthy
patients from around the world. And individuals still travel
seeking the latest technology, highest quality, or perhaps miracle
cures, in expensive private clinics. Studies indicate that hundreds
of thousands of Americans still travel abroad, despite the fact
that could mean legal, economic, or medical risks. All this bodes
to have greater effects on US providers. One source predicts that
the medical travel market could soar to an astronomical USD $3
trillion by 2025! Some of those travelers could be your patients!
Fig. 2. Top 10 Medical Tourism Destinations in the World
India
Brazil
Malaysia
Thailand
Turkey

Mexico
Costa Rica
Taiwan
South Korea
Singapore

[Source: Medical Tourism magazine (2/20/18)]
Fig. 3. Risks Involved in Medical Tourism
** Specific risks will depend on the area visited and the
procedures performed
** Communication can be a problem where you don't speak the
language fluently
** Medication could be counterfeit or of poor quality in some
countries
** Antibiotic resistance is a global problem

In addition to American patients traveling from their homes
to more distant American urban centers and specialty facilities,
the purchasing and consolidation of private practices by larger
groups, and the integration of academic and community centers,
the first category has grown rapidly here as big discounters have
announced plans to develop hundreds more clinics in their
stores, in addition to those already set up in pharmacies and
supermarkets across the nation.
The second category was fairly common, and happily received
in the US, which traditionally had the reputation of leading
the world in education, research and technological advances
in health care. Famous people from around the world would
come here for specialized care, and patients with extremely
complicated conditions (e.g., conjoined twins) would be referred

** Flying after surgery can increase the risk of blood clots
** Tropical countries have different infectious disease
epidemiology
** Some foreign facilities lack adequate complaints policies
** MT may subject the patient to unfamiliar legal issues, laws
and customs
** Ethical issues (beyond the scope of this article) can exist and
should be researched in advance of travel.
[Sources: CDC and Wikipedia websites]
continued on next page

SPRING 2018 | CHESTER COUNT Y Medicine 31
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