2. Definition of medical tourism
3. Different kinds of medical tourism
a. Surrogate Parenthood
b. Plastic surgery
4. Risks of medical tourism
This seminar paper concentrates on the topic of medical tourism. What is medical tourism? Since when does it exist? What kinds of medical tourism are the most famous ones? What kind of impact does it have on the quality of medical treatments or a state’s economy? Those questions will be answered in this seminar paper. In the first part, I will concentrate on the definition on medical tourism. Later, I will focus on different kinds of medical tourism regarding to the definition, for example surrogate parenthood, plastic surgery, and abortion. Afterwards, I will name negative and positive impacts of medical tourism in a short summary.
2. Definition of medical tourism
In this chapter, I will define what is meant by the term “medical tourism”. Also, I want to make clear, which aspects belong to medical tourism.
Medical migration, a form of medical tourism, was described as the following by Roberts and Scheper-Hughes:
“Migration, at the most essential level, refers to the directed, regular or systematic movement of objects, organisms, viruses, animals, plants and people, as well as knowledges, therapies and technologies. (…) Medical migrations emphasize their production within particular political-economic configurations of globalized bio-medicine, which involve the disparate and unequal distribution of health and sickness, health care and the maintenance of borders between bodies, social collectives (classes, castes, races), polities and nation states.” (Roberts/Scheper-Hughes 2011, p. 4f.)
As a loose definition of medical tourism, one can take the following: Medical tourism is travel with the aim of improving one’s health (cf. Bookman/Bookman 2007, 1). As well medical tourism is an economic activity which entails trade in services and represents the splicing of the two sectors medicine and tourism (cf. Bookman/Bookman 2007, 1). Medical tourism includes both urgent and elective medical procedures (cf. Casanova/Sutton 2013, p. 58).
Medical tourism is a complex picture (cf. Hanefeld/Horsfall/Lunt 2015, p. 3). This picture consists of – for example – different approaches to choose, provide, and deliver medical treatments and the patients’ motivations like perceived quality, familiarity, affordability, and availability (cf. Hanefeld/Horsfall/Lunt 2015, p. 3). Also, the patients’ preferred destinations, the source country, the patient characteristics, and the system context should be kept in mind (cf. Hanefeld/Horsfall/Lunt 2015, p. 3). Often, medical tourism is characterized as the solution to rising domestic health care costs and patient wait times in our globalized world, that encourages consumer choice (cf. Sethna/Doull 2012, 457).
Medical tourism already took place in ancient times – for example in Ancient Greece or Ancient Egypt (cf. Hanefeld/Horsfall/Lunt 2015, p. 3). At this point of time, the people most often travelled due to therapeutic benefits of hot springs and baths (cf. Hanefeld/Horsdall/Lunt 2015, p. 3). So, the travel for medicine pre-dates the rise of modern medicine and the existence of passports (cf. Henefeld/Horsfall/Lunt 2015, p. 3).
Nowadays, tourists from the United States mostly travel to Asia for medical treatments – especially organ transplants, plastic surgery, and artificial insemination (cf. Bookman/Bookman 2007, p. 2). Those US-American patients travel to Asia since the treatment there is cheaper than in the US (cf. Bookman/Bookman 2007, p. 2). Also, Australian patients travel for medical treatments – they most often go to East Asian country, the most popular countries for Australians are Thailand, South Korea, Malaysia, and China (cf. Bell et al. 2015, p. 299). Patients from South America, the Middle East, and other parts of Asia travel for medical treatments, because those are often unavailable in their country of origin (cf. Bookman/Bookman 2007, p. 2). As can be seen, the medical tourists’ main reasons are treatments, which are abroad cheaper than in their country of origin, and treatments, that are not available in their home country due to e.g. different laws.
3. Different kinds of medical tourism
In the following chapter, different kinds of medical tourism will be described. Also, the reasons for them will be explained. I will start with surrogate parenthood and afterwards I will describe the touristic aspect of plastic surgery, later I will concentrate on the abortion tourism.
a. Surrogate Parenthood
In the following paragraphs, I will concentrate on the topic of surrogate parenthood and its link to medical tourism.
Surrogate Parenthood is a good example for medical tourism – often, the procedure is prohibited in the patients’ country of origin, so they must travel for their medical treatment. In the following, numbers of mobility will be named and the costs for surrogate parenthood shown.
Most often, medical tourism, which includes the aim of surrogate parenthood, is called “procreative tourism”, “fertility tourism” or “reproductive tourism” (cf. Bergmann 2012, p. 73). But many authors do not use the label “tourism” anymore due to its negative connotation (cf. Bergmann 2012, p. 73). Some conceptual alternatives to the term “tourism” in this concept are “reproductive exile”, “cross-border-flow of patients” and “cross-border reproductive care” (cf. Bergmann 2012, p. 73f.).
Surrogate parenthood is used by infertile couples, who describe their preferences not to travel if only legal, trustworthy, and economical services were made available closer to home (cf. Inhorn/Patrizio 2009, p. 905).
The number of EU-citizens, who travel abroad in terms of reproductive medicine, is not high compared to the whole context of medical tourism – only 20,000 to 25,000 EU-citizens travel abroad for reproductive issues (cf. Bergmann 2012, p. 72). People, who perceive a reproductive treatment, do not commit a crime in most of the countries (cf. Bergmann 2012, 72). Half of the European in-vitro-fertilizations with egg donation take place in Spain (cf. Bergmann 2012, p. 73).
A quantitative study about reproductive mobility in Europe asked 1,230 female patients in six destination countries (Belgium, Denmark, Switzerland, Slovenia, Spain, Czech Republic) (cf. Bergmann 2012, p. 76). The most questionnaires were filled out by patients from Italy (31.8 %), followed by patients from Germany (14.4 %) and the Netherlands (12.1 %), but still the patients originated from 49 countries (cf. Bergmann 2012, p. 76). Other questionnaires were filled out by French women (8.7 %), and women from Norway (5.5 %), the United Kingdom (4.3 %) and from Sweden (also 4.3 %) (cf. Bergmann 2012, p. 76). Most often a treatment in a neighbor country was chosen (cf. Bergmann 2012, p. 76). Dutch patients went most frequently to Belgium (96.6 %), Norwegian and Swedish patients to Denmark (Norwegian: 98.5 %, Swedish: 92.4 %), Germans to Czech Republic and half of the Italian women went to Switzerland (cf. Bergmann 2012, p. 76). 85 % of the French women were treated in the francophone parts of Belgium, whilst only 7.5 % of the French patients went to Spain for a reproductive treatment (cf. Bergmann 2012, p. 76). Spain as a destination for reproductive treatments was most common to be named by Italian patients (31.7 %), followed by British (28.3 %) and German women (10.7 %) (cf. Bergmann 2012, p. 76). Czech Republic as their favorite destination was named by 67.2 % of the German patients and 52.8 % of the British ones.
But not only some European countries are well-known for surrogate parenthood, it is also legal in some states in the US (cf. Li 2012). Especially California is one of the most famous destinations for reproductive issues (cf. Li 2012). For example, in China surrogacy is forbidden, so many Chinese infertile couples go to California for a medical treatment (cf. Li 2012). California is the most common place for infertile Chinese couples, since a large Chinese-American community has settled there ages ago. Both US and Chinese authorities claim that they do not track the numbers of Chinese couples coming to the United States for surrogacy, but still surrogacy experts and clinic operators state that there has been a sharp upswing (until 2012) (cf. Li 2012). Parham Zar, who is managing director of the Egg Donor & Surrogacy Institute in Los Angeles, says that there was a massive increase in Chinese couples coming to the US for surrogacy (cf. Li 2012). His company made estimations that roundabout half of their business comes from Chinese couples (cf. Li 2012). The company Surrogate Alternatives Inc. of San Diego has three agents in China, they recruit couples (cf. Li 2012). In 2011, Surrogate Alternatives Inc. had 140 clients, about 40 % of them were Chinese couples (cf. Li 2012). One treatment – starting with the research for the perfect surrogate mother and ending with having a baby – costs from 80,000 US-dollars up to 120,000 US-dollars, but it can get even more expensive if complications take place (cf. Li 2012). If donor eggs are needed, costs rise again by about 30,000 US-dollars (cf. Li 2012).
In conclusion, there can be seen that surrogacy maybe does not have a big influence on tourism due to the small number of patients, but it still shows that this medical treatment is only available for those who can afford travelling to another country and pay high fees. Still it is also important to see that it makes it possible for infertile parents to get a baby, which should be named as another advantage.
b. Plastic surgery
In the following paragraphs, different aspects of plastic surgery in the context of medical tourism will be shown.
Plastic surgery tourism or the so called cosmetic surgery tourism is a new trend regarding to the topic of medical tourism (cf. Casanova/Sutton 2013, p. 57). In the past, many people from the developing world traveled to Europe and the US to have plastic surgery done, but times have changed (cf. Casanova/Sutton 2013, p. 58). Nowadays we see the reversal of this: Most of the times people from the global North – usually the United States and Europe – travel to less prosperous countries to modify their bodies through plastic surgery (cf. Casanova/Sutton 2013, p. 57f.). Also, people who travel for plastic surgery, are usually not elite, but middle- or lower-middle-class individuals, who aspire the bodies of the upper-class people built by plastic surgery (cf. Casanova/Sutton 2013, p. 59). For example, the patients in the US who want to have plastic surgery, those are willing to make financial sacrifices and go into debt to pay for their surgeries, so plastic surgery tourism offers a more economical alternative or the opportunity to undergo multiple procedures for a low price (cf. Casanova/Sutton 2013, 60). In different US-American surveys, 90 % of the people said that cost was a factor for their decision to travel abroad for plastic surgery (cf. Sifferlin 2016). Sometimes, the patients can save even 88 % on a plastic surgery by getting it outside the United States (cf. Sifferlin 2016).