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David Morgan

This chapter considers the globalization of healthcare and recent trends as a rationale for the need to improve the measurement of trade in this area. In order to meet the increasing data demands, the chapter sets out some of the concepts and definitions of external trade in relation to healthcare expenditure and, where applicable, the implications beyond the boundary of healthcare. Where possible, links to existing concepts developed in the domains of international trade statistics and trade negotiations are exploited to ensure close synergy. There is also a discussion of the reporting of imports and exports as part of an international accounting framework, and their relation to other economic statistics.

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Charlotte Hamlyn-Williams, Monica Lakhanpaul and Logan Manikam

Though there has been much focus on medical tourism in research and the wider media, research about child medical tourism remains limited; however, many of the reflections on global medical tourism and children travelling will be relevant to adults. Although the numbers of cases of children travelling abroad are difficult to quantify, medical tourism for children occurs for a wide variety of medical conditions and ailments. This includes: travelling to receive novel treatments such as stem cell or proton beam therapy for cancer; bariatric surgery (i.e. gastric banding); and families travelling abroad for investigations, diagnoses, opinions or a holistic/alternative approach to managing commonly seen clinical problems in the UK. Therefore, an understanding of which groups of children are travelling abroad (and for what reasons) is necessary to assess, understand and manage the full extent of this phenomenon. This chapter will focus primarily on the movement of children travelling abroad from the UK for healthcare interventions and the impact that this has on the National Health Service, but will develop concepts that are relevant to other healthcare systems. The concept of child medical tourism raises many issues. What benefits or risks does such tourism bring to the child, family and the NHS? How do healthcare professionals evaluate the quality and effectiveness of investigations and treatments initiated abroad? What impact do they have on the care and management provided to the child on return to the UK, and how confident are they in engaging with these children and their families?

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C. Michael Hall

Department of Management, Marketing and Entrepreneurship, University of Canterbury, Christchurch, New Zealand; Department of Geography, University of Oulu, Oulu, Finland; School of Business and Economics, Linnaeus University, Kalmar, Sweden; School of Tourism & Hospitality, University of Johannesburg, Johannesburg, South Africa Biosecurity is the protection of a location’s or firm’s economic, environmental and/or human health from the introduction, emergence, establishment and spread of harmful organisms. Although continued growth in human, animal and trade mobilities has been recognised as an extremely significant feature in the movement of infectious diseases, the role and nature of medical tourism has arguably not been so well understood. As a form of tourism that, by its very nature, has broader health implications medical tourism provides distinct biosecurity challenges. The chapter examines one of the emerging major challenges for cross-border medical tourism, namely the coming together of several trends: the growth of international mobility, and medical tourism in particular; the emergence of antibiotic resistance; and environmental change. It suggests that shifts towards neoliberal models of public health provision will only intensify the biosecurity risks that will arise from increased medical tourism related mobility, and that these, in turn, will be affected by growing antibiotic resistance and climate change.

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Ruth Holliday and David Bell

Cosmetic surgery tourism (CST) can be defined as travel to access procedures to enhance appearance. It is a rapidly growing form of medical tourism, normally paid for out-of-pocket and constructed as elective. This chapter presents an overview of CST informed by the results of the largest research project to date to investigate CST. Drawing on participant observation and over 200 interviews, the authors provide a picture of the CST sector and of patient experiences. The chapter describes the main drivers and the decision-making processes of patients, outlines the roles of key players such as facilitators and agents, considers the marketing of CST and in particular the role of the internet and social media, and discusses patient outcomes. CST is seen as a trailblazer for medical tourism and the globalisation of health care, and the chapter discusses the likely future developments in the field. Issues of regulation and debates about the ‘burden’ of CST on domestic health care are highlighted.

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Nicky Hudson and Lorraine Culley

Since 1978, five million babies have been born via IVF and its related technologies. However, political and cultural differences between nations and the unequal global spread of Assistive Reproductive Technologies (ARTs) means that the access that individuals have to medicalised solutions to childlessness varies internationally. In response to this variability, cross-border reproductive travel appears to have burgeoned in recent years, though accurate assessment of its extent remains a challenge. This chapter provides a brief overview of the current knowledge on cross-border fertility travel before presenting empirical findings from a qualitative UK study about the experiences of British residents who travel abroad to seek access to ARTs. The ‘Transrep’ study sought to address some of these gaps and this chapter summarises key findings from the study regarding the profile of UK fertility travellers, their motivations, destinations and experiences. These data demonstrate that in a country like the UK, where there is largely liberal and inclusive regulation surrounding access to fertility treatment, the reasons for and direction of patient travel are complex and diverse. Cross-border reproductive travel, a phenomenon at the intersection of kinship, science, politics and commerce, presents a very particular set of ethical and legal dilemmas.

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Elisa J. Sobo

Medical travel is an inherently cross-cultural exercise. But what, exactly, does culture entail? How and where does it make its mark? This chapter demonstrates that we are all cultural beings, and that culture (biomedical culture included) is processual and porous rather than a static, self-contained, ethnically-anchored entity. The chapter then examines the various ways in which culture informs diverse dimensions of medical travel, including not only marketing, facilitation, and health services delivery, but also care seeking. Indeed, culture underwrites diverse health-related demand-side desires themselves, and motivates many of the varied secondary outcomes that patients, and families, strive for when undertaking medical travel. Culture also has important supply-side ramifications, as for subjective self-experience and local self-definition. As this chapter shows, an in-depth understanding of culture must be applied if we are to achieve full, fine-grained knowledge of medical travel’s varied forms, diverse purposes, and sundry ramifications.

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Arun Chandu

Like its counterpart medical tourism, dental tourism is on the rise. In Australia, as in most Westernised countries, the main reason for this increase is the issues of access and affordability. Dental tourism offers the opportunity for patients to access dentistry rapidly at a lower cost and easier convenience. Treatments may also be combined with the ability to either have a holiday or visit family and friends making dental tourism even more palatable. Common treatments obtained include general and cosmetic dentistry but also specialist services such as oral and maxillofacial surgery, dental implants and complex restorative work. The main issue with patients seeking these treatment modalities overseas is a lack of accountability and regulation. Complications and the management of complications are a significant issue with the seeking of dental treatment. This chapter addresses the reasons why patients seek dental tourism, types of dental tourists, treatments sought, and the outcomes and issues related to complications and their management.

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Jane Yeonjae Lee, Robin A. Kearns and Wardlow Friesen

This chapter explores the phenomenon of migrants travelling back to their country of origin for health care. Specifically, we reflect on the nature of diasporic populations and their health care practices, situating our enquiry at the intersection of literatures on home, therapeutic spaces and health care consumption. We then examine the case of Korean immigrants to New Zealand making trips to their homeland to obtain medical operations. Using semi-structured in-depth interviews we focus on the question of why and how first generation Koreans in Auckland, New Zealand, seek medical services in their country of birth. Narratives yielded suggest that strong preferences for decisive and comprehensive treatment in culturally comfortable settings are revealed. The study highlights a particular link between health and place: that if financially able, immigrant patients from this diasporic population will seek not only effectively but also affectively satisfying medical care in their country of origin.

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David Reisman

The old medical tourism was South to North. It was the sultans and the sheikhs who could afford trips to the Mayo Clinic and Harley Street. The new medical tourist is global: not just from poor countries to rich countries but South to South and North to South as well. Comparative advantage, rising incomes, rising expectations, the ageing population, long waits, budget flights, differences in provision, the opportunity to combine medical care with recreational tourism are all drivers in the globalization of medical services. This chapter concentrates on three particular advantages for the international patient: price, quality and product differentiation. Price can be lower and labour often cheaper even if technical equipment has to be bought at world prices. Quality is assured by certifying bodies like Joint Commission International (JCI) and by professional training in respected medical schools. Product differentiation can take the form of traditional Chinese medicine in Beijing or Ayurveda in India, but also experimental drugs and commercial transplants. The new middle classes benefit from a greater range of choices, not least in elective areas such as cosmetic surgery and dentistry. The poor do not benefit directly, although indirectly they may enjoy spillovers such as employment, tax-funded welfare and cross-subsidization of services for the home population. The chapter concludes that, suitably managed, medical tourism can stimulate a regional and even a national multiplier that delivers a plus-sum gain through economic growth.

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Guido Pennings

The chapter analyses two questions: first, how should we evaluate the effects of medical tourism? Second, who should be held responsible for these effects? The first question is answered by presenting four theories of justice that can be applied to the outcomes of medical tourism. These theories do not generate a common answer on a considerable number of points. The second question is answered by referring to the liability model of responsibility. In order to avoid over-inflated obligations, responsibility should be linked to causation of harm. A flexible application of this principle attributes responsibility to states for the negative consequences of their own policy and to medical tourists for the health care capacity reduction in destination countries when health care services outside the package of decent health care are pursued.