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An essential fact sheet and guide on medical tourism statistics, medical tourism: the full picture, medical tourism facts: why do people go abroad to get medical treatment.

• Approximately 2.5 million foreign patients traveled to hospitals in Thailand in 2013. In Bangkok's prestigious Bumrungrad International Hospital, over 520,000 international patients received treatment at the hospital.
• Singapore has been a growing medical tourism center in South East Asia with 850,000 medical tourists arriving in 2012. In January 2019 however, a report was released by RHB Research , the article quotes analyst Juliana Cai saying "As healthcare costs in neighbouring countries like Malaysia and Thailand are much lower, they have been attracting medical tourists from the region – thereby eating into Singapore's market share."
• Latin America , particularly Costa Rica and Panama , are fast becoming tourist spots for medical travelers with approximately 40,000 foreign patients seeking healthcare in Costa Rica in 2011.
• Due to its close proximity to the U.S., Mexico has become a top medical tourism destination with 40,000 to 80,000 American seniors spending their retirement there with a considerable number receiving nursing home and health care. According to Politico however, the recent events with Donald Trump and the wall could damage the flow of medical tourism across the border.
• After visitors number more than doubling in the last 5 years, Malaysia is also becoming a famous destination with 770,134 medical travelers in 2013. In 2016 Malaysia received numerous awards and global recognition from International Medical Travel Journal . Among the awards won by The Malaysia Healthcare Travel Council (MHTC) were ‘Health & Medical Tourism: Destination of the Year’, International Hospital of the Year, ‘International Cosmetic Surgery Clinic of the Year, ‘International Dental Clinic of the Year’, ‘International Fertility of the Year’, and ‘Best Marketing Initiative of the Year’.
• India has become a medical tourism hot spot, with 166,000 international patients in 2012 coming to the country due to the selection of highly skilled doctors and improved medical infrastructure. In 2016 the numbers kept rising, with over 170,000 medical visas awarded . This represents only a fraction of the total medical tourists entering the country.
• South Korea has now entered the top ten countries in the world in terms of tourist volume. At the last available count in 2016, 390,000 people travelled to Korea as a medical tourist compared to the overall patient volume of 14 million.
• The UK has recently announced the need for improved quality standards for cross border care. There seems to be room for more private inbound medical tourism but there needs to be a change in the cap on numbers allowed currently.
• In Spain , the demand for medical tourism has skyrocketed, especially in the town of Marbella. Over 330 million euros a year are generated in the province. The Quirón business group is the biggest medical supplier in Spain and it treats up to 20,000 foreign patients a year, with most of the patients coming from the UK, Netherlands and Finland.
• As fertility decreases in the MENA region the demand for IVF and related services grows. In North Africa and the Middle East there is a $1 billion market, serviced by Turkey but also increasingly by the United Arab Emirates and Saudi.

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Outbound medical tourists: The interplay of perceived quality, length of stay, group-size, post-visit destination image and revisit intention

Imran rahman.

Department of Nutrition, Dietetics & Hospitality Management, College of Human Sciences, Auburn University, Auburn, AL, United States of America

David S. Martin

Associated data.

Data will be available after acceptance. More information will be provided upon acceptance.

Using halo effect as the underlying theory, we examined how perceived quality of medical care influenced components of post-visit destination image (infrastructure, attraction, value for money, and enjoyment) and how each component influenced Bangladeshi outbound medical tourists’ revisit intentions. Additionally, we examined how these relationships varied based on their length of stay (LOS) and travel-group size (TGS). Results showed a significant positive effect of the perceived quality of medical care on all four components of the post-visit destination image. Except for enjoyment, all three components had a significant positive influence on revisit intentions. All the proposed relationships were supported for medical tourists with higher LOS and TGS. However, for medical tourists with low LOS, the perceived quality of medical care did not influence value for money. Furthermore, value for money and enjoyment did not significantly influence revisit intentions for medical tourists with low LOS and TGS.

Introduction

Medical tourism refers to patients leaving their resident country and crossing a border to receive medical care [ 1 , 2 ]. The medical tourism market is estimated to produce $65 to $87.5 billion in revenue, which is generated from the 20 to 24 million medical tourists across the world who spend more than $3000 on average per visit [ 3 ]. While much of the current research has focused on medical tourism emanating from a developed country, patients from many developing countries, such as Bangladesh, continue to travel abroad for better medical care and represent an essential part of the overall medical tourism market [ 4 ]. For instance, the Government of India reported that in 2017, as many as 221,751 Bangladeshi medical tourists traveled to India for various medical treatments [ 5 ]. In 2019, before COVID-19 made international travel difficult, Bangladeshis accounted for 57.5% of international medical tourists to India [ 6 ]. Medical tourism is also one of the fastest-growing tourism sectors globally [ 7 ]. It has become an essential part of several countries’ tourism economies [ 8 ]. Increases in the size of the medical tourism marketplace and rising levels of competition for the medical tourists’ dollars has led practitioners to seek new ways to attract potential medical tourists and motivate those same tourists to revisit the same destination in the future, whether that be for future medical treatments or as a more traditional tourism destination [ 9 ]. As the medical tourism marketplace continues to develop and mature, both practitioners and researchers require a better understanding of specific factors that impact the revisit intentions of these specialized tourists to maintain a competitive advantage in this growing market.

While previous research has investigated multiple areas within medical tourism, the majority of these studies have focused on first-time destination choice or visit intention [ 10 – 12 ], with only a limited number of research studies evaluating the revisit intentions of medical tourists [ 7 , 13 ]. Moreover, much of the previous research has used evaluations of the overall destination image instead of looking into specific components of the tourists’ post-visit destination image [ 14 ]. While understanding the impact that overall destination image has on the revisit intentions of medical tourists is certainly important, a more nuanced approach to the individual factors that make up destination image and how each of these may or may not impact the revisit intentions of medical tourists is warranted. Practitioners and marketers need this level of detail to better understand what factors drive re-visit intentions and provide important information into where money and effort should be directed by medical tourism destinations, especially in light of the growing competition for medical tourism dollars globally.

Using halo effect as the underlying theoretical foundation, this study investigates how the perceived quality of medical care affects the post-visit destination image components. Variables considered include infrastructure, attractions, value for money, and enjoyment. Additionally, we measured how each of these components, in turn, influences medical tourists’ revisit intentions and how these relations vary depending on the length of stay and travel group size. The following research questions are addressed in this study:

• How does the perceived quality of medical care influence components of the post-visit destination image of medical tourists?
• How do the components of post-visit destination image influence the revisit intentions of medical tourists?
• How do the relationships between perceived quality of medical care, components of post-visit destination image, and revisit intention vary based on medical tourists’ length of stay and travel-group size?

Literature review

Understanding destination image.

Destination Image (DI) is defined as perceptions that individuals have about a destination [ 15 ]. More simply put, DI is how a tourist both thinks and feels about a tourism destination. As noted by many, DI is currently, and has been, a primary focus of researchers within the tourism literature [ 16 , 17 ]. According to [ 18 ], DI has been worthy of scholarly focus since the 1970s but started to gain traction as an essential research topic as early as the 1990s [ 19 ]. Much of this focus has been derived from the need to distinguish one tourist destination from another, especially in an increasingly competitive global marketplace [ 19 ]. Classifying and organizing DI has primarily been based on the cognitive-affective theoretical model of image formation. Cognitive evaluation refers to consumers’ specific beliefs and knowledge about a destination, while affective imagery relates to a consumer’s feelings about the destination [ 20 , 21 ]. In combination, both cognitive and affective images form the overall image of a destination [ 22 ].

[ 23 ] postulated that three types of DI exist: organic, induced, and complex images. An organic image is formed through exposure to stimuli from non-tourism-related media. Examples of this include television shows or movies, which feature images from a specific location. An induced image is based on specialized marketing or advertising material, usually prepared by or in concert with a specific tourist destination. Noted for their intentionality, these materials are often produced by a destination marketing organization (DMO). They are focused on promoting particular tourism-related activities, aka trying to convince potential tourists to visit a specific location or country. It should also be noted that both organic and induced images are formed before an actual visit by a tourist to an actual destination [ 24 ]. Complex images differ from both induced and organic images in that they are based on the individual’s direct experience on-site [ 23 , 25 ]. These complex images are significant, especially when considering the importance of revisit intentions to destinations.

[ 25 ] developed an eighteen-item scale to measure tourists’ post-visit complex DI. Their scale includes four components–infrastructure, attraction, value for money, and enjoyment. Infrastructure refers to the physical elements, both public and private, needed to access the destination and enjoy it safely, such as police service, airports, road networks, hospitals, etc. [ 26 ]. The attraction of a tourist destination is the perceived ability of a destination to meet the needs of tourists through its desirable features and attributes [ 27 ]. Cultural and natural attractions, recreation facilities, and events are considered major facets of visitor attraction of a destination [ 28 ]. The value for money of a destination refers to the price-quality relationship when purchasing a tourism product such as food, accommodation, tour, souvenir, etc. [ 29 ]. Lastly, enjoyment refers to the process of deriving a psychological benefit such as pleasure from visiting a destination or from participating in a touristic activity in that destination [ 30 ]. Infrastructure, attraction, and value for money represent the cognitive images, while enjoyment represents the affective component [ 25 ]. These four factors, sometimes in different forms, are found to represent destination image in the extant tourism literature (e.g. [ 31 , 32 ]).

Destination image has been a reliable and accurate antecedent of tourism satisfaction, destination choice, and post-visit behavioral intentions [ 33 , 34 ]. This may be due to the influence DI plays in forming expectations about a location, which is then used as a point of comparison both during and after a visit has occurred [ 35 ]. Repeat visitors are a much sought-after market segment for many, including countries that have invested heavily in becoming a medical tourism destination [ 36 ]. Repeat visitors incur much lower marketing costs than first-time visitors [ 37 ], stay longer at a destination [ 38 ], spread positive word of mouth [ 37 ], and participate in destination-specific consumptive activities more meticulously [ 39 ]. More recently, [ 14 ] conducted a meta-analysis of 35 articles and found a strong connection between positive complex DI and behavioral loyalty.

[ 23 ] found that expectations of non-visitors exceeded the actual performance reported by visitors, indicating a disconnect between what the destination projects in its promotional and marketing efforts and the actual delivery of those same products and services. They also found that the overall DI held by non-visitors significantly differed from that of actual visitors. Such differences have primarily been attributed to tourist destinations’ marketing and promotional efforts, which may or may not reflect the real experiences that occur once on-site. Medical tourism destinations have indeed engaged in similar types of promotions, with even specific hospitals devoting significant resources to developing websites promoting their services to potential medical tourists [ 40 ]. Because of the inherent differences between organic/induced and complex images, it may be beneficial to examine the factors which contribute to complex images, as we do in this study, to gain a complete understanding of revisit intentions. A recent study by [ 41 ] on Chinese medical tourists visiting Malaysia found that the overall image of Malaysia as a medical tourism destination positively influences revisit intentions. In this study, we look into the components of complex destination image of the country to determine which components influence revisit intentions.

Perceived quality of medical care and the halo effect

[ 42 ] noted that medical services themselves are challenging for a consumer to evaluate, especially before their application. This is because medical services are high in credence properties, which are attributes that make them difficult to assess without a unique level of skills and background knowledge specific to medical treatment [ 43 ]. Furthermore, previous research has indicated that medical tourists consider the perceived quality of medical care as the most critical attribute for destination selection [ 10 , 44 ], and according to [ 45 ], higher levels of perceived quality of medical care from a medical facility leads to a better corporate image of that same medical provider.

[ 13 ] and [ 46 ], using a purposive sample of Bangladeshi medical tourists to India, showed that healthcare service quality positively influences medical tourists’ satisfaction, which in turn affects their loyalty, i.e., revisit intention and intention to recommend. However, the satisfaction and loyalty measured in the aforementioned studies were specific to the medical facility, not for the destination as a whole. Because medical services themselves can only be evaluated after they have been performed, it is vital to examine how the perception of the quality of medical care impacts the medical tourist’s DI and how these images also impact revisit intentions. We anticipate that higher levels of perceived quality of medical care provided by the medical facility can lead to improved DI due to a positive halo effect.

Initially conceptualized by psychologist Edward L. Thorndike in 1920, the halo effect is a popular theory used in marketing and consumer behavior studies. A more common understanding of the halo effect is that positive impressions in one area can spill over positive opinions or feelings in other areas [ 47 ]. For example, customers are often biased toward certain products because of favorable or unfavorable experiences with other products made by the same company or brand. In the tourism literature, [ 48 ] have shown that tourists’ DI of a country positively influences perceptions of products originating from that country. Beyond tourism, in a study of perceptions of wine attributes, [ 49 ] confirmed the positive halo effect of natural corks when compared with screw caps and synthetic corks. In their study, wine thought to have been poured from a bottle with a natural cork closure registered significantly higher ratings on appearance, bouquet, taste, and overall quality compared with wines closed with screw caps or synthetic cork closures, creating a positive halo effect for wines enclosed with the superiorly perceived natural cork. Similarly, [ 50 ] showed via a sensory experiment involving 203 consumers that wines primed as genetically modified received less desirable evaluations on appearance, aroma, and taste relative to conventional samples, confirming a negative halo effect of gene technology in wine production.

As a widespread and widely researched cognitive bias, the halo effect has not been applied in the context of medical tourism. By applying the halo effect to medical tourism, the perceived quality of medical care that a patient receives from a medical provider might also influence his/her overall evaluation of the destination. Similarly, a negative experience with a medical provider may also taint the medical tourist’s views about the destination itself and other related ancillary components, such as the infrastructure, the attractions, value for money, and even enjoyment. Based on these ideas, we propose the following hypotheses:

Hypothesis 1 : Perceived quality of medical care positively influences the components of post-visit DI: A)Infrastructure; B)Attraction; C)Value for money; D)Enjoyment.

Hypothesis 2 : The components of post-visit DI: A)Infrastructure; B)Attraction; C)Value for money; D)Enjoyment positively influence revisit intention.

The impact of length of stay and travel-group

It is anticipated that the proposed hypotheses in this study may vary based on medical tourists’ length of stay (LOS) and travel-group size (TGS). LOS as a variable has received considerable attention in tourism research, with most studies focusing on its determinants [ 51 – 54 ] and a few on its outcomes [ 55 , 56 ]. [ 57 ] suggested a positive but diminishing relationship between LOS and tourism expenditures. [ 58 ] found that repeat visits influenced LOS negatively. [ 23 ] found that long-term tourists had better images of social opportunities, attractions and infrastructure, food, and friendly people than short-term tourists in the Rio Grande Valley in Texas, USA. According to [ 56 ], LOS significantly increased the desirability of a destination and knowledge related to it. According to [ 59 ], long-term tourists (travelers who spent seven nights or more) were significantly more satisfied with the quality of tourism service providers, the perceived efficiency during their vacation, and the cost of the trip than short-term tourists. Therefore, it is highly likely that tourists, who stay longer at a destination, may develop a more positive image of the destination, contributing to higher revisit intentions. According to [ 55 ], higher LOS significantly increased the positive experience of nursing care received at a hospital. Therefore, the positive halo effect that spills from the quality of medical care to the components of DI might be stronger for long-term medical tourists.

Travel-group size (TGS), or in other words, the number of people traveling with a patient, can have an impact on the overall medical tourism experience. According to Lovelock and [ 60 ], those who travel alone were less likely to engage in a range of normally expected holiday behavior in a medical tourism context. According to [ 61 ], a larger TGS indicates more time spent on the tourism component of medical tourism because leisurely travel is more predominant when friends and family are present. A survey of medical tourists in South Korea found that when medical tourists are accompanied by family or caregivers, tourism and tourist facilities become highly essential [ 62 ]. In general, traveling companions in a medical tourism context help in recovery, moral support, and the motivation to behave in a more conventionally touristic way [ 60 ]. Therefore, the perceived quality of medical care, DI, and revisit intention might be higher when TGS is larger.

Based on the related literature review, it is safe to assert that LOS and TGS are expected to impact our proposed model. More specifically, we anticipate that the strength of most of our proposed relationships will be stronger for long-term medical tourists and for medical tourists with a larger travel group.

Methodology

This study was approved by the Auburn University IRB Board prior to data collection. A self-report survey was developed using Qualtrics. Data were collected using telephone surveys. The convenience sample consisted of 331 Bangladeshi medical tourists who traveled abroad for medical tourism between January 2015 and March 2018. We contracted with a local consumer panel company to solicit responses from outbound Bangladeshi medical tourists. The consumer panel company managed a database of Bangladeshi outbound tourists who traveled abroad for medical tourism. A total of 978 Bangladeshi medical tourists were contacted via telephone. The response rate, therefore, was 33.8%. The company was paid $500 (about $1.50 per completed survey). Data was collected in March 2018. It took the consumer panel company three weeks to collect the 331 completed responses. The questions in the survey were not tailored to any particular destination or medical facility. Respondents were asked to only consider their last international outbound medical tourism trip when answering this survey.

Destination image was measured using [ 25 ] 18-item scale. The scale has four components–infrastructure, attraction, value for money, and enjoyment. The four components of destination image–infrastructure, attraction, value for money, and enjoyment, validated in [ 25 ], were treated as four variables in the proposed model of this study. Perceived medical quality was gathered from the previously validated three-item scale used by [ 63 ] and [ 7 ]. Revisit intention was measured using three items adapted from [ 64 ]. The questions were measured on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). Demographic information was collected via questions about gender, age, education, marital status, income, country visited, travel-group size, length of stay, and type of procedure. The survey was translated to Bengali, the official language of Bangladesh, by a professional native-speaking translator from a professional translation service organization. The survey was back-translated to English by another native-speaking professional translator as a form of validation for accurate wording. Participants answered the phone survey in 5 to 15 minutes. On average, it took participants 8 minutes to answer the 33-question survey, as reported by the consumer panel company.

Data were analyzed in SPSS and AMOS. Descriptive analysis, reliability analysis, confirmatory factor analysis, path analysis, and multi-group analyses were conducted to examine the data. Data were further broken down into multiple groups to test any effects of length of stay (LOS) and travel-group size (TGS) on the proposed hypotheses. LOS was broken down into two groups: medical tourists who stayed six nights and less and medical tourists who stayed seven nights and more. We used this breakdown based on prior studies [ 59 , 65 , 66 ]. TGS was divided into two groups: medical tourists who traveled with three people and less and those who traveled with four people or more. This division was based on our data as most medical tourists traveled with 3 or 4 people in our sample.

We received 331 completed responses from the consumer panel company. Nine responses were discarded for being incomplete. The participants for the current project were overwhelmingly male (91%), below the age of 51 (94.1%), married (74%), and well-educated (72.7% had at least a bachelor’s degree). 52.5% of respondents went for relatively simple procedures such as a routine check-up, and 60.6% of respondents stayed longer than seven nights. Interestingly, 100% of the participants traveled with at least one companion, with 48.8% of the participants traveling in a group of 4 or more. More than half of the sample traveled to India, which shares a border with Bangladesh and is accessible via air and road networks. Additionally, it should be noted that language and cultural barriers in India are very low for Bangladeshi natives due to the historical connections between these two countries and the popularity and availability of products and services in Bangladesh that originate from India. Other Asian countries such as Thailand (20.5%) and Singapore (20.2%) were also popular choices for Bangladeshi medical tourists. Table 1 presents the demographic profiles of the respondents.

Descriptive analysis and reliability analysis were computed in SPSS. All variables demonstrated strong Chronbach’s Alpha values (0.82 and above), confirming the reliability of our measures. Please see Table 2 for the details.

The four-factor destination image scale of [ 25 ] was validated in this study through confirmatory factor analysis (CFA) using maximum likelihood estimation. All factor loadings, except for one, were above .60, the recommended minimum suggested by most researchers [ 67 , 68 ]. Accordingly, one of the items under enjoyment, “city is a novel travel destination”, was deleted for having a factor loading of 0.57. All the remaining factor loadings ranged from 0.60 to 0.89. [ 69 ] suggested the most important measures to report are the model chi-square, CFI, RMSEA and SRMR. The resulting CFA yielded the following fit statistics. χ 2 = 208.39; df = 81; p < .001; CFI = .94; RMSEA = .09; SRMR = .06. Therefore, the four-factor model as suggested by [ 25 ] was deemed acceptable.

Path analysis was undertaken using AMOS. The results of the analysis in Table 3 showed that all hypotheses, except H2D , were supported. Therefore, the image of enjoyment was not found to influence the revisit-intention of medical tourists significantly. Perceived quality of medical care has significant positive effects on all four components of the post-visit DI. Image of infrastructure, image of attraction, and image of value for money had significant positive effects on revisit intention.

***P<0.001

**P<0.01

*P<0.05.

The respondents were divided into sub-samples to examine the interactions based on length of stay (LOS) and travel-group size (TGS). This part of the study was exploratory, and the researchers anticipated that there will be some variations in our results depending on LOS and TGS.

LOS was divided into two groups. Group 1 consisted of participants who stayed six nights or less, resulting in a sample of 127 participants. Group 2 comprised participants who stayed seven nights or more, resulting in a sample of 195 participants. A few studies have determined that the average LOS of medical tourists is around 6–7 nights [ 65 , 66 ]. Descriptive statistics and reliability analysis of the two groups are presented in Table 4 .

We carried out path analysis on the two groups. For group 1, all hypotheses were supported except H1C, H2C, and H2D. For group 2, all hypotheses were supported. The results are presented in Table 5 .

Travel-group was divided into two groups. Group 1 consisted of three people or less, resulting in a sample of 165 participants, and group 2 consisted of more than three people, resulting in a sample of 157 participants. Groups were divided to ensure each group had an adequate number of samples to analyze. Descriptive statistics and reliability analysis are represented in Table 6 after the division of the travel group.

For the travel group representing three people and less, all hypotheses were supported except for H2C and H2D. For the larger travel group representing more than three people, all hypotheses were supported. Table 7 presents the findings.

Regarding the path analysis of the overall model (See Fig 1 ), the perceived quality of medical care had a significant positive effect on the images of infrastructure, attraction, value for money, and enjoyment. These findings indicate support for a halo effect between the perceived quality of medical care and all four components that make up destination image. Therefore, our results suggest that the perception of the quality of medical care received does spill over into the overall evaluation of destination image made by medical tourists. As noted by previous researchers [ 70 – 72 ], a medical tourist’s primary motivation for medical tourism is often driven by the desire to secure high-quality medical care. This seems especially likely for medical tourists departing from Bangladesh, where high costs, unethical practices in the medical supply chain, poor service, improper treatment, long waiting times, and a lack of skilled personnel have been identified as issues within the Bangladeshi health care system [ 46 , 71 , 73 , 74 ]. Based on the previous work of [ 75 ], which found that tourists often use environmental cues to form and guide their perceived image of a destination, the researchers propose that perceived quality of medical care is taking on the role of an environmental cue for Bangladeshi medical tourists, which then shaped their overall formation of DI and significantly impacted all four individual components of destination image.

Three out of the four components of DI (image of infrastructure, attraction, and value for money) positively influenced revisit intention, which leaves the image of enjoyment as the only variable to not influence revisit intention. This finding may be best explained by the primary motivation of the travel itself (medical treatment vs. for pleasure) and the general aversion that many consumers have when engaging with medical treatment [ 76 ]. This reticence to engage with medical treatments, coupled with the high credence levels associated with medical care, may lead to a perception by patients that future visits are either unnecessary or not worth the investment, even if the quality of medical care was perceived favorably. This finding is noteworthy in that it highlights the importance of the three other variables that make up DI (infrastructure, attraction, and value for money) in the revisit intentions of medical tourists.

Interestingly, when examining the proposed model after the data set had been divided based on length of stay (seven nights or more vs. less than six nights), differences between the two groups emerged, as well as differences between each group and the overall model. For respondents that stayed more than six nights, every path proposed (See Fig 1 ) was supported, including the path from enjoyment to revisit intention. While further work is needed in this area, this finding is similar to the previous work of [ 55 ], who found that increased length of stay significantly increased the positive experience of nursing care received at a hospital. Increased lengths of stay may also improve the ability of the medical personnel and the patient to form a more personal connection and build trust, which may also increase overall healing by the patient. As noted by [ 77 ], "The development of trust in the physician leads to a proper patient-doctor relationship and is part of the healing process." This increased time and trust would also potentially allow the patient to realize the importance and necessity of the treatment(s) being offered and follow-up visits. Finally, increased length of stay may provide more opportunity for the patient to engage with more pleasurable aspects of the tourism experience, instead of shorter visits that may be only focused on the medical-based experiences.

The results differed more drastically for patients who stayed for six nights or less, with the path between perceived medical care and value for money not being supported. The researchers feel that this finding requires more research to better understand why this sub-group path was not supported. One possible explanation may be the direct and indirect costs associated with travel to a foreign country for medical treatment vs. the time spent in the country. In other words, the time-value proposition for shorter trips, which in theory provides less opportunity for engagement in the more hedonistic features of the tourism destination and less time to developing a trusting relationship with the medical provider (and potentially less overall healing), may be perceived by the patients to be of inferior value. This may also help to explain why the paths between value for money and enjoyment to revisit intentions were also not supported for patients who stayed for six nights or less. More research into these specific areas is warranted, as it seems that patients with shorter visits are evaluating their experiences differently than patients who stayed for more than six nights.

Regarding travel group size, subsets were created using groups of three or less and groups of four or more. Similar to the findings for individuals who stayed more than six nights, groups of four or more had supported paths between all of the variables proposed in Fig 1 . For groups of three travelers or less, the paths between value for money, enjoyment, and revisit intentions were not supported, which mirrors the findings for a length of stay that is six nights or less. This finding seems to support previous results by [ 61 ], where a larger travel group size indicates more time spent on the tourism component of medical tourism. Similarly, [ 62 ] found that when family or caregivers accompany medical tourists, tourism and tourism facilities become of great importance. Again, the researchers feel that more research is needed to help identify the underlying issues here, but fewer caregivers accompanying the patient may mean that each caregiver has more individual work to do to care for their traveling patient. This, in turn, may impact the patients’ ability to enjoy more traditional tourism activities and impact their perception of the value they receive in relation to the direct and indirect costs associated with their travel. In a similar vein, overworked caregivers who have not been able to engage in the more pleasurable aspects of the medical tourism experience may also influence the patients’ perceptions.

Practical implications

The current study indicates that medical tourists are not a monolithic group. Instead, they have essential subgroups that evaluate their experiences as medical tourists differently. Specifically, shorter stays and smaller groups of travelers are different in determining their revisit intentions compared to longer stays (seven or more nights) and more extensive travel groups (more than three people). For groups of three people or less, or for travelers who are staying for six nights or less, both value for money and enjoyment did not support revisit intentions. When medical tourists and their caregivers stay for six nights or less, tourism agencies can work with the medical providers to develop specifically designed services for the caregivers and the patients. This may include extra nursing support from the medical facility housing the patient, thus freeing up time and mental capacity for the caregivers of the patients to engage in more traditional tourism activities. For example, Children’s Hospital in Birmingham, AL., provides caregivers with a “parents night out,” along with coupons and a map to local attractions. Similarly, programs designed to bring local food and beverage to both the patient and the caregivers inside the medical facility could also be developed and packaged as an “add-on” when booking the medical tourism trip. Programs that offer assisted tourism activities to accommodate recovering patients and their caregivers may also be a worthwhile investment. Specialized transportation to accommodate wheelchairs and other mobility issues, the ability to skip long lines at popular tourism destinations, private tours that would allow for a nurse to join in on the excursion, and even bringing cultural or history-based lessons and programs to the medical facility are all practical ways to help ensure that both the patient and the caregivers themselves can fully engage with their destination from a tourism perspective. Furthermore, providing in-house travel planners at medical facilities which serve a large number of medical tourists may also be useful in this regard.

As noted earlier, a decreased length of stay may contribute to a less fulfilling and trustful relationship between patients and the doctors providing medical treatments, which may help explain why patients with the lowest length of stay did not see a supported path between the quality of medical care and the value for money. While the mean score of this sub-group was the second lowest out of the four (4.49), it was still relatively high considering that a five-point scale was used. Medical providers in destination countries may want to extend the contact time with the doctors and nurses providing the care, primarily via telehealth both before and after the physical manifestation of travel. This may also allow for the medical personal to interact with and respond to questions from a higher number of the patient’s caregivers (family and friends). Thus, simulating the experience of traveling with a larger group that consequently had a lower mean score for perceived medical care (4.36) but still supported the path between the quality of medical care and value for money. This mode of interaction may have also become more accepted by patients and medical providers due to the current Covid-19 pandemic.

Theoretical implications

From a theoretical perspective, the current study has provided a substantive argument for using more nuanced measures when it comes to DI and medical tourists. The application of halo effect theory and the importance of post-visit evaluations of outbound medical tourists from a single country to different destinations has also added to the current body of knowledge. The uniqueness of the findings, especially based on LOS and TGS, may need further investigation, not only regarding why LOS and TGS seem to be such a differentiator for Bangladeshi medical tourists, but if the same finding would also be found in other groups that also participate in medical tourism.

Limitations

This study utilized a non-probability convenience sampling technique to collect the necessary data via a paid consumer panel. As such, the results of this study cannot be generalized to the population of Bangladeshi outbound medical tourists. In addition, there was a lack of female respondents (only 9%) in the completed sample, which certainly brings into question the representativeness of the sample. A request was made to check for non-response bias. Several follow-up phone calls were made to women who did not respond to the survey. It was revealed that many of them did not feel comfortable answering the survey as they were not the primary decision-makers in choosing the medical tourism destination. In Bangladesh, men are overpoweringly the primary decision makers for large health-related purchases [ 78 ].

This study has identified that subgroups within the Bangladeshi medical tourism customer base do exist and that these groups are examining the medical tourism product differently. These differences are essential because these groups are also flowing through the four components of DI to their re-visit intentions differently. The two subgroups, as identified by either their length of stay or the number of travelers accompanying the patient, represent opportunities for specialized marketing and services development, with the intent of maximizing their re-visit intentions.

Supporting information

Funding statement.

The authors received no specific funding for this work.

Data Availability

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Health Care

The 4 kidnapped americans are part of a large wave of u.s. medical tourism in mexico.

Bill Chappell

A Red Cross worker closes the door of an ambulance carrying two Americans found alive after they were abducted in Matamoros, Mexico, last week. Two of four Americans have been found dead, after they were caught in a cartel shootout, officials said Tuesday. AP hide caption

A Red Cross worker closes the door of an ambulance carrying two Americans found alive after they were abducted in Matamoros, Mexico, last week. Two of four Americans have been found dead, after they were caught in a cartel shootout, officials said Tuesday.

The four Americans who were shot at and abducted in Mexico were reportedly visiting for medical tourism — making them part of a booming industry that is vital to Mexico's economy.

"Pre-pandemic, some 1.2 million American citizens traveled to Mexico for elective medical treatment," Josef Woodman, CEO of Patients Beyond Borders , told NPR. His firm publishes a guide to international medical travel.

Latin America

2 surviving americans who were kidnapped in mexico are back in the u.s..

Here's an update on medical tourism, and the recent tragedy:

U.S. medical travel is rising sharply

"Today, the market is recovering rapidly in Mexico, nearly back to its pre-pandemic levels," Woodman said.

Nearly 780,000 people were projected to leave the U.S. for health care in 2022, according to Healthcare.com , citing data from the medical travel website Medical Departures.

Medical tourism in Mexico isn't new, but the recent tragedy put it in the spotlight

Medical tourism in mexico isn't new, but the recent tragedy put it in the spotlight.

That outburst of activity got a big boost in late 2021, when the U.S. relaxed key border restrictions with Mexico.

Costa Rica is the second-most popular destination for U.S. visitors seeking medical care elsewhere, Woodman said. It's a particular draw, he added, for people in the Northeast and Southeast.

Most people travel for dental and cosmetic work

Cosmetic surgeries are just one of the procedures that are far cheaper in Mexico — for years, people have been visiting from the U.S. to get elaborate dental work or cosmetic treatments done, or to pick up antibiotics and other medicines at favorable prices.

Shots - Health News

A reason to smile: mexican town is a destination for dental tourism.

Many people also travel to get orthopedic work done, replacing knees or hips for less than half the cost of such procedures in the U.S.

"North American patients travel to Mexico for care primarily to save 50-70% over what they would pay in the United States for an elective treatment," according to Woodman.

Medical tourism does bring risks, experts say

While an element of risk is inherent in many procedures no matter where they're performed, medical tourism can heighten complications, according to the Centers for Disease Control and Prevention.

Potential problems range from the dangers of flying in a pressurized plane cabin too soon after a surgery to the complications of getting follow-up care for a procedure done in another country.

Medical tourism numbers are on the rise in Mexico, after the practice was curtailed by COVID-19 restrictions. Here, foreign patients are seen at the hospital Oasis of Hope in Tijuana in, 2019, in Mexico's Baja California state. Guillermo Arias/AFP via Getty Images hide caption

Medical tourism numbers are on the rise in Mexico, after the practice was curtailed by COVID-19 restrictions. Here, foreign patients are seen at the hospital Oasis of Hope in Tijuana in, 2019, in Mexico's Baja California state.

Some of the most serious warnings from the CDC are for infections, from wound and blood infections to pathogens that might be more common or resistant in the host country than in the U.S.

"Recent examples include surgical site infections caused by nontuberculous mycobacteria in patients who underwent cosmetic surgery in the Dominican Republic," the CDC says, "and Q fever in patients who received fetal sheep cell injections in Germany."

U.S. medical tourists rate Mexico highly

A 2020 research paper that surveyed some 427 Americans crossing the U.S.-Mexico border in California for medical services found that most of the respondents "felt that Mexican health care services are of the same or better quality compared with those in the United States, for a lower cost."

People had come from 29 states across the U.S. to get care in Mexico, with the vast majority driven by cost concerns, according to the paper, published in the Journal of the American Pharmacists Association .

Hit with $7,146 for two hospital bills, a family sought health care in Mexico

The researchers also collected data about the medical tourists themselves, reporting an average age of 64.5 years. Their most common yearly income range was reported to be between $25,001 and $50,000 — but that reflects less than a quarter of the respondents.

More than 400 of the survey's 427 participants said they would undertake more medical tourism in the future, the paper said.

Most of Mexico's hospitals follow U.S. standards

Mexico has worked for years to promote medical tourism to draw patients across the U.S. border. That includes improving its health system and following international standards.

"About 10 years ago, the Mexican federal government licensed the Joint Commission accreditation standards, which are used to accredit U.S. hospitals," as David Vequist, who runs the Center of Medical Tourism Research at the University of the Incarnate Word in San Antonio, told NPR's All Things Considered .

"So most Mexican hospitals are now basically using the same standards we use in hospitals in the United States," Vequist added.

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

Affiliations.

• 1 Mayo Clinic Alix School of Medicine, Scottsdale, AZ 85054, Kingston, RI 02881, USA.
• 2 University of Rhode Island.
• 3 Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
• PMID: 31281926
• DOI: 10.1093/jtm/taz049

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.

Keywords: Dentistry; antimicrobial resistance; bariatric surgery; cosmetic tourism; orthopedic surgery; stem cell tourism; transplant surgery.

© International Society of Travel Medicine 2019. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: [email protected].

Publication types

• Systematic Review
• Decision Making
• Health Services Accessibility
• Medical Tourism* / economics
• Medical Tourism* / ethics
• Medical Tourism* / standards
• Quality of Health Care / standards*

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Why Medical Tourism Is Drawing Patients, Even in a Pandemic

The coronavirus pandemic has devastated medical tourism, but pent-up demand remains for affordable treatment in foreign lands.

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By Ceylan Yeginsu

On a cold February morning last year, as she lay curled up in a fetal position on her kitchen floor, Melissa Jackson called her manager at a New Jersey beauty salon to ask for some unpaid time off.

It was the sixth consecutive week that the 39-year-old beauty technician was unable to work full time because of the debilitating pain in her pelvis caused by endometriosis, a chronic condition triggered by the growth of uterine tissue outside of the uterus.

As her symptoms worsened, she started exploring options to get less costly medical care abroad.

In recent years, while still on her ex- husband’s health insurance policy, she had received hormonal treatments to ease the pain so she could go about her daily life. But since her divorce last year and the coronavirus restrictions placed on the beauty industry in March, those treatment costs have become prohibitive, especially with no insurance.

“There is no real cure for endometriosis, but if I want to free myself from this pain then I need to get a hysterectomy,” Ms. Jackson said, her voice shaking as she described the procedure to remove her uterus. “As if the surgery isn’t bad enough, I need to find 20,000 bucks to pay for it, which is just crazy so I’m going to have to find a way to go to Mexico.”

The coronavirus pandemic has pushed millions of Americans into poverty and stripped more than 5.4 million American workers of their health insurance, according to a study by the nonpartisan consumer advocacy group, Families USA. Many people like Ms. Jackson have experienced a significant deterioration in their health because they have delayed medical procedures. The fear of large medical bills has outweighed fear of contagion for some, giving rise to an increased number of patients seeking medical treatment in a foreign country.

“We are seeing a pent-up demand for medical tourism during the pandemic, particularly in the U.S. where a fast-growing number of Americans are traveling across the land border with Mexico for health purposes,” said David G. Vequist IV, the founder of the Center for Medical Tourism Research , a group based in San Antonio, Texas, and a professor at t he University of the Incarnate Word in San Antonio.

Even before the pandemic, millions of Americans traveled to other countries for savings of between 40 to 80 percent on medical treatments, according to the global medical tourism guide Patients Beyond Borders. Mexico and Costa Rica have become the most popular destinations for dental care, cosmetic surgery and prescription medicines while Thailand, India and South Korea draw in patients for more complex procedures including orthopedics, cardiovascular, cancer and fertility treatment.

In 2019, 1.1 percent of Americans traveling internationally did so for health treatments, according to the National Travel and Tourism Office , although that figure only accounts for those who traveled by air and does not include the thousands of travelers who crossed the United States-Mexico border. Definitive statistics on medical tourism are hard to come by because countries have different recording methods and definitions of the sector.

Medical tourism has been decimated by coronavirus restrictions, but, even so, the twin crises of the economy and the enormous strain that Covid-19 has placed on the already faulty American health care system are pushing many patients to travel. Demand for nonessential surgeries has also been building up after more than 177,000 scheduled surgeries were postponed in the United States between March and June in 2020, according to the Center for Medical Tourism Research.

“Our market has always been what I call the ‘working poor’ and they just keep getting poorer,” said Josef Woodman, the chief executive of Patients Beyond Borders. “The pandemic has gutted low-income and middle-class people around the world and for many of them the reality is that they have to travel to access affordable health care.”

In April, following the initial global lockdown to curb the spread of the coronavirus, medical travel bookings were down by more than 89 percent in the most popular destinations, including Mexico, Thailand, Turkey and South Korea, according to Medical Departures, a Bangkok-based medical travel agency. Since August, the numbers have slowly been rebounding, but bookings in Mexico, which has seen an uptick in American travelers in recent months, are still down by 32 percent compared to the same period of August to December in 2019.

“Covid-19 has devastated the whole medical tourism ecosystem because of all the uncertainty over travel restrictions and quarantine measures that keep changing across the world,” said Paul McTaggart, the founder of the agency.

“Despite this, we are still seeing a growing number of people traveling and booking trips to address their urgent health needs, especially between the U.S. and Mexico border where patients can travel safely by car,” Mr. McTaggart said. The Center for Medical Tourism Research found that Google searches in the United States for the terms “Mexico medical tourism” went up by 64 percent since July, compared to pre-pandemic levels before travel restrictions were imposed in March.

“Google searches are almost directly correlated with consumer behavior when it comes to travel across borders,” Mr. Vequist said.

Before the winter resurgence of the coronavirus, Ms. Jackson had started to plan and save for a trip to Mexicali, a border city in northern Mexico, where she can get a hysterectomy for $4,000, one-fifth the cost of the procedure offered in New Jersey. Her best friend had offered to drive her there and pay for the gas and accommodations.

“We wanted to make a vacation out of it and have some fun before the surgery because it’s such a heavy and dark thing with real consequences,” Ms. Jackson said. “At 39, I have to come to terms with the reality that I’ll never have kids. That’s even more painful than my condition.”

For now, Ms. Jackson has put the surgery on hold and will wait until the virus is brought under control. Her doctor had pointed to cheaper options for the operation in New Jersey, starting at $11,000 in a local outpatient facility. But Ms. Jackson is adamant about having it in the hospital and says the aftercare is more thorough in Mexico.

“Going for the cheaper option at home means getting lower quality care and taking a risk. That just isn’t the experience for people who do this in specialized hospitals in Mexico,” she said. “It’s cheap and safe.” (Many hospitals and clinics in Mexico and other countries have accreditation to ensure their standards are equivalent to medical facilities in the United States.)

In recent weeks, Ms. Jackson has had a flare up of symptoms, which is common when the condition goes untreated.

“I’m not sure if I will be able to wait for Covid to get better,” she said. “This thing cripples every part of my life.”

The land border with Mexico — closed to tourists — has remained open for essential travel, which includes all medical treatment, and a handful of Americans cross the border every day into Los Algodones (also known as Molar City ) to receive dental treatment or purchase pharmaceuticals.

“It’s just Americans over there getting dental care,” said Jeff Somerville, a Delta Air Lines flight attendant who visited the Supreme Dental Clinic in Los Algodones in September to get his crowns replaced. “You park on the U.S. side and just walk across. It’s easy and felt very safe.” He said the procedure would have cost around $25,000 in Tampa, Fla., close to where he lives in the city of Clearwater. In Mexico, he paid $7,000.

Now, Mr. Somerville, 47, is preparing to travel to Turkey in February for a hair and beard transplant, which will cost $3,000 and includes plasma treatments, medications, hotel lodging for three nights and a translator.

“I’m going to live my life, but I’m going to take my precautions while I do that,” he said. “I’m not going to sit at home and be scared.”

Turkey has remained open to tourists throughout the latest surge of the pandemic in Europe and only visitors from Britain are required to take a test as a precaution against a new, more transmissible variant of the virus. On weekends in Turkey a strict curfew is imposed on local residents to curb the spread of the virus, but foreign visitors are allowed to roam free without any restrictions. On Istanbul’s main Istiklal Avenue, men recovering from hair transplant procedures can easily be spotted with bandages around their heads.

“This is the best time to get surgery,” said Martin Wright, a British tourist, who had a hair transplant in Istanbul in December, before the new variant of the virus was identified in Britain. “Hotels are cheap, sites are empty and you get to have down time in a foreign city where you don’t have to explain to anyone why or how you got a hair transplant.”

Over the summer, when lockdown restrictions were eased across Europe, Britons traveled to the continent to receive medical treatment, after waiting lists for elective surgery on the National Health Service reached record levels. With British hospitals operating at reduced capacity to accommodate patients with Covid-19, hundreds of thousands of patients, who have been waiting for more than a year for non-urgent surgery, are facing further delays, N.H.S. figures show.

Cynthia Hedges, a 77-year-old retired nurse from Plymouth in southwest England, traveled to France in August for a knee replacement after waiting more than 19 months to get the procedure at her hospital.

“It just became hopeless, I could barely walk and was just living off pain medication, which is not good for my health,” she said in a telephone interview. “I know we can’t go far these days, but I became very depressed not even being able to walk to my garden. I know it was risky to travel at the time, but it was the best thing I did. It was worth it.”

Even as travel restrictions tighten, experts in the medical tourism industry see an opportunity as demand builds and health care becomes more inaccessible in people’s home countries.

“It doesn’t matter if you’re in Europe or the Americas,” said Mr. McTaggart of Medical Departures. “Financially challenged individuals will seek out and be more receptive to the idea that you can travel abroad and see substantial savings for medical treatment and get past the line.”

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.

An earlier version of this article gave an incorrect name for a global medical tourism guide. It is Patients Beyond Borders, not Patients Without Borders.

How we handle corrections

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

Medical tourism: strategies for quality patient/guest experiences

Journal of Hospitality and Tourism Insights

ISSN : 2514-9792

Article publication date: 10 September 2019

Issue publication date: 10 September 2019

Kucukusta, D. , Hudson, S. and DeMicco, F.J. (2019), "Medical tourism: strategies for quality patient/guest experiences", Journal of Hospitality and Tourism Insights , Vol. 2 No. 3, pp. 221-223. https://doi.org/10.1108/JHTI-08-2019-090

Emerald Publishing Limited

Copyright © 2019, Emerald Publishing Limited

A recent headline in the Wall Street Journal indicated that Walmart will now require (and not ask) their employees to travel for their (spinal) surgery. These employees will probably take a flight, and then spend an overnight or more in a hotel or other hospitality facility such as a time share rental, Airbnb or other. This is one part of the growing phenomenon of global Medical Tourism, the focus of this special issue in the Journal of Hospitality and Tourism Insights ( JHTI ).

For most of us, getting sick is a good way to ruin a vacation. However, for growing numbers of people, needing to see the doctor is the whole point of going abroad. When medical tourists require surgery or dental work, they combine it with a trip to the Taj Mahal, a photo safari on the African veldt, or a stay at a luxury hotel – or at a hospital that feels like one – all at bargain-basement prices compared to home. Simply walking across the bridge from San Ysidro, Texas, to Tijuana can cut the price of dental work in half or less, sometimes much less.

Medical tourism is one of the hottest niche markets in the hospitality industry. Patients Beyond Borders (PBB), an online clearinghouse of information about medical tourism estimates that 12m to 14m people travel internationally for care each year ( PBB, 2018 ). Only one in ten go for medical treatment, and 70 percent of them want cosmetic surgery or other elective procedures. The remainder seek a variety of “wellness” services like spa visits, supervised exercise and dieting. This puts medical tourism revenues between $40bn and $60bn per year. PBB’s best guess is that the market is growing by 15–25 percent annually ( DeMicco et al. , 2018 ).

For a quick analysis, let us accept that there were about 14m medical tourists in 2018, revenue was $50bn and growth was 20 percent. This multiplies out to about 60m medical tourists estimated in the year 2025, producing revenues of $260bn, or about $4,333 per person. Until better data becomes available, we will make this forecast: through 2025, expect medical tourism to grow by 20 percent per year, reaching 60m people and a market value in the neighborhood of $260bn ( DeMicco et al. , 2018 ).

What is Medical Tourism vs Medical Travel?

“Medical Tourism” and “Medical Travel” can both include an international visit or inter-state or intra state in the USA and in to other countries. To distinguish between the two, Medical Tourism usually involves a leisure or vacation aspect in addition to the medical care. It is typically for cosmetic, fertility, spa and other wellness reasons. However, Medical “Travel” is predominantly for more acute and often more crucial medical care (and not typically for leisure activities – as is the case with Medical Tourism). Examples would be for heart treatment, orthopedics, cancer and other life threatening health reasons. Tourists and vacationers that get injured or develop a (minor or major) medical condition while traveling long distances away from home and need medical care we call “Accidental Tourists” ( DeMicco et al. , 2018 ).

This special issue medical tourism. In the first paper, Bruno Sousa and Gisela Alves examines the role of relationship marketing in behavioral intentions of medical tourism services and guest experiences. The main purpose of this study was to analyze how relationship marketing relates to other relevant variables in patient/guest behavior applied to healthcare management and medical tourism contexts. Under an interdisciplinary perspective, this research brings together inputs from relationship marketing, medical tourism and healthcare management (service excellence). The study found that relationship marketing leads to commitment, trust and cooperation towards the healthcare and medical tourism facility and enhances the tourist satisfaction and service loyalty.

The second paper by Alicia Mason, Lynzee Flores, Pan Liu, Kenzie Tims, Elizabeth Spencer and T. Gabby Gire provides an analysis of the digital communication strategies used by medical tourism providers (MTPs) during the 2017 Caribbean hurricane season. The authors discuss improving risk information and crisis communication tactics and strategies. Understanding how best to communicate during adverse events, such as natural disasters, can help to ensure high-quality patient experiences in medical tourism encounters. There are practical insights to be gleaned from the findings from this paper. First, small-scale MTPs (i.e. specialty clinics, private practitioners and medical tourism facilitators) can improve on any weaknesses through proactive planning and preparation by creating organizational goals to complete basic crisis communication training courses and in doing so support the applied professional development of crisis management. Second, MTPs outside of the Caribbean region exposed to similar environmental risks of natural disasters (i.e. hurricanes, earthquakes, typhoons and tsunamis) may use these findings for comparative analysis purposes to support their own organizational planning. Findings from this study can help other medical tourism providers in at-risk regions plan and prepare should similar events manifest resulting in international medical tourism patient vulnerability.

The third paper by Simon Hudson and Karen Tahl in this special issue assesses the service product at a wellness facility, proposing and testing a theoretical framework to identify aspects of the service environment at a destination spa that contribute to psychological well-being. Self-determination theory (SDT) was used as the theoretical framework. According to SDT, basic needs must be met in order for psychological well-being to be achieved. The study examined whether basic need fulfillment may be achieved through the quality of the service environment and interactions with staff and guests. Psychological precursors to well-being, or basic needs, were estimated using structural equation modeling. In analysis, all precursors were significant with the model explaining considerable variation in the outcome variable, well-being. Results confirm that in addition to the wellness services and amenities, the service product uniquely contributes to psychological well-being. Thus, the study provides a theoretical framework for measuring the outcomes of a stay at a wellness destination. Practical implications for managing the service product include ensuring that guests’ sense of autonomy or choice is supported, that guests are encouraged to develop a sense of mastery with respect to activities, and that interactions with other guests are facilitated.

The next paper by Sethumadhavan Meera and Attambayintatvida Vinodan examines the attitude towards alternative medicinal practices in wellness provision. Here, wellness tourists have various motivations despite their specific requirements; however, it can be concluded from the study that wellness tourists have a favorable attitude towards alternative medicinal practices akin to Kalarichikilsa as they meet their expectations of physical, emotional, social, psychological and personal wellbeing. India, the focus of this study, has been known as a major destination for wellness tourism especially for Yoga, Meditation and Ayurveda. Spiritual healing practices are also popular in India.

The final paper by Ilhan Sag and Ferhat Zengul investigates the relationships between the medical tourist’s perceptions on decisive factors in choosing Turkey as their medical tourism destination. The data for this empirical study were collected from 288 patients in Turkey, all of whom were medical tourists from various countries. Descriptive statistics and Kruskal–Wallis difference tests were used for analyses. Statistically significant differences were found among medical tourists in regards to the geographical regions of their residence. For example, lack of expertise or technologic devices in the home country of the medical tourist was the most crucial factor in choosing Turkey for those from the Balkans and Middle Asia than the other regions, particularly Europe and America-Australia, given the technological development levels of these specific regions. These findings suggest that differences among medical tourists in regards to the geographic regions of their residence contributed to the medical tourists’ behaviors and medical tourism market segmentation in Turkey.

We hope that our readers will enjoy reading these insightful articles in this special issue on medical tourism in the JHTI .

DeMicco , F.J. , Cetron , M. and Davies , O. ( 2018 ), “ Medical tourism ”, Strategic Management for Hospitality and Travel: Today and Tomorrow , Kendall-Hunt Publishers .

Patients Beyond Borders ( 2018 ), “ Medical tourism statistics & facts ”, available at: https://patientsbeyondborders.com/medical-tourism-statistics-facts (accessed November 24, 2018 ).

Corresponding author

About the authors.

Deniz Kucukusta, PhD, is Associate Professor at The Hong Kong Polytechnic University, School of Hotel and Tourism Management, Kowloon, Hong Kong.

Simon Hudson, PhD, is Director and Endowed Chair at the Center of Economic Excellence in Tourism and Economic Development, College of Hospitality, Retail and Sport Management, University of South Carolina, Columbia.

Frederick J. DeMicco, PhD, is RDN, Visiting Professor at the University of South Florida Sarasota – Manatee; Visiting Scholar at the Colorado State University and Aramark Chair Emeritus and Professor at the University of Delaware 917 Majestic Circle, Steamboat Springs, Colorado.

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ABOUT US

The Most Trusted Resource in Medical Tourism

Through our work with leading internationally accredited hospitals and clinics, Ministries of Health, Ministries of Tourism, top private hospital associations, and public-private initiatives, we have located the world's most trustworthy medical destinations, the top facilities, doctors and specialists around the world. Our mission is to help connect these global healthcare stakeholders toward impactful programs that provide world-class, affordable medical care to millions of patients seeking trustworthy solutions and successful outcomes.

Over the past twelve years, Patients Beyond Borders has partnered with governments, industry leaders, providers and consulting groups to expand various initiatives within a complex international healthcare community.

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Patients beyond borders  . . . has helped thousands of patients plan successful health travel journeys abroad., a must-read for those considering medical tourism., washington post, a practical guide to planning a medical trip., aarp life@50+, patients beyond borders . . . is a leading advocate of affordable, high-quality medical care for healthcare consumers worldwide..

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16 Years in the Medical Travel Business

14 Years in the Medical Travel Business

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As CEO of Patients Beyond Borders, Josef Woodman has spent the past 16 years researching and vetting international options for quality, affordable medical care. He has met and consulted with ministries and key stakeholders in the world's leading medical travel destinations, touring more than 200 medical facilities in 35 countries. Co-founder of MyDailyHealth (1998) and Ventana Communications (1987), Woodman's pioneering background in publishing, healthcare and technology has allowed him to compile a wealth of information and knowledge about international medical care, telemedicine, wellness, integrative medicine and consumer-directed healthcare.

Woodman has lectured at the UCLA School of Public Health, Harvard Medical School, Duke Fuqua School of Business, Scientific American and the International Society for Travel Medicine. He has keynoted and moderated conferences on medical tourism and global healthcare in 20 countries. He has appeared in numerous print and broadcast media, including The Economist, The New York Times, CNN, ABC News, Fox News, Huffington Post, Barron's, The Wall Street Journal, and more.

Woodman is an outspoken advocate of affordable, high-quality medical and preventative care for healthcare consumers worldwide.

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Healthy Travel Media Announces Fourth Edition ofPatients Beyond Borders

Rising healthcare costs spawn millions of us medical refugees.

Newswise — Chapel Hill, North Carolina, USA; 21 January 2020 : Calvander Communications, publishers of Patients Beyond Borders: Everybody’s Guide to Affordable, World-Class Medical Tourism , today announced the publication of the updated and expanded Fourth Edition of the world’s best-selling consumer guide to medical tourism and international health travel.

As millions of Americans drift into financial crisis due to an unaffordable medical treatment, this impartial, easy-to-navigate trade print and ebook reference provides cross-border health travelers a trusted road map to safe, cost-effective decisions about traveling abroad for healthcare.

In 2020, more than two million US patients will cross borders for medical care, up more than tenfold from just a decade ago. "Costs have become unbearable for some 82 million uninsured or underinsured Americans," says author Josef Woodman. "US patients who would otherwise undergo treatment at home are now driven in droves to seek affordable medical options in other countries."

Readers gain concise information on how to make safe, informed decisions about their treatment while saving 30-80% on medical procedures. Some 800 medical centers and clinics in 70 countries around the world are now US-accredited, offering patients a wide range of treatment options. Patients Beyond Borders remains the best-read, most comprehensive, accessible medical tourism guide, authored by the world's leading spokesperson on international health travel.

Key 2020 medical tourism trends:

• The international medical travel market is expanding at 15-18% annually, with rising costs of treatment and aging millennials driving the growth.

• Americans seeking inexpensive pharmaceuticals for complex conditions are beginning to explore destinations such as Mexico and Thailand, where formal hospital-sponsored programs have been created to serve healthcare consumers burdened by ever-increasing US drug prices (e.g. another 5% hike in early 2020). Expensive drugs sought by patients include treatment for cancer, Hepatitis C and spinal conditions such as osteoporosis.

• Fewer inbound patients are visiting US medical centers for care, in favor of culturally compatible, friendlier venues closer to home. Thailand, Singapore, Korea, and Malaysia are the big beneficiaries. China is a big exception as Chinese patients flood US medical centers for complex treatment of cancers and other environmentally driven diseases.

About the Author

As CEO of Patients Beyond Borders, Josef Woodman has spent 14 years advocating for patient choice in quality, affordable medical care. He has toured more than 250 medical facilities in 35 countries, researching and vetting international healthcare options. Co-founder of MyDailyHealth (1998) and Ventana Communications (1987), Woodman's pioneering background in publishing, health, and technology has allowed him to compile a wealth of data and knowledge about international medical care, telemedicine, wellness, integrative medicine, and consumer-directed healthcare.

Woodman has lectured at the UCLA School of Public Health, Harvard Medical School, Duke Fuqua School of Business, Scientific American and the International Society for Travel Medicine. He has keynoted and moderated conferences on medical tourism and global healthcare in 20 countries. He has appeared in numerous print and broadcast media, including The Economist, The New York Times, CNN, ABC News, China Daily, Fox News, Huffington Post, Sydney Morning Herald, Wall Street Journal, and more. About Patients Beyond Borders

Founded in 2005 and based in Chapel Hill, North Carolina, Patients Beyond Borders, dba Calvander Communications, Inc. is primarily a publisher of books and related information on international healthcare travel. The company offers custom, collaborative programs and consulting services designed to help global healthcare stakeholders extend visibility and branding within the international medical community, attract more patients, expand online search and credibility, and assist with strategic planning.

For media queries, please contact: [email protected]

Qualified members of the media are invited to request a review copy . Researchers and media professionals may also request updated comparative cost information by country for typical treatments and patient flows by destinations . Please contact [email protected] .

Please see related article Top Ten Cities for Medical Tourism in 2020

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Medical Tourism

"beyond borders: discovering the world's top 10 hospitals for medical tourists".

In an era of increasing globalization, the field of medical tourism has gained momentum as individuals travel across borders to seek exceptional healthcare services. These discerning medical tourists seek access to cutting-edge facilities, renowned specialists, and personalized care, making their healthcare journey a transformative experience. In this article, we embark on an extraordinary exploration of the world's top 10 hospitals that have become prime destinations for medical tourists. These prestigious institutions symbolize the epitome of excellence in global healthcare, providing cutting-edge technology, renowned medical experts, and bespoke services to cater to the unique needs of international patients.

• Global Medical Center of Excellence - London, United Kingdom

Delivering Unparalleled Care: Global Medical Center of Excellence

Located in the vibrant city of London, the Global Medical Center of Excellence sets a benchmark for exceptional healthcare. With its world-class facilities and internationally renowned medical professionals, the center offers a comprehensive range of specialized treatments, including advanced diagnostics, robotic surgeries, and regenerative medicine. With a patient-centric approach and a relentless pursuit of medical excellence, the Global Medical Center of Excellence is a preferred choice for medical tourists seeking top-tier healthcare services.

• Elite Healthcare Institute - Seoul, South Korea

Excellence Redefined: Elite Healthcare Institute

Seoul, the bustling capital of South Korea, has established itself as a prominent destination for medical tourism, renowned for its technological advancements and exceptional healthcare services. Among the leading institutions in this vibrant city is the Elite Healthcare Institute, offering a wide range of specialized treatments, including plastic surgery, orthopedics, and fertility procedures. With cutting-edge facilities and a team of renowned specialists, the institute provides outstanding medical care, attracting international patients from around the world.

• World Health Hub - Zurich, Switzerland

Where Excellence Meets Compassion: World Health Hub

Zurich, the picturesque city nestled in the heart of Switzerland, is home to the World Health Hub, a renowned hospital that blends innovation with compassion. This esteemed institution combines state-of-the-art infrastructure with a multidisciplinary approach to provide comprehensive medical care. From advanced cancer treatments to neurosurgery and cardiovascular interventions, the World Health Hub excels in delivering high-quality medical services. With a focus on personalized attention and patient well-being, it has positioned itself as a leading destination for medical tourists.

• International Wellness Center - Dubai, United Arab Emirates

A Paradigm of Healing: International Wellness Center

Dubai, the vibrant city known for its luxury and opulence, also offers exceptional healthcare services through institutions like the International Wellness Center. Integrating cutting-edge medical technology with a focus on holistic wellness, the center provides a comprehensive range of services, from preventive medicine to specialized surgeries and rejuvenation therapies. With a commitment to delivering world-class medical expertise and a luxurious healthcare environment, the International Wellness Center has become a sought-after destination for medical tourists.

• Avant-Garde Medical Institute - New York City, United States

Redefining Medical Excellence: Avant-Garde Medical Institute

New York City, a global hub of innovation, is home to the Avant-Garde Medical Institute, renowned for its groundbreaking research and exceptional patient care. The institute boasts state-of-the-art facilities and a team of distinguished specialists across various medical disciplines. From advanced cancer treatments to complex surgeries and specialized therapies, the Avant-Garde Medical Institute remains at the forefront of medical advancements. The institute's commitment to personalized care and patient empowerment makes it an attractive choice for medical tourists seeking world-class healthcare solutions.

• Asia Pacific Medical Center - Singapore

Innovating Care: Asia Pacific Medical Center

Singapore has emerged as a leading medical tourism destination, renowned for its advanced healthcare infrastructure and commitment to excellence. The Asia Pacific Medical Center stands as a shining example of superior medical care in this global city-state. With state-of-the-art facilities, cutting-edge technology, and a multidisciplinary team of experts, the center offers a comprehensive range of medical specialties. From complex surgeries to advanced diagnostic procedures and specialized treatments, the Asia Pacific Medical Center provides exceptional care to international patients, emphasizing both medical excellence and patient well-being.

• Global Health Oasis - Sydney, Australia

Wellness Redefined: Global Health Oasis

Sydney, the vibrant city on Australia's east coast, is home to the Global Health Oasis, which offers a unique combination of world-class medical care and a tranquil healing environment. The hospital focuses on providing comprehensive healthcare services across various specialties, including advanced cardiac care, neurology, and orthopedics. With its commitment to patient-centric care, advanced medical technology, and a team of renowned specialists, the Global Health Oasis has earned a reputation as a sought-after destination for medical tourists seeking superior healthcare experiences.

• Continental Medical Center - Tokyo, Japan

Leading the Way: Continental Medical Center

Tokyo, the bustling capital of Japan, is renowned for its technological advancements and cutting-edge healthcare services. The Continental Medical Center stands out as a leading hospital in the city, offering advanced medical treatments in various disciplines. The hospital's state-of-the-art facilities, internationally trained specialists, and commitment to patient care make it an ideal choice for medical tourists seeking high-quality healthcare in Japan. From innovative surgeries to specialized therapies, the Continental Medical Center delivers exceptional medical services to international patients.

• Mediterra International Hospital - Istanbul, Turkey

A Haven of Healing: Mediterra International Hospital

Istanbul, the vibrant city bridging Europe and Asia, is home to Mediterra International Hospital, a renowned institution that combines world-class healthcare with a rich cultural experience. The hospital offers a comprehensive range of medical specialties, including cardiology, orthopedics, and oncology, using cutting-edge technology and innovative treatment approaches. Mediterra International Hospital prides itself on providing personalized care, state-of-the-art facilities, and a dedicated team of internationally trained medical professionals, making it a preferred choice for medical tourists seeking exceptional healthcare.

• Pacific Medical Center - Vancouver, Canada

Pioneering Medical Excellence: Pacific Medical Center

Vancouver, a stunning city nestled between mountains and the Pacific Ocean, is home to Pacific Medical Center, a leading institution renowned for its advanced medical services and patient-centered care. The center offers a wide range of specialties, including neurology, pediatrics, and reproductive medicine, delivered by highly skilled physicians and supported by state-of-the-art technology. With a focus on holistic well-being, Pacific Medical Center provides comprehensive medical services, personalized treatment plans, and a warm, welcoming environment, making it a top choice for medical tourists seeking exceptional healthcare in Canada.

The top 10 hospitals for medical tourists presented in this comprehensive guide represent the pinnacle of global healthcare excellence. These prestigious institutions, ranging from the Global Medical Center of Excellence in London to the Pacific Medical Center in Vancouver, combine cutting-edge technology, renowned specialists, and personalized care to provide exceptional healthcare experiences. As medical tourism continues to grow, these hospitals serve as beacons of excellence, attracting international patients seeking world-class medical services. From Istanbul to Vancouver, these destinations offer a wide range of medical specialties, ensuring that patients receive the highest standard of care in a supportive and nurturing environment. Medical tourists can embark on their healthcare journeys with confidence, knowing they will receive exceptional treatment and a transformative healthcare experience at these premier hospitals.

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Patients are advised to seek hospitals that are accredited by Global Healthcare and only work with medical tourism facilitators who are certified by Global Healthcare Accreditation or who have undergone certification from the Certified Medical Travel Professionals (CMTP). This ensures that the highest standards in the industry are met. Click the link to check out hospitals accredited by the Global Healthcare Accreditation: https://www.globalhealthcareaccreditation.com/

It is recommended that consumers do not share their personal and confidential information on random medical tourism platforms as they may not be secure. Consumers must be cautious when disclosing their private information as some organizations may not protect their privacy and could misuse their information. Additionally, there are agencies that may prioritize their commissions over the well-being of the patients. Consumers should avoid choosing the cheapest price and instead make a thorough comparison across multiple facilitators to make an informed decision.

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The Medical Tourism Magazine (MTM), known as the “voice” of the medical tourism industry, provides members and key industry experts with the opportunity to share important developments, initiatives, themes, topics and trends that make the medical tourism industry the booming market it is today.