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The rise of medical tourism: A global perspective

Medical tourism, a rapidly evolving industry, has been making headlines worldwide. It has become an increasingly popular choice for millions of patients seeking accessible, affordable, and high-quality healthcare. In this article, we will explore the reasons behind the rise of medical tourism, the current trends shaping the industry, and the challenges and opportunities facing stakeholders in this ever-expanding market.

I. The origins and growth of medical tourism

Medical tourism is not a new phenomenon, as people have traveled for medical treatment for centuries. However, advancements in transportation, communication, and medical technology have transformed the industry, making it more accessible to a broader range of people.

• Factors driving the growth of medical tourism:

a) High cost of healthcare in developed countries: The rising cost of healthcare in countries like the United States has prompted many individuals to seek more affordable alternatives abroad. For instance, a heart bypass surgery in the United States can cost up to $100,000, while the same procedure in India may only cost around $10,000.

b) Long waiting times: Lengthy waiting periods for elective surgeries and specialist consultations in countries with public healthcare systems, such as Canada and the United Kingdom, have driven patients to seek faster treatment in other countries.

c) Accessibility to advanced treatments: Some patients choose medical tourism to access cutting-edge treatments unavailable or not yet approved in their home countries.

d) Improved quality of healthcare services: The quality of healthcare services in developing countries has significantly improved in recent years, with many facilities achieving international accreditations and certifications.

e) Increasing ease of travel: Air travel has become more accessible and affordable, allowing people to travel long distances for medical treatment without significant inconvenience.

II. Popular medical tourism destinations and treatments

The global landscape of medical tourism is diverse, with different regions specializing in various treatments and offering unique advantages to international patients.

• Asia: Countries such as India, Thailand, and Singapore have emerged as major medical tourism hubs in Asia. They offer a wide range of treatments, from orthopedic surgeries and cardiac procedures to cosmetic surgeries and dental treatments. These countries are known for their state-of-the-art facilities, highly skilled medical professionals, and relatively low costs.
• Latin America: Mexico, Costa Rica, and Brazil are among the top medical tourism destinations in Latin America. Patients from the United States and Canada often choose these countries for their proximity and lower cost of treatments. Popular procedures in this region include bariatric surgery, dental care, and cosmetic surgery.
• Europe: Turkey, Hungary, and Poland are gaining prominence in the European medical tourism market. They offer advanced treatments, such as oncology, fertility treatments, and dental care, at competitive prices.

III. The role of technology in the rise of medical tourism

Technology has played a critical role in the growth of medical tourism. The internet and social media have facilitated easier access to information about medical facilities, treatments, and medical professionals. Telemedicine and virtual consultations have also enabled patients to connect with healthcare providers remotely, further increasing the appeal of medical tourism.

IV. Challenges and opportunities in medical tourism

Despite the rapid growth of medical tourism, the industry faces several challenges that must be addressed to ensure its continued success.

• Legal and ethical issues: Differences in medical standards, regulations, and malpractice laws across countries can pose challenges for patients and healthcare providers alike. Ensuring the highest level of care and addressing ethical concerns, such as organ trafficking, will be crucial in maintaining the reputation of the industry.
• Quality and safety concerns: Ensuring the quality and safety of medical treatments and facilities is paramount. International accreditation and certification bodies, such as the Global Healthcare Accreditation(GHA), play a vital role in maintaining high standards.
• Coordination and communication: Effective coordination and communication between healthcare providers, insurance companies, and medical tourism facilitators are essential to ensure a smooth experience for patients. Addressing language barriers and cultural differences can further enhance the patient's overall experience.
• Competition: As the medical tourism industry expands, competition among destinations increases. Countries must invest in the development of their healthcare infrastructure, marketing strategies, and workforce to remain competitive.

V. The future of medical tourism

As the global medical tourism market continues to grow, new trends and opportunities will emerge for both patients and industry stakeholders.

• Personalized medicine and genomics: Advances in personalized medicine and genomics are expected to play a significant role in the future of medical tourism. Patients may travel abroad to access tailored treatments based on their genetic makeup.
• The rise of wellness tourism: Wellness tourism, which focuses on preventive care and holistic well-being, is a growing market. Destinations that offer a combination of medical and wellness services may have a competitive advantage in attracting medical tourists.
• Digital health and virtual care: The integration of digital health technologies, such as telemedicine and AI-driven diagnostics, will likely play a critical role in the expansion of medical tourism. These technologies can help patients access care remotely and provide more personalized, efficient services.
• Sustainable medical tourism: As environmental concerns become increasingly prominent, medical tourism destinations will need to prioritize sustainability and eco-friendly practices in their healthcare infrastructure and facilities.

The rise of medical tourism is a testament to the global demand for accessible, affordable, and high-quality healthcare. As the industry continues to evolve, new challenges and opportunities will shape its future trajectory. By addressing these challenges and capitalizing on emerging trends, medical tourism destinations can secure a sustainable and successful place in the global healthcare landscape.

To receive a free quote please click on the link: https://www.medicaltourism.com/get-a-quote

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.

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Why Patients Are Turning to Medical Tourism

Statistics, Benefits, and Risks

Planning Ahead

Frequently asked questions.

Medical tourism is a term that refers to traveling to another country to get a medical or dental procedure. In some instances, medical tourists travel abroad seeking alternative treatments that are not approved in the United States.

Medical tourism is successful for millions of people each year, and it is on the rise for a variety of reasons, including increasing healthcare costs in the United States, lack of health insurance, specialist-driven procedures, high-quality facilities, and the opportunity to travel before or after a medical procedure.

According to a New York Times article from January 2021, pent-up demand for nonessential surgeries, as well as the fact that many Americans lost their health insurance during the coronavirus pandemic led to a surge in medical tourism once other countries re-opened.

However, there are specific risks that come with traveling overseas for surgery. If you're thinking of pursuing a medical procedure in another country, here's what to know about the benefits and the risks.

Medical Tourism Benefits

The most common procedures Americans go abroad for include dental care, cosmetic procedures , fertility treatments, organ transplants , and cancer treatment.

This is not to be confused with having an unplanned procedure in a foreign country due to an unexpected illness or injury.

Among the reasons a person might choose to go abroad for a medical procedure are:

Lower Costs

Medical tourists can save anywhere from 25% to 90% in medical bills, depending on the procedure they get and the country they travel to. There are several factors that play into this:

• The cost of diagnostic testing and medications is particularly expensive in the United States.
• The cost of pre- and post-procedure labor is often dramatically lower overseas. This includes labor costs for nurses , aides, surgeons , pharmacists, physical therapists , and more.
• High cost of malpractice insurance—the insurance that protects medical professionals against lawsuits—in the United States.
• Hospital stays cost far less in many overseas countries compared to the United States. In other words, quality care, hospital meals, and rehabilitation are far more affordable abroad for many people.

For someone who doesn't have insurance , or someone having a procedure that is not covered by insurance , the difference can be enormous.

Popular Countries for Medical Tourism

Dominican Republic

South Korea

Culture and Language

Many immigrants prefer to have treatments and procedures done in their country of origin—a sensible decision, considering just how much language barriers alone can affect the quality of their care.

Furthermore, at least 25% of immigrants and noncitizen residents in the United States are uninsured, compared to 9% of American citizens. Children with at least one noncitizen parent are also more likely to be uninsured.

Practicalities aside, many people choose to have their procedure done in their country of origin simply because it allows them to be close to family, friends, and caretakers who can assist them through their recovery .

Insurance Incentives

Some insurance companies have started promoting medical tourism. The reason behind this is simple: savings for the insured means savings for the insurance provider and vice versa.

Several insurance providers, including Aetna have programs specifically geared at promoting safe medical tourism. Some insurance providers even offer financial incentives for medical tourism, like discounts on medical bills .

That said, many insurance companies will not pay for surgery performed outside of the country unless it is an emergency.

Luxury and Privacy

Medical tourism is a lucrative business for many countries, and much of the money brought in by medical tourists is reinvested into the local economy and health infrastructure.

The effect of this is apparent in the spa-like luxury that some foreign hospitals offer, providing medical tourists the opportunity to be pampered during their stay for a fraction of the cost they would pay at home.

Some facilities offer hospital rooms that are more like a hotel suite than a traditional hospital room. Other hospitals offer one-on-one private nursing care, which is far more generous and attentive than the staffing ratios that most hospitals allow.

Medical tourists who seek that added layer of privacy can find it abroad. Many can return home from their "vacation" without anyone knowing they had a procedure at all.

Vacation in a Foreign Country

Medical tourists often take advantage of their stay in a foreign country to travel for pleasure by scheduling a vacation before or after their procedure.

This is an especially inexpensive way to travel to a foreign country, especially if their insurance provider is paying for the flight and the cost of staying is low. 

While it seems logical to recover on a beach or in a chalet by the mountains, keep in mind that it's important not to jeopardize your recovery.

Swimming isn't recommended until your incisions are completely closed. You may not feel up to doing much more than napping in the days following your procedure, either.

Don't let your vacation disrupt your recovery. Any time you have a procedure done, especially a surgery, it's important to listen to your body, take your medications as directed, and follow your doctor's recommendations closely.

Bypassing Rules and Regulations

Some travelers seek surgery abroad to bypass rules that are set in place by their own government, insurance company , or hospital. These rules are typically in place to protect the patient from harm, so getting around them isn't always the best idea.

For example, a patient may be told that their weight is too low to qualify for weight loss surgery . A surgeon in a foreign country may have a different standard for who qualifies for weight loss surgery, so the patient may qualify overseas for the procedure they want.

Talented Surgeons

Surgeons in certain countries are known for their talent in a specific area of surgery. For example, Brazilian surgeons are often touted for their strong plastic surgery skills .

Whereas in the United States, insurance companies might only cover cosmetic procedures if it is medically necessary, cosmetic surgery is often free or low-cost in Brazil's public hospitals—giving cosmetic surgeons there ample practice.

Thailand is reported to be the primary medical tourism destination for individuals seeking gender reassignment . It is often easier to qualify for surgery and the cost is significantly reduced. Surgeons are performing the procedures frequently, and as a result, many have become quite specialized in them.

It is often surprising to many medical tourists that their physician was trained in the United States. Not all physicians are, of course, but a surprisingly high percentage of them working in surgery abroad are trained in English-speaking medical schools and residency programs and then return to their home country. These physicians often speak multiple languages and may be board certified in their home country and a foreign country, such as the United States.

Medical tourism isn’t limited to countries outside of the United States, either. Many people travel to the United States for medical care due to the country's cutting-edge technology, prescription medication supply, and the general safety of healthcare.

Medical Tourism Risks

The financial and practical benefits of medical tourism are well known, and you may even know someone who had a great experience. Nonetheless, the downsides of medical tourism can be just as great if not greater. Sometimes, they can even be deadly.

If you are considering a trip abroad for your procedure, you should know that medical tourism isn't entirely without obstacle and risks. These include:

Poorly Trained Surgeons

In any country—the United States included—there will be good surgeons and bad. And just as there are great surgeons abroad, there are also some surgeons who are less talented, less trained, and less experienced.

Regardless of what procedure you are getting or where, you should always do some preliminary research into the surgeon or physician who will be treating you as well as the hospital you will be treated at.

In the United States, it is fairly easy to obtain information about malpractice lawsuits , sanctions by medical boards, and other disciplinary actions against a physician.

Performing this research from afar can be challenging, especially if you don't speak the local language. Yet countless people take the risk anyway, without knowing whether the physicians who will treat them are reputable.

A physician should be trained in the specific area of medicine that is appropriate for your procedure. For example, you should not be having plastic surgery from a surgeon who was trained to be a heart doctor. It isn’t good enough to be a physician, the physician must be trained in the specialty .

Prior to agreeing to surgery, you should also know your surgeon’s credentials : where they studied, where they trained, and in what specialty(s) they are board-certified. Do not rely on testimonials from previous patients; these are easily made up for a website and even if they are correct, one good surgery doesn’t mean they will all be successful.

Quality of Staff

Nurses are a very important part of healthcare, and the care they provide can mean the difference between a great outcome and a terrible one.

A well-trained nurse can identify a potential problem and fix it before it truly becomes an issue. A poorly trained nurse may not identify a problem until it is too late. The quality of the nursing staff will have a direct impact on your care.

Once again, it's important to research the hospital staff where you will be having your procedure done. Read the reviews but don't trust them blindly. If you can, seek out a recommendation from someone who can vouch for the medical staff where you will be going.

Quality of the Facility

While researching healthcare facilities for your procedure, you want to learn not just about the quality of the facilities themselves, but about the country's healthcare system as a whole.

In some countries, there is a marked distinction between public hospitals and private hospitals. In Turkey, for example, private hospitals are considered on-par with hospitals in the states, while many locals will advise you to steer clear of public hospitals if you can.

You will also want to seek out facilities that are internationally accredited. In the United States, the Joint Commission evaluates hospitals and certifies those that provide safe, quality care. The international division does the same for hospitals outside the United States.

Once you have a few options for potential facilities, you can start to investigate specifics. For one, you should find as many pictures and reviews of the facility as you can. Ask yourself whether the facility is state of the art or whether it seems dirty and outdated.

You will also need to find out if the facility has ICU level care available, in case something goes wrong. If not, there should be a major hospital nearby so that you can be transferred quickly.

To learn more about a healthcare facility, consider joining expat groups on social media for the city or country you will be traveling to. Ask the group for recommendations, or inquire about any positive or negative experiences they may have had at a particular facility.

Flying Home After Surgery

Any surgery comes with risks, including infection and blood clots . Flying home increases the risk of blood clots, especially on long-haul flights that are longer than four hours.

Try to avoid flying home in the days immediately after surgery; waiting a week will decrease the chances of developing a blood clot or another serious complication during the flight.

For longer flights, plan on getting up and walking up and down the aisles each hour to improve blood flow in your legs. You might also benefit from wearing compression socks with your doctor's approval.

If you are taking blood thinners or are at-risk of blood clots , be sure to talk to your doctor about how you can reduce your risk of blood clots after your procedure and while traveling.

Furthermore, you should know the symptoms of blood clots and stay alert.

Unplanned Illness

Any time you travel abroad, you run the risk of catching an illness that you have never been exposed to or that your body is not prepared to fight off. This is especially a concern when spending time in a foreign hospital.

If you have a sensitive stomach, you may also want to think long and hard about having surgery abroad. The food is often very different in foreign hospitals, and in some areas, there is a risk that even the water will be upsetting to your body.

Having diarrhea or postoperative nausea and vomiting makes for a miserable recovery experience, especially if you do not have a friend or family member nearby who can help you through it.

Before you travel abroad, check with your doctor to see if you need any vaccines to travel to your destination or if there are any foreign illnesses you should be aware of. Picking up an illness abroad, particularly after your surgery, can potentially be life-threatening.

Language Barriers

If you are having surgery in a country where English is not the primary language, you will need to make preparations in order to be able to communicate with the staff.

You may be pleasantly surprised to learn that the staff speaks your primary language well. If not, then you will need to consider how you will make your wishes and needs known to the surgeon, the staff, and others you will meet.

Whether you are at home or abroad, remember to speak up and advocate for yourself to make sure your needs are met. If you don't speak the local language, download a language translation app on your smartphone and don't hesitate to use it to communicate your needs. Hiring a translator is another option.

A Word About Transplant Tourism

Transplant tourism is one area of medical tourism that is strongly discouraged by organ and tissue transplant professionals in multiple countries. Most international transplants are considered “black market” surgeries that are not only poor in quality, but ethically and morally wrong.

China, for example, the country that is believed to perform more international kidney transplants than any other country, is widely believed to take organs from political prisoners after their execution.

In India, living donors are often promised large sums of money for their kidney donation, only to find out they have been scammed and never receive payment. Selling an organ in India is illegal, as it is in most areas of the world, so there is little recourse for the donor.

Then there is the final outcome: how well the organ works after the surgery is complete. With black market transplants, less care is often taken with matching the donor and recipient, which leads to high levels of rejection and a greater risk of death. Furthermore, the new organ may not have been screened for diseases such as cytomegalovirus , tuberculosis , hepatitis B , and hepatitis C . It is often the new disease that leads to death, rather than the organ rejection itself.

Finally, transplant surgeons are often reluctant to care for a patient who intentionally circumvented the donor process in the United States and received their transplant from an unknown physician.

It is important to arrange your follow-up care prior to leaving your home country.

Many physicians and surgeons are hesitant to take care of a patient who received care outside the country, as they are often unfamiliar with medical tourism and have concerns about the quality of care overseas.

Arranging for follow-up care before you leave will make it easier to transition to care at home without the stress of trying to find a physician after surgery .

Just be sure to inform your follow-up care physician where you are having your procedure done. After you return, they will also want to know what prescription medications you were given, if any.

What are popular countries for medical tourism? 

Mexico, India, Costa Rica, Turkey, Singapore, Canada, and Thailand are among the many countries that are popular for medical tourism.

How safe is medical tourism?

Medical tourism is generally considered safe, but it's critical to research the quality of care, physician training, and surgical specialties of each country. There are several medical tourism organizations that specialize in evaluating popular destinations for this purpose.

What countries have free healthcare? 

Countries with free healthcare include England, Canada, Thailand, Mexico, India, Sweden, South Korea, Israel, and many others.

A Word From Verywell

If you are considering medical tourism, discuss the risks and benefits with your doctor, and consider working with your insurance provider to arrange a trip that balances financial savings with safety. (Also, before you embark on a trip overseas for your procedure, make sure you are financially prepared for unexpected events and emergencies. Don't go abroad if you don't have enough money to get yourself home in a crisis.)

A medical tourism organization such as Patients Without Borders can help you evaluate the quality and trustworthiness of healthcare in various countries. Making sure a high level of care is readily available will lead to a safer, more relaxing experience.

Centers For Disease Control and Prevention. Medical Tourism: Getting medical care in another country . Updated October 23, 2017.

University of the Incarnate Word. Center for Medical Tourism Research .

Patients Beyond Borders. Facts and figures .

Kaiser Family Foundation. Health coverage of immigrants . Published July 2021.

Paul DP 3rd, Barker T, Watts AL, Messinger A, Coustasse A. Insurance companies adapting to trends by adopting medical tourism . Health Care Manag (Frederick). 2017 Oct/Dec;36(4):326-333. doi: 10.1097/HCM.0000000000000179

Batista BN. State of plastic surgery in Brazil .  Plast Reconstr Surg Glob Open . 2017 Dec;5(12):1627. doi:10.1097/GOX.0000000000001627

Johns Hopkins Bloomberg School of Public Health - Global Health Now. Brazilians' risky right to beauty . Published May 2018.

Chokrungvaranont P, Selvaggi G, Jindarak S, et al. The development of sex reassignment surgery in Thailand: a social perspective .  Sci World J . 2014 Mar;2014(1):1-5. doi:10.1155/2014/182981

The Joint Commission. For consumers .

Centers for Disease Control and Prevention. Blood clots and travel: what you need to know . Reviewed February 2021.

Hurley R. China harvested organs from political prisoners on substantial scale, says tribunal . BMJ . 2018 Dec;363(1):5250. doi:10.1136/bmj.k5250

Ambagtsheer F, Van Balen L. I'm not Sherlock Holmes: suspicions, secrecy, and silence of transplant professionals in the human organ trade . Euro J Criminol . 2019 Jan;17(6):764-783. doi:10.1177/1477370818825331

Centers for Disease Control and Prevention. Transplant Surgery. Key facts . Reviewed January 2019.

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

More From Forbes

What is medical tourism traveling for healthcare explained.

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Excited young woman is showing her documents to check-in attendant. She is standing and smiling

Medical tourism is nothing new. People have been seeking more affordable, sometimes higher-quality care for as long as humans could cross borders. In today’s world that usually means travel to foreign countries for a wide range of medical procedures from elective surgeries like liposuction and rhinoplasty to advanced care for complex medical conditions like cancer and fertility treatments. And it’s a multibillion dollar market that continues to grow with globalization.

There are as many alternative medical offerings as there are destinations in the world – giving people countless reasons to seek medical care away from home.

These often include pursuing more affordable treatment options to accessing specialized medical expertise that is not available locally to combining medical procedures with a luxury travel experience. And admittedly, in some cases individuals may opt for health travel because specific treatments are not recommended locally, have long wait times or for desired anonymity.

But to dispel any misconceptions about medical tourism, not all medical travel is for cosmetic surgery procedures such as breast augmentation, liposuction, facelifts and rhinoplasty. While those are popular, it may come as a surprise that dental procedures, heart valve replacements, fertility treatments and orthopedic surgeries are standard in the medical tourism industry . And according to the CDC , many seek more stigmatized care such as substance use rehabilitation and even physician-assisted death abroad because of cultural differences and acceptance.

What To Know Before You Go

There are many risks, big and small, to pursuing care outside the traditional and highly regulated U.S. system. And it’s important to note that even some small perceived risks carry great weight. For example, language and cultural barriers might seem insignificant at first, but will certainly influence the treatment experience and post-operative care. What is considered standard in one place, may be unacceptable in others.

Differences in healthcare regulations and standards across countries may lead to discrepancies in the quality of care and patient safety, necessitating thorough research and due diligence before choosing a health provider abroad. Common complications include infection, inadequate training and lack of follow up protocol. Additionally, managing post-operative complications and follow-up care from a distance can be challenging, especially when returning to the patient's home country for ongoing medical support. This makes planning and preparation crucial steps for a successful medical tourism trip, ensuring patients make informed decisions and have a comfortable experience throughout the journey.

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Thorough research into accredited medical facilities, experienced providers and patient reviews it is possible to find a reputable destination that aligns with the patient's specific medical needs. But, one must also understand the legal and ethical considerations surrounding medical procedures in their chosen destination, including medical malpractice laws and patient rights. This is where planning and proactive actions come into play.

Arranging travel logistics, including flights, accommodation and transportation, plays a pivotal role in creating a seamless and stress-free medical tourism experience for patients and their accompanying companions. But with the right care providers, treatment plan, facilities and travel goals patients can achieve all their objectives.

One can often save a substantial amount of money, even when factoring in travel and accommodation expenses, compared to undergoing the same procedures in their home country. Further, medical tourism provides access to specialized treatments and medical expertise that may not be readily available in the patient's home country. This can be particularly beneficial for individuals seeking advanced or experimental procedures for specific medical conditions.

Depending on country of origin health travel additionally offers the advantage of shorter wait times and the option to combine necessary medical procedures with a leisurely, often luxurious, travel experience, offering a unique opportunity to recuperate in a new, exciting and relaxing environment.

Where To Go And What To Do

Unfortunately, medical care costs and the health insurance industry in the U.S. have pushed many Americans beyond their means . Although it can be frightening and uncertain to explore options outside the regulated system, each day more and more people are choosing - or are forced - to do so. And countries around the world are stepping up to meet the demand.

For example, countries like Thailand, Brazil and South Korea are renowned for their expertise in cosmetic surgery and attract a significant number of international patients seeking these procedures. For dental treatments many go to Mexico, Hungary or Costa Rica. Those looking for assistance with fertility often travel to Spain, India and the Czech Republic. In contrast, Germany, Malaysia and the United Arab Emirate are top of people’s lists for orthopedic surgeries.

No matter what one is seeking in their exploration abroad, it’s vital to remember that healing time, post-operative care and self-awareness are essential to recovery and safety. This is in addition to all the pre-travel research, validation and planning that must take place. Any kind of medical treatment outside the U.S. poses a risk to the traveler.

But with that knowledge one cannot deny that medical tourism offers a range of attractive services from cosmetic surgeries to complex procedures like organ transplants or cardiac surgeries that can save travelers from prohibitively high costs or long waiting times in their home countries. Destinations with advanced medical infrastructure and skilled health professionals can capitalize on this by promoting their services to international patients, providing not only medical expertise but also opportunities for travel and recuperation in attractive destinations. Although challenges such as varying quality standards, language barriers and post-operative care logistics remain valid concerns for those considering medical tourism, the barriers for seeking care outside the United States are reduced every day.

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What Do We Know About Medical Tourism? A Review of the Literature With Discussion of Its Implications for the UK National Health Service as an Example of a Public Health Care System

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Johanna Hanefeld, Richard Smith, Daniel Horsfall, Neil Lunt, What Do We Know About Medical Tourism? A Review of the Literature With Discussion of Its Implications for the UK National Health Service as an Example of a Public Health Care System, Journal of Travel Medicine , Volume 21, Issue 6, 1 November 2014, Pages 410–417, https://doi.org/10.1111/jtm.12147

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Medical tourism is a growing phenomenon. This review of the literature maps current knowledge and discusses findings with reference to the UK National Health Service (NHS).

Databases were systematically searched between September 2011 and March 2012 and 100 papers were selected for review.

The literature shows specific types of tourism depending on treatment, eg, dentistry, cosmetic, or fertility. Patient motivation is complex and while further research is needed, factors beyond cost, including availability and distance, are clearly important. The provision of medical tourism varies. Volume of patient travel, economic cost and benefit were established for 13 countries. It highlights contributions not only to recipient countries' economies but also to a possible growth in health systems' inequities. Evidence suggests that UK patients travel abroad to receive treatment, complications arise and are treated by the NHS, indicating costs from medical travel for originating health systems.

It demonstrates the importance of quality standards and holds lessons as the UK and other EU countries implement the EU Directive on cross‐border care. Lifting the private‐patient‐cap for NHS hospitals increases potential for growth in inbound medical tourism; yet no research exists on this. Research is required on volume, cost, patient motivation, industry, and on long‐term health outcomes in medical tourists.

Medical tourism—people traveling abroad with the expressed purpose of accessing medical treatment—is a growing phenomenon associated with globalization. 1 This includes cheaper and more widely available air travel and cross‐border communication through the Internet, which allows medical providers from one country to market themselves to patients in another. 2 At the same time, increased movement of health workers for education means doctors providing care in middle‐ and low‐income countries have in many cases the same qualifications as those in the high‐income countries in Western Europe and the United States. This has been coupled with an increase in foreign direct investment in health care providers in destination countries. 3 The increasing acceptance of health care portability is evident in Europe where greater patient mobility led to an EU Directive on cross‐border health care. 4 Together with a rise in out‐of‐pocket expenditures for health in many high‐income countries at a time of economic crisis, this conspires to form a perfect storm for medical tourism.

Yet, understanding of medical travel is limited. 5 Little is known as to which patients choose to travel and why, when others do not. Details of the volume of patient flows and resources spent remain uncertain. 3 This has hampered efforts to understand the economic costs and benefits to countries experiencing inflows and outflows of patients. Similarly, for the medical tourism industry, the role of private providers and brokers and marketing remain a “black box.” 1 While interest in the issue has grown over the past decade, effects on patients and health systems are not fully understood.

This review of the literature seeks to outline the current level of knowledge on medical tourism. Specifically, it aims to better understand (1) patient motivation, (2) the medical tourism industry, (3) volume of medical travel, and (4) effects of medical travel on originating health systems. Results are reported and discussed, paying specific attention to evidence of impact and lessons for the UK National Health Service (NHS) as an example of how medical tourism affects even universal public health systems. The authors conclude on current levels of knowledge, critical gaps, and future research priorities on medical travel.

The review was conducted between September 2011 and March 2012 as part of wider research, assessing implications of medical tourism on the UK NHS. Authors developed a search strategy based on the aims set out above. They adapted the strategy used by Smith and colleagues, 5 deemed particularly relevant as it presented a recent review of medical tourism albeit focused on bilateral tourism. It was amended to focus more broadly on medical tourism. Initial papers identified were reviewed for inclusion by J. H. and R. S. according to title and where this proved inconclusive according to the abstract. In line with research objectives, papers with general focus on medical tourism, published in English and German (languages read by authors), and focused on the NHS, were included. The following were excluded: papers on well‐being, news items, commentaries, laws or directives, and conference proceedings; papers focusing on stem cell tourism, travel for assisted suicide, and transplant tourism, given the distinct ethical issues. Three hundred and seventy‐four papers remained as initial sample. References of papers identified were further examined to ensure comprehensiveness and four additional papers were included. The initial selection of papers was then reviewed (abstract or full paper) applying these criteria and focusing more specifically on the aims of the review (as above). Two papers were not accessible and therefore excluded. 6,7 A final list of 100 papers was derived for inclusion in this review. This sample was tested based on the criteria by D. H. The literature search is summarized in the PRISMA flowchart (Figure 1 ).

PRISMA flow diagram for literature review medical tourism.

A rapidly expanding literature over the past 5 years with an “explosion” in 2010 and 2011 is reflected in the dates of publication of papers included in the review—73 were published in 2010 and 2011.

Types of Studies Reviewed

Papers included in the review were classified into the following categories: (1) those based on primary data collection (quantitative and qualitative): interviews, surveys, analysis of datasets collected and obtained by authors, or the calculation of revenue and tourist flows, and case studies of patients; (2) reviews: literature reviews of medical tourism websites or promotional materials; (3) analysis: papers which while drawing on secondary sources, provide substantive new insights or conceptualize it in a new way (a number of papers presented frameworks); and (4) overview articles which gave an introduction to the issue of medical tourism. The results are summarized in Figure 2 .

Type of study reviewed.

Geographic Focus

Papers were grouped according to the region the research investigated (see Figure 3 ), or global where they were general. Europe was the focus of 29 papers, 13 explicitly focus on the UK and a further 11 papers refer to either UK patients or the NHS, thus a total of 24 papers mentioned or focused on the UK.

Countries covered.

Literature reviewed suggests a regional dimension to medical tourism: Japanese companies send their employees to Thailand, 8 or to countries in the Gulf. 9,10 A study of medical tourists in Tunisia found that they were from neighboring countries. 11 Countries are known for specific areas of medicine: Singapore for high‐end procedures, 12 Thailand for cardiac, orthopedic, and gender reassignment surgery, 13 Eastern Europe for dental tourism, 14 and Spain for fertility treatment. 15 While some destinations were recognized as popular with UK patients, eg, Budapest for dental treatment, evidence from literature suggested that proximity alone does explain preference for one destination over another.

Motivation to Travel

Most papers made reference to push and pull factors determining patients' decision to travel. These relate to cost, perceived quality, familiarity, waiting lists or delays in treatment, or the lack of availability of certain treatments in the country of origin. 16 As this list demonstrates, these are often complex and dynamic, 6 and may vary according to the treatment for which a patient travels. Evidence suggests that patients traveling for cosmetic surgery may enjoy the anonymity of a destination far from their country of origin, 17 whereas migrants may prefer to return “home” to feel more comfortable with language or type of care provided. 18 These different factors allow for a division into different subsets of medical tourism.

A number of studies refer to a group of tourists classified as diaspora, documenting the return of recent migrants from India, China, Korea, and Mexico, to access treatment either not available or perceived to be not available in their country of residence, or perceived to be more effective. 9,18–20 While cost plays a part in explaining why, eg, Mexican immigrants to the United States return to Mexico for treatment, trust emerged as the key determining factor. This may partly be linked to language barriers, as a study of Korean immigrants to Australia suggests. 18

Reproductive or fertility travel is comparatively better documented than other forms of medical tourism. 15 Of the 16 papers identified for inclusion in this review, 6 papers focus on equity and ethical issues relating to fertility tourism, highlighting the rights of women in recipient countries and equity concerns where they may be compelled by poverty to donate eggs or act as surrogates. Four papers provide a general overview of the issues relating to fertility tourism. 7,21–23 A review of literature on cross‐border reproductive care 15 finds a consistent gap of empirical research—of 54 papers reviewed only 15 were based on empirical investigation. It noted the absence of evidence about patients' backgrounds and factors motivating their travel, and a gap in research on industry. A specific feature of fertility travel cited across papers reviewed is that availability of treatment (in this case gametes and surrogacy) is a factor in patient decision making. This includes the wish for timely and affordable treatment; in the UK it includes perceptions of the NHS as stressful and less effective. 6 Evidence also highlights health effects of fertility travel on patients, showing an increase in multiple births in a London hospital resulting from fertility treatment received abroad. 24 Combined, these studies show that there is an effect of fertility travel on the health system of the country from which medical tourists originate, in this case the NHS, and that regulation of availability and (perceived) quality of service are factors leading patients to travel.

Dental Tourism, Bariatric and Cosmetic Surgery

Other types of tourism are identifiable, including dental tourism. 25 Three papers 26,27,28 indicated this is likely to be an area of increasing travel by UK citizens, given the high cost of dentistry in the UK private sector, limited availability in the public sector, and lower cost in Eastern Europe. 27 A survey of dental clinics in Western Hungary and Budapest showed the largest group of patients (20.2%) originating from the UK with lower prices cited as main motivating factor. 28 Two papers focused in depth on issues surrounding bariatric surgery, exploring the ethical challenges and a case study of complications experienced by a US patient. 29,30 Papers by Birch and colleagues 31 and Miyagi and colleagues 32 focus on complications from cosmetic tourism in UK patients. Others reported that a poll conducted amongst the members of the UK public found that 92% would consider traveling abroad for cosmetic surgery. 33 The possibility of a large number of UK patients seeking cosmetic surgery abroad appears supported by a survey conducted by the British Association of Plastic, Reconstructive and Aesthetic Surgeons which found that 37% of respondents had seen patients in the NHS with complications from overseas surgery. 31

Risks for patients are covered in 29 papers. But surprisingly only 8 of these papers focus exclusively on the issue, and 10 studies mention longer‐term health outcomes of patients. Three describe the recent outbreak of NDM1 bacteria following patients receiving treatment in India, a fourth describes an outbreak of hepatitis B in a London hospital traced to a patient recently returned from surgery in India, pointing to potential risks of diaspora travel. 34–37

While papers tend to mention regulation, only two 38,39 review this more systematically. Both point to a vacuum in regulation, with no one specific regulator or quality assurance standard in place, but rather a number of private companies offering quality assurance through affiliation, creating a market for quality assurance rather than independent standards.

Effect on Countries

As summarized in Table 1 , 37 papers focused on the effects on recipient country's health system. Issues highlighted include the potential for medical tourism to retain or attract doctors in low‐ and middle‐income countries who may otherwise emigrate, thus preventing or reversing a brain drain, and generating foreign currency. 12 Also considered is the danger of creating a two‐tiered health system, resulting in increasing inequities in access and quality of health care for the local population in destination countries, 40,41 mainly as a result of a rise in price where public health services are not provided for free in recipient countries, and the potentially greater concentration of doctors in the private sector. 42

Issues covered

A total of 34 papers focused on potential effects on originating countries' health system. These referred to factors leading to patients' travel, including rise in costs. Papers documented patients returning with complications. 43 Seven papers specifically highlighted complications dealt with in the NHS. 31 Research highlighted the need for regulation, the lack of quality control of overseas providers, and the cost (potential or real) arising to the originating country from treating such complications. Two papers calculated the potential cost saving and benefits of sending patients abroad. 20,44 Overall, papers focusing on the effects on originating countries' health system concentrate mainly on perceived negative consequences.

Forty‐one papers reviewed focus at least partly on providers of medical tourism. A subset of 22 papers studied the medical tourism industry in a more focused way. These provide evidence of a highly diversified industry, with no clear typology emerging. For example, in Southeast Asia medical tourism is state‐led, with large hospitals targeting foreign patients. In other cases, such as cosmetic or dental tourism, intermediaries organize travel and treatment for patients. Examining the entire literature, it is clear that there is not a uniform model or chain for medical tourism.

Articles examining communication materials and websites highlight the limited information on follow‐up care and redress in case of complications. 2 They point to an emphasis on testimonies by patients, rather than formal accreditation or qualification of clinicians, a focus on tourism aspects of the destination and on trust—offering services “as good as at home.” 41 These are in addition to low cost used as a selling point. Studies focusing on medical tourism facilitators identify these as a heterogeneous group. 45,46

Papers reviewed mention individual hospitals or a medical tourism provider at the country level to give a flavor of the industry. 8,45 However, only four papers 47–50 report findings of a more systematic assessment of the industry, including focus on the strong state role in the development of medical tourism in Hong Kong, Malaysia, and Singapore, analyzing how these countries have fostered medical tourism, including through tax incentives. Singapore, for example, made a conscious decision to focus on the high‐end complex procedures to have a competitive advantage. 47

Number of People Traveling

The actual volume in flow of medical patients was referred to in many papers but investigated in few 10,11,28,42,51–54 ; all papers provided further estimates or trends. Most papers cited similar figures of patient flows, but often sources were not accessible or based on media reports or other academic papers, which in turn quoted inaccessible sources. Seven papers referred directly to a report by Deloitte Consultancy, and six to McKinsey; the exact ways in which these were calculated remain unclear. Even where these were not referenced, the figures cited suggest these two reports as a source. For example, one paper 33 cites The Economist stating 750,000 US patients traveling abroad for treatment in 2007. This is the figure provided in the report from Deloitte consultancy in 2008.

Eight papers reviewed had either generated or collected own data on patient flows. Only three papers had calculated the total volume of medical tourism for 13 countries, including actual cost and effect on recipient country's health systems. NaRanong and colleagues calculate the contribution of medical tourism to Thai GDP (0.4%), while medical tourists with their higher purchasing power are likely to increase the cost of health services and lessen access in the public sector. 42 This contrasts with Lautier's findings which highlight that export of health services in Tunisia simply makes use of excess capacity in the country's private sector. 11 Siddiqi's 11‐country study in the Middle East showed complex flows within the region. 10 Findings across the different studies suggest that the impact on recipient country's health system depends on the context and capacity, but that there is likely to be a small contribution to overall GDP. How income gained from medical tourism is in turn invested has not been studied.

This review of the literature provides the most comprehensive overview of knowledge on medical tourism to date. The main limitation of the studies is the focus on English (and German) literature, and as set out in the search strategy a narrow definition focused on medical tourism rather than on the inclusion of broader health and well‐being travel literature. This was essential to maintain feasibility of the review, given the large number of papers published.

Main Findings: What We Can Learn From the Literature on Medical Tourism

The literature reviewed clearly indicates that medical tourism is no unified phenomenon. Sub‐types of travel, such as diaspora or fertility travel, travel for bariatric surgery, dental, or cosmetic work, were evident from the review. Decisions by patients to travel are not simply guided by cost considerations or even clinical outcomes. Rather, the literature points to a complex matrix of perceptions of care, waiting times, cost, and others, depending on the type of treatment sought. For example, trust appeared as a motivation for diaspora travelers but not for dental tourists, cost or availability in cosmetic procedures, and regulation in the case of fertility. However, lack of information about patients' characteristics limits deeper understanding of push and pull factors. With very few exceptions, 16,6 the absence of in‐depth interviews with more than one or two patients poses the greatest weakness of the literature reviewed and opens the potential to bias within studies reviewed.

A diverse picture of the medical tourism industry emerges. Some countries have become known for excellence in certain areas of treatment such as Spain for fertility or Hungary or Poland for dental treatment. Yet, this did not appear the case for all medical tourism destinations, eg, while India clearly is a destination for medical tourists, this is for a whole broad spectrum of treatments.

Few studies were able to quantify patient flows and calculate effect on recipient health systems and the economy. Evidence does suggest that the inflow of medical travelers can increase inequities within the recipient country health systems 42 but that depends on the context. 11

Perhaps the most surprising finding was the increase in papers presenting primary research—a shortfall or gap that had been noted by the earlier literature reviews. 5,55,56 The recent publication date of many confirms the increase in research of medical travel.

Implications for the UK NHS

Evidence demonstrates that UK patients travel abroad to receive treatment and return with complications or infections that require follow‐up in the public sector. Based on papers reviewed, cosmetic procedures appear an area of growth for medical travel by UK patients and likely to result in cost to the NHS due to resulting complications, but costs resulting from other types of travel, including fertility and dental tourism, are evident. While complications experienced by UK medical tourists were reported, these were not compared to rates of complications for similar procedures undertaken in the UK, which would have further strengthened such research. However, in individual cases of patients described, these often focused on cases so unusual or extreme that the comparison or lack thereof to the UK was implicit. Case studies also underlined the challenges relating to information and communication, with often limited patient records available for returning medical tourists.

Despite a number of studies focusing on UK patients, overall the evidence presented underlines the need for further research to ascertain the potential impact and costs arising from medical tourism on the NHS. Only one study 42 estimated actual costs arising from complications of returning medical tourists and this was based on a small sample of patients. We found no research calculating the potential savings arising from UK patients traveling abroad for treatment. While research on risks associated with medical travel proved limited, the documented NDM1 outbreak in the UK highlighted the potential of infections that may result from medical travel. 36

Research focused on communication materials and websites highlights the lack of credible information about qualification and an absence of regulation and legal safeguards. This lack of clear information paired with the increasing willingness to travel of the UK public makes a greater numbers of complications a likely scenario.

Considering findings from the literature focused on the UK, these are particularly salient for the NHS at a time of reform. The lifting of the cap on private patients increases the potential for greater earning and marketing of NHS hospitals to foreign private patients. In this context, the lack of evidence on incoming tourists limits the possibility of informed decision making. Moreover, findings about complications of returning medical tourists, which highlight the need of quality control and continuity of care, are likely to mirror some of the policy challenges that will become evident in the implementation of the EU Directive on cross‐border health care implemented from 2013. In this context, it seems opportune for policymakers within the EU to further explore lessons from medical travel.

This review of the literature highlights a growing trend in medical travel that is likely to continue and have an increasing impact on patients, and originating and recipient health systems. It shows a diverse industry and different types of tourism depending on treatment, each with a complex set of patient motivation. Evidence also highlights complications experienced by patients, resulting in health problems and costs to originating health systems. While the review shows an increase in research over the past 2 years, it also clearly identifies limits to current knowledge and areas where the need for further research is evident:

A lack of information about patients' background and numbers of patients traveling abroad for treatment persists. The lack of data also restricts analysis about possible cost and benefits of medical travel.

Limited insights on why some patients travel when others do not.

Little is known about the industry beyond reviews of information materials and websites. Further research is needed to better understand how the sector operates, to ultimately understand impact on health services and outcomes of medical travelers.

Moreover, there is an absence of research examining the long‐term health outcomes of medical tourists when compared to patients treated within their country of residence. As a result, evidence on the comparative effect of treatment received abroad is lacking. Further qualitative and quantitative research beyond immediate clinical outcomes is needed to truly understand the effect of medical travel on patients, and its cost to the health system.

As medical tourism is set to rise, addressing these gaps in the evidence is urgently required to avoid potential harm to patients and health systems by enabling more informed policymaking on aspects of medical tourism.

This is a hospital in Hualien, Taiwan, which has two prominent advertising boards on its front facade promoting the hospital. Taiwan is a hot spot for medical tourism in Asia, attracting thousands of medical tourists mostly from China. Photo Credit: Eric Caumes .

The authors wish to acknowledge the members of the study advisory committee for their input into the review. This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number HSR 09/2001/21). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS, or the Department of Health.

The authors state that they have no conflicts of interest to declare.

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Medical tourism and national health care systems: an institutionalist research agenda

Daniel béland.

Johnson Shoyama Graduate School of Public Policy, 101 Diefenbaker Place, Saskatoon, SK S7N 5B8 Canada

Amy Zarzeczny

Although a growing body of literature has emerged to study medical tourism and address the policy challenges it creates for national health care systems, the comparative scholarship on the topic remains too limited in scope. In this article, we draw on the existing literature to discuss a comparative research agenda on medical tourism that stresses the multifaceted relationship between medical tourism and the institutional characteristics of national health care systems. On the one hand, we claim that such characteristics shape the demand for medical tourism in each country. On the other hand, the institutional characteristics of each national health care system can shape the very nature of the impact of medical tourism on that particular country. Using the examples of Canada and the United States, this article formulates a systematic institutionalist research agenda to explore these two related sides of the medical tourism-health care system nexus with a view to informing future policy work in this field.

In this era of globalized medicine, when international travel and access to online health information are readily accessible, medical tourism is an important issue both for national health care systems and from a global health perspective [ 1 – 3 ]. Patients from countries around the world are exercising increasing degrees of autonomy over their health care options by obtaining information from sources other than their regular health care providers and, in some cases, by electing to pursue care alternatives outside their domestic medical system. Medical tourism is a broad and inclusive term that captures a wide range of diverse activities [ 3 ]. It has been defined as “the practice of travelling to another country with the purpose of obtaining health care (elective surgery, dental treatment, reproductive treatment, organ transplantation, medical checkups, etc.),” and is generally distinguished from both care sought for unplanned medical emergencies that occur abroad and from formal bi-lateral medical trade agreements [ 4 , 5 ]. Individual motivations for engaging in medical tourism vary widely and may include imperatives such as avoiding wait times, reducing costs, improving quality, and accessing treatments not available or legal in the home jurisdiction, or for which the individual is not eligible [ 5 – 8 ].

While medical tourism is far from new, shifting patient flow patterns and a growing recognition of the complex ethical, social, economic, and political issues it raises are underscoring renewed efforts to understand this phenomenon and its future [ 3 , 9 , 10 ]. Some of the current attention focused on medical tourism concerns its implications and potential risks for individual patients and health care systems [ 11 – 13 ]. Medical tourism impacts both importing and exporting health care systems, albeit in different ways [ 14 ]. Various terms exist to describe trade in health services [ 15 ]. For the purpose of this discussion, we will use importing or destination to describe systems whereby patients come from other jurisdictions to receive care, and exporting to describe the departure of individuals from their domestic medical system to pursue health services elsewhere. Recognizing that there are important knowledge gaps and a need for definitional clarity and further empirical work to understand the effects of medical tourism on the countries involved [ 16 ], concerns for importing or destination systems include, though are not limited to, ethical questions about inequity of access for local residents versus high paying visitors and about the “brain drain” of local talent into private, for-profit organizations focused on non-resident care [ 15 ]. Conversely, the issues exporting systems face often revolve around implications for domestic health care providers, the potential for patients to avoid domestic wait lists, and the costs of follow-up care upon patients’ return [ 12 ]. For example, research from Alberta, Canada, suggests that the financial costs associated with treating complications from medical tourism for bariatric surgery are substantial, and complication rates are considerably higher than similar surgeries conducted in Alberta (42.2–56.1% versus 12.3% locally) [ 6 ].

Although a growing body of literature has emerged to study medical tourism and address the policy challenges it creates for health systems [ 3 , 16 ], the comparative scholarship on medical tourism remains too limited in scope, a remark that should not hide the existence of a number of recent comparative studies in the field [ 17 – 19 ]. These studies demonstrate that comparative research is helpful in identifying both the unique and the most common policy challenges facing each country [ 20 ] and can, if done appropriately, offer learning opportunities [ 21 ]. Indeed, this process can facilitate policy learning (related terms include lesson drawing, policy transfer, diffusion, and convergence) whereby ideas, policies, or practices (e.g., regulatory tools) in one jurisdiction inform or shape those in another [ 22 , 23 ].

With a view to ultimately informing policy related to medical tourism, this article discusses the value of a comparative research agenda about medical tourism that stresses the multifaceted relationship between medical tourism and the institutional characteristics of national health care systems. On the one hand, these characteristics may shape the content of the demand for medical tourism among the citizens of a particular country [ 24 ]. From this perspective, as argued, existing typologies of health care systems can shed light on the varying features of the demand for medical tourism across countries. In other words, different types of health care systems are likely to produce different configurations of demand for medical tourism, which influences the range of policy instruments available to governments and other actors seeking to influence decision-making and behavior within their particular context [ 25 ]. On the other hand, the institutional characteristics of each national health care system may also shape the very nature of the impact of medical tourism on that system. Accordingly, the institutional characteristics of health care systems, such as insurance structures [ 26 ], may impact both citizens’ demand for medical tourism and the ways in which medical tourism affects each country. Obtaining a better understanding of these relationships may inform new ways of thinking about both the challenges and opportunities medical tourism presents. As medical tourism markets continue to grow and diversify, and as domestic health care systems increasingly feel the stress of limited resources, this kind of work will be critical to support policymakers and health system leaders in their efforts to mitigate the potential harms of medical tourism while, at the same time, responding to the needs of the citizens they serve [ 3 ].

Using the examples of Canada and the United States (US), this article proposes the use of an institutionalist research agenda to explore these two related sides of the medical tourism-health care system nexus as a central element of future policy strategies. We first take a comparative perspective on medical tourism and present what we see as key aspects of the issue from a policy perspective. Drawing on current evidence and leading literature in the field, we highlight ways in which national health care systems shape the demand for medical tourism and then, in turn, how medical tourism impacts national health care systems. From this discussion, we identify four key lines of enquiry that we suggest are of critical importance in the medical tourism policy landscape and propose an agenda for future comparative research on medical tourism and national health care systems that could play an important role in informing future policy decisions in this area.

Medical tourism in comparative perspective

Although gathering robust data on the magnitude of medical tourism continues to be a challenge and more empirical work in this area is needed [ 3 , 5 , 10 , 12 ], a strong body of literature addresses different aspects of the issue. For example, research is improving understandings of how medical tourism impacts destination and departure jurisdictions [ 16 , 27 ], affects relationships with domestic health care providers [ 28 ], relates to economic factors including health system costs [ 29 ], and impacts clinical outcomes for patients [ 30 ], among other important lines of enquiry. However, much of this valuable scholarship focuses on particular forms of medical tourism in specific contexts (bariatric surgery [ 31 ], dental care [ 32 ], reproductive services [ 33 ], etc.) or on the policy and health system implications for individual jurisdictions [ 13 ]. There is an increasing amount of comparative research exploring how different features of health care systems may in some cases help drive demand for medical tourism and in other cases constrain it (i.e., push/pull factors), and how they relate to the impact of medical tourism [ 24 ], but more work remains to be done in this important area [ 4 , 10 ]. The potential value of data on the impact of medical tourism in one jurisdiction to structurally- similar systems (e.g., other universal public health care systems) has already been recognized [ 34 ]; we agree and suggest that going further with an associated analysis considering the role of their institutional features is critical. This approach is particularly valuable from a policy perspective, especially when it comes to maximizing opportunities for policy learning from other jurisdictions and to identifying and evaluating the respective strengths and limitations of different policy options for decision-makers seeking to, for example, discourage particular forms of medical tourism (e.g., organ transplant tourism [ 35 ]).

The governance of medical tourism in its various forms is complex and highly fragmented given its broad range of influential stakeholders (both state and non-state, individual and institutional), its international market-based nature, and its engagement of vastly different and often competing priorities and interests (e.g., profit-driven, patient care, autonomy, ethics, etc.). As a result, policy makers and health system leaders face considerable challenges when it comes to seeking to influence medical tourism markets, whether by encouraging their development or restricting access to them. Obtaining a better understanding of the institutional forces that shape the demand for, and impact of, medical tourism—and connecting those forces to the policy context—may help identify a broader range of tools and options decision- makers can employ to achieve their particular objectives with respect to medical tourism.

Looking at Canada and the US is an appropriate starting point for this comparative work and we use this comparison to ground our analysis of the value of an institutional research agenda as a policy strategy for addressing potential concerns and opportunities associated with medical tourism. While these neighboring countries are similar in many ways, there are dramatic differences in important institutional features of their respective health care systems, including funding and delivery models. The US is both an established importer and exporter of medical tourists, the latter supported in part by insurers offering medical tourism coverage in an effort to reduce the high costs associated with domestic health care services [ 11 , 36 ]. In contrast, the structure of Canada’s largely publicly-funded, single-payer medical system limits foreign access to non-emergent care and makes it challenging for Canadians to be reimbursed for care received abroad via medical tourism [ 7 ]. It also makes the current involvement of Canadians in medical tourism [ 37 ] a public policy issue because of its implications for the public purse.

How national health care systems shape demand for medical tourism

Because health care systems can be understood as relatively stable institutional settings that shape human behavior [ 38 , 39 ], their features are likely to impact the demand for medical tourism in a particular country or even, in the case of decentralized health care systems subject to considerable regional variation, in a particular region. Health care systems can vary greatly from one country to the next, or even from one region to the next within the same country. Accordingly, what citizens might be looking for when they seek medical treatment abroad is likely to fluctuate based on the nature of health care coverage, financing, and regulation they have at home. Research about these and other drivers is growing but important gaps in knowledge remain [ 5 ]. In other words, alongside factors like geographical mobility and travel costs, the institutional configurations of health care systems likely shape, at least in part, the types of services people are looking for based on what health services they can access in their home country, with what degree of quality and timeliness, and at what cost [ 24 ].

A comparison between Canada and the US is illustrative here. Starting with the Canadian context, universal coverage has existed in Canada since the early 1970s [ 40 , 41 ]. Under this framework, regardless of the province or territory in which they live, Canadian citizens and permanent residents are entitled to medically necessary health care services with no user fees, which are strictly prohibited under the 1984 Canada Health Act (CHA). Yet, although the CHA mandates comprehensive coverage for “all insured health services provided by hospitals, medical practitioners or dentists,” many services do not fall under this umbrella and the Canadian health care system has long waiting lists for many non-emergency surgeries like hip replacement [ 40 , 42 ]. Wait times vary from province to province but they are a source of frustration for many Canadians, some of whom elect to go abroad to get their non-emergency procedure done faster, even if they have to pay for it themselves, instead of relying on the slower public system back home [ 7 ]. Gaps in coverage within the single-payer system in important areas such as prescription drugs [ 43 ] and dentistry [ 44 ] also sometimes push Canadian citizens and permanent residents to go elsewhere for care to reduce costs. There are also a wide variety of medical treatments and health-related interventions offered in private markets that are either not available or not publicly funded in Canada. There are a variety of reasons for this lack of public funding, including those related to evidence (or, more precisely, the lack thereof) regarding safety and efficacy. For example, there is a large international market for unproven stem cell interventions that are not part of the approved standard of care in Canada or available in the publicly funded health care system [ 45 ]. Therefore, key motivations underlying the pursuit of Canadian medical tourism often relate to a desire to access care faster, to reduce out of pocket costs for care not covered by provincial health insurance, and/or to access options that are not available in Canada [ 7 ].

In the US healthcare system, where about 9% of the population remains uninsured despite the enactment of the Affordable Care Act (ACA) in 2010 [ 46 ], people who lack insurance coverage but who face a medical need might go abroad to seek cheaper treatment. In fact, the high cost of care in the US has been recognized as a major factor pushing Americans to seek care at lower cost outside the US, an option that is facilitated by health care globalization [ 2 ]. For example, there is research documenting the strong market in the Mexican border city of Los Algodones for Americans seeking dentistry, optometrist, and pharmacy services [ 47 ]. Others may be motivated to return to systems with which they are more familiar, as is the case with the Mexican diaspora [ 24 ]. In the US, in contrast to Canada where universal coverage prevails, the lack of health care coverage is likely to be a key factor driving the demand for medical tourism. At the same time, waiting times are much less likely to drive the demand for medical tourism in the US, where waiting lists are less of an issue [ 40 ].

These brief remarks highlight how key institutional features in both Canada and the US shape patterns in the demand for medical tourism in these two countries, creating both similarities and differences between them. At the same time, regional differences in health system institutions within the two countries can also shape the demand for medical tourism within their borders. For instance, in states like Texas, where elected officials have thus far refused to expand Medicaid as part of the ACA [ 48 ], more people live without health care coverage than elsewhere (about 18% of the population as of March 2016 [ 49 ]), which may push them to look to Mexico for cheaper health care. Here the institutional characteristics of a state’s health care system and the geographical proximity to Mexico, coupled with the presence of a large population of Mexican descent who speak Spanish, are likely to favor cost-saving medical tourism from Texas to Mexico. This example highlights how geographical and even ethno-cultural factors can shape medical tourism alongside and even in combination with the institutional features of a particular health care system. This is also the case when we deal with issues such as dental care and cosmetic surgeries, which are not covered by many US public and private insurance plans [ 50 ].

How medical tourism impacts national health care systems

At the most general level, existing national and sub-national institutions may mediate the impact on particular countries of transnational processes stemming from globalization [ 20 , 51 ]. This general remark also applies to global medical tourism, which is unlikely to affect all national health care systems in the same way. Put bluntly, systems will react differently to external pressures, based in part on their own institutional characteristics. Those same institutional characteristics also form part of the policy matrix that shapes the options available to decision makers.

There are two central aspects to this story. First, we can look at how domestic health care institutions are specifically impacted by inbound medical tourism (i.e., destination countries at the receiving end of medical tourism). Research suggests that the way in which health care systems cope with foreign users, and what impact those foreign users have on the system, will vary according to the institutional characteristics of that system [ 16 ]. For instance, countries that attract many medical tourists could witness price increases and the diversion of services away from their less-fortunate citizens [ 1 ]. At the same time, the institutional features of national health care systems can explain why some countries attract more medical tourists than others. The comparison between Canada and the US is particularly revealing here. On the one hand, although some provinces have considered alternate approaches that would encourage inbound medical tourism as a source of revenue generation [ 52 ], at present the limited scope of private health care in Canada restricts the availability of medical tourism opportunities for wealthy foreigners seeking treatments. On the other hand, the large scope of private health care in the US makes that country an obvious target for wealthy medical tourists who can afford its high medical costs.

Second, and more important for this article, national health care institutions may also shape the way in which each country is affected by outbound medical tourism. For example, in a single-payer health care system such as Canada’s, both routine follow-up care and complications resulting from medical acts performed abroad are typically dealt with within the public system, engendering direct costs to taxpayers and potentially impacting access for others in the system (i.e., if physicians’ time is diverted to attend to emergent issues) [ 6 ]. The extent of these concerns varies depending on the urgency of the issue and whether it falls within hospital and physician services covered by the universal system (versus, for example, dental care where public coverage is more limited) [ 52 ]. By comparison, within the fragmented public-private US health care system, public programs may only absorb a fraction of the costs of complications related to outbound medical tourism, thus reducing their direct negative impact on taxpayers, whereas private insurance companies or individuals themselves might bear the majority of these costs.

The potential savings for outbound countries medical tourism generates are also likely to depend on the institutional features of each national or sub-national health care system [ 16 ]. In Canada, for instance, people who decide to go abroad for non-emergency surgeries might help reduce the length of waiting lists, although this positive impact might be limited by the fact that some of these surgeries are simply not available in Canada or, at least, not available to the individuals who seek treatments abroad (e.g., because of their age or health status). Because waiting lists are much less of an issue in the US [ 40 ], this potential benefit of medical tourism to domestic health care systems may be less relevant there.

Conversely, the prospect of affordable medical tourism may convince people in the US who do not have access to Medicaid, Medicare, or employer-based coverage that they do not need coverage at all, because they can always go abroad and save money should they need medical treatment. In this context, global medical tourism could interact with the question of whether people will seek coverage or not. At the same time, to save money, “US companies, such as Anthem Blue Cross and Blue Shield and United Group Programs, are now exploring the idea of including medical tourism as a part of their coverage,” a situation that could increase their administrative burden and create further complications along the road [ 53 ].

Policy implications

Our aim with the preceding high-level overview was to draw on existing knowledge to highlight not only that national health care institutions may shape the demand for medical tourism in a particular country or region, but also that the consequences of such tourism for national health care systems are likely similarly mediated by the institutional features of these systems. These connections have a number of important potential implications for health system governance of medical tourism and, more specifically, for the options available to policy makers seeking particular objectives. For example, depending on the jurisdiction, efforts to reduce demand for medical tourism could include a range of options such as investing resources targeted at reducing domestic wait times, expanding public health insurance, limiting public coverage for follow-up care needs, or educating the public about the potential risks associated with medical tourism [ 2 ], among other options. Conversely, efforts to encourage the development of a medical tourism industry within a particular jurisdiction might involve regulatory change to expand options for private system offerings and targeted marketing campaigns, again among other possibilities [ 5 , 17 ].

In fact, it has long been recognized the governments have a variety of tools or policy levers at their disposal when they seek to influence behavior [ 54 ]. Identifying which tool (or combination of tools) is likely to be most effective in a particular set of circumstances, such as medical tourism, requires a nuanced understanding of relevant institutional characteristics and situational factors. Accordingly, we propose that a comparative research agenda should be a key element of future analysis and decision-making efforts in this field. Such an agenda would not only help empirically test the above hypotheses about the institutional-medical tourism nexus, it could also help facilitate lesson drawing between jurisdictions that have attempted different approaches by helping pinpoint salient commonalities and points of difference between the systems that might initially explain, and ideally ultimately even predict, the likely results of particular policy initiatives.

Research agenda

We propose a comparative research agenda that aims to explore the relationship between medical tourism and key institutional features of national health care systems. Although some aspects of our research agenda are already present in the existing literature, we think studying these elements together and with a comparative policy lens would be of tremendous value to health system decision -makers seeking to navigate different objectives including, for example, avoiding “brain drain” from public to private health care, minimizing added costs to publicly funded systems, protecting vulnerable individuals, and facilitating patient autonomy.

Drawing on our review of the health care systems in Canada and the US, we have identified three key institutional features that we suggest are particularly relevant to medical tourism and its broader policy context. These key features are health care funding models, delivery structures (e.g., public/private mix, provider payment models, role of user choice, and competition between providers), and governance systems (e.g., location of authority, health care provider regulation, liability systems). Future empirical research may identify other more salient features and certainly an iterative approach may be valuable. Nonetheless, we suggest that these features would provide a useful starting point for the next step, which we propose be an exploration of how these institutional features relate to the following areas:

• (i) Patient flow patterns – e.g., inbound versus outbound, treatment destinations, types of treatment sought.
• (ii) Patient motivations – e.g., cost reduction, wait list avoidance, pursuit of quality, circumvention tourism.
• (iii) Health system interactions – e.g., costs and options for follow-up treatment, roles of domestic health care professionals.
• (iv) Existing policy levers – e.g., public and private insurance structures, incentive schemes, information campaigns, regulation.

These four areas are not intended to serve as a comprehensive list of all relevant lines of enquiry. However, they present a valuable starting point, particularly because of their relevance to policy instrument selection processes. Having said that, and although it is beyond the scope of this piece to go further than laying a foundation for this proposed research agenda, we suggest that future research take a broad and scoping approach to draw on existing data and information and, where possible, conduct new empirical work addressing these critical areas. With a view to identifying patterns and generating hypotheses, researchers will likely need to continually refine the initial assumptions, outlined above, about the relationships between different institutional features and aspects of medical tourism. Doing so will require careful thought regarding the selection of an appropriate scientific paradigm, with a view to research validity and reliability [ 55 ].

We also anticipate that end-users and important stakeholders, including elected officials, civil servants, health care providers, and patients and families, would have an important contribution to make to the research design and with respect to interpreting the findings, particularly as they relate to the identification and evaluation of policy options. One important limitation in this type of work will relate to data availability. We expect that comparative work of this nature and any future empirical analyses it includes will highlight gaps in knowledge and potentially trigger future research agendas. Overall, the research envisioned here should complement and augment ongoing efforts in the field to improve understandings of important factors including patient flows, expenditure trends, system impacts, and individual decision-making determinants, among others.

Conclusions

This article discussed the relationship between medical tourism and key institutional aspects of national health care systems with a view to highlighting the value in a comparative research agenda focused on identifying and evaluating policy options. First, we argued that these characteristics directly affect the demand for medical tourism in each country. Second, we suggested that such institutional characteristics shape the actual impact of medical tourism on that particular country . This discussion led to the formulation of an institutionalist research agenda about medical tourism. It is our hope that this proposed agenda will trigger discussion and debate, help develop future research, and inform new ways of thinking about medical tourism in the global landscape. Medical tourism is a complex phenomenon and we suggest that applying a comparative, institutional lens will shed new light on its drivers, constraints, and impacts and, in so doing, ultimately help inform policy development in this area.

Acknowledgements

The authors thank Rachel Hatcher for the copy-editing support and anonymous reviewers for their helpful suggestions. DB acknowledges support from the Canada Research Chairs Program, and AZ funding from the Canadian National Transplant Research Program.

Authors’ contributions

DB wrote the theoretical paragraphs and AZ the paragraphs focusing more directly on medical tourism. Both authors read and approved the final manuscript.

Authors information

DB has published extensively on institutionalism and on health care systems, and AZ has published extensively on health law and policy issues, including topics related to medical tourism.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Daniel Béland, Phone: 306 966-1272, Email: [email protected] .

Amy Zarzeczny, Email: [email protected] .

The Rise of Medical Tourism

• Medical tourism is a new term but not a new idea. Patients have long traveled in search of better care. Today, constraints and long waiting lists at home, as well as the ease of global travel, make medical tourism more appealing.
• Superior medical schools, a low cost of living, family preferences, and the barriers to foreign accreditation mean that Indian doctors may prefer to work in India rather than elsewhere.
• The medical services industry is evolving quickly. Khanna expects to see dynamics in China similar to those in India and in other parts of Southeast Asia.

What used to be rare is now commonplace: traveling abroad to receive medical treatment, and to a developing country at that.

So-called medical tourism is on the rise for everything from cardiac care to plastic surgery to hip and knee replacements. As a recent Harvard Business School case study describes, the globalization of health care also provides a fascinating angle on globalization generally and is of great interest to corporate strategists.

"Apollo Hospitals—First-World Health Care at Emerging-Market Prices" explores how Dr. Prathap C. Reddy, a cardiologist, opened India's first for-profit hospital in the southern city of Chennai in 1983. Today the Apollo Hospitals Group manages more than 30 hospitals and treats patients from many different countries, according to the case. Tarun Khanna, a Harvard Business School professor specializing in global strategy, coauthored the case with professor Felix Oberholzer-Gee and Carin-Isabel Knoop, executive director of the HBS Global Research Group.

The medical services industry hasn't been global historically but is becoming so now, says Khanna. There are several reasons that globalization can manifest itself in this industry:

• Patients with resources can easily go where care is provided. "Historically doctors moved from Africa and India to London and New York to provide care. Now we are basically flipping it around and saying, 'Why don't the patients move? It's not as difficult as it used to be.' "
• High quality care, state-of-the-art facilities, and skilled doctors are available in many parts of the world, including in developing countries.
• Auxiliary health-care providers such as nurses go where care is needed. Filipino nurses provide an example, perhaps.

"From a strategic point of view you can move the output or the input," explains Khanna. "Applying this idea to human health care sounds a bit crude, but the output is the patient, the input is the doctor. We used to move the input around, and make doctors go to new locations outside their country of origin. But in many instances it might be more efficient to move the patients to where the doctors are as long as we are not compromising the health care of the patients."

Khanna recently sat down with HBS Working Knowledge to discuss the globalization of health care in the context of India and Apollo Hospitals.

Q: What led you to research and write this case?

A: I came across the company during some of my travels in South India. It was so unusual to find "first-world health care at emerging-market prices" as the case says. Often better care—by which I mean technologically first-rate care with far greater "customer service" and accessibility—is available in parts of India than in my neighborhood in Boston.

Felix Oberholzer-Gee, Carin-Isabel Knoop, and I decided to write the case just because health care is such a primal thing—it arouses a lot of emotions and insecurities. After all, it's one's life and health that one is dealing with. And the prospect of entrusting health care to a developing country had a pedagogical "shock value," too.

“A lot of entrusting medical care to different locations is about a psychological fear of the unknown.”

For a long time I've been interested in studying world-class companies in developing countries. For me and my colleague Krishna Palepu, India has served as an intellectual laboratory. So I've always been anecdotally aware of the possibility that people could benefit from India's soft assets, so to speak. In this case that means skilled health-care professionals—doctors, nurses, technicians, etc. The fact that the cost of living is so much lower in India means that the same service is possible at a fraction of the price elsewhere. For most routine issues, as well as invasive procedures that are routine, I see no reason why more people would not go to India.

Q: The term "medical tourism" is fairly new, but how new is the phenomenon of going overseas for medical treatment?

A: When I was a college student in the United States I discovered that dental care was very expensive. Even back then, many of my international classmates essentially engaged in medical tourism—they would simply bundle up the care they needed, make a trip to their country of origin, and take care of it. India was certainly one of those countries I was aware of due to my own personal background.

We didn't have a term for medical tourism, but in a sense it was all around us. It took a set of entrepreneurs to begin to make it happen. By the late 1990s, when I was teaching courses in global strategy, some of my Thai, Malaysian, and Singaporean students were perfectly aware of the term, because these countries of Southeast Asia already had very good tertiary-care hospitals.

Medical tourism usually refers to the idea of middle-class or wealthy individuals going abroad in search of effective, low-cost treatment. But there is another dimension of medical tourism that is not called medical tourism. Narayana Hrudayalaya, a heart hospital in India [see article ], treats indigent people from neighboring countries—Pakistan, Bangladesh, Burma—who suffer from heart disease and can't afford surgery. Treatment for them is free. The hospital is able to provide it because surgical methods are efficient enough that pro bono care doesn't hurt the bottom line.

Q: Why is India gaining prominence for medical tourism?

A: India is encouragingly less "scary" now. I think a lot of entrusting medical care to different locations is about a psychological fear of the unknown. An important strategic challenge for developing-country hospitals is to reduce the psychological fear.

In addition, India is rising because there's just a ton of very well-trained doctors just like there is a ton of well-trained engineers. Over the decades, many engineers have relocated to Silicon Valley, but for doctors it remains the case that barriers to entering the U.S. medical profession are still large.

In India, the same depth of pool of engineering and mathematical talent for software, offshoring, and outsourcing is there for medicine, too. In the 1950s and '60s, the Indian government invested a lot in tertiary education. By now there is at least a small handful of medical institutes that are really first-rate, and the doctors they produce are extremely well trained.

When my colleagues and I began to research this case, some other countries had already stolen a march on India—Singapore, and Malaysia in particular, and areas of the Middle East—yet there was still a lot of room for growth. India has had a unique competitive advantage as a result of this deeper pool of technical knowledge and the fact that it is simply a large country and has more people.

I would expect to see dynamics in China similar to what is happening in other parts of Southeast Asia. China frequently makes the news for stem cell therapies that are not allowed in the West. So while I think India has some unique features it is not strictly unique.

Q: What are the recruiting challenges for staffing these hospitals with doctors?

A: In the case, Dr. Prathap C. Reddy, the founder and chairman of Apollo Hospitals, says he spent a lot of time studying specialists almost like an executive search firm would, to identify their pleasure points and pain points in terms of building a successful practice in the West and potentially in India. He wanted to understand not just medical training and specialties but also family circumstances, since it is always a family decision to relocate.

In the past, Indian doctors left India so they could multiply their incomes. But now we're seeing the reversal of that. India is booming so why leave, and by the way, patients can go there.

As the case describes, accreditation is a pretty huge barrier for doctors going abroad. Just as Dr. Reddy had to spend time convincing the Indian government that the idea of medical tourism was a good use of national resources, when we wrote the case he was in the process of convincing various countries that similar development made sense. So it's a tricky public policy issue.

Q: How does growth in private hospitals affect public health care in India?

A: There is an assumption in the view often expressed in the media in India and Europe, for instance, that when private hospitals in India provide care to heart patients from England, the hospitals are somehow taking care away from poor people in India. The assumption seems to be that if medical tourism was banned, the doctors in question who were catering to wealthy patients would suddenly, as a practical matter, move to a village. It takes a different set of individuals, a different set of infrastructure circumstances to create that scenario. We need good scholarship to verify the idea that there is a potential substitution between caring for sick people from England and providing medication for malaria in an Indian village. I'm not aware of such analysis yet.

My guess is that the bulk of India's problem is primary health, and has nothing to do with tertiary care. And the primary health problem is not going to be addressed by a private hospital for the most part anyway. These are almost different industries. If someone analyzes the landscape and discovers that there is substitution between care, then there is a real public policy issue that needs to be debated.

Q: How are marketing strategies evolving?

A: My observations are that medical tourism is promoted much more heavily in the United Kingdom than in the United States. Public interest in Britain is in the context of the National Health Service and its constraints. Initially the rules required that patients be treated only in the United Kingdom. I believe there has been a gradual relaxation in these rules, so that some care can be provided within some EU countries. I know that various Indian hospitals are continually attempting to get accredited to perform certain procedures.

What is striking is that in London medical tourism makes the front page of newspapers. People ranging from generals in the British Army to politicians to blue-collar workers are quoted, all saying, in effect, "I had a great time, and now I'm well." The most common treatments seem to be for cardiovascular issues, bone-related issues such as hip replacements, and general age-related issues. Most of these articles depict people going to India, but they almost never profile an Indian going to India. They profile a wide spectrum of citizens, not just British citizens of Indian or Asian origin.

Q: For-profit hospitals around the world have been associating with well-regarded U.S. medical schools and clinics. How can Apollo Hospitals differentiate itself from growing competition?

A: What is happening now is the normal evolution of an industry, and these hospital companies are all trying to figure out what their angle will be.

I certainly don't think affiliating with a medical school or clinic in the West is a panacea. We will see solutions emerge that have nothing to do with the West and that specialize in particular kinds of care where the West may not even have much competence: tropical diseases in Southeast Asia and Africa, for instance. On the other hand, you might see very interesting links between particular companies, research institutes, and hospitals in different parts of the world—in the Middle East, Europe, the United States. My guess is that 3 or 4 prominent hospital companies will survive because the demand is so huge.

At the end of the day we all ought to celebrate the development of these hospitals, because a lot of people who would have to wait in pain for 8 months for a hip replacement can get it tomorrow, at much lower expense. People with excruciating dental pain can get it fixed, cost effectively, much quicker. And patients who need a kidney transplant and have to be on dialysis can get attention sooner. As always there are challenges, but from humanity's standpoint we ought to celebrate.

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Medical Tourism: Travel to Another Country for Medical Care

Traveling to another country to get medical care can be risky. Learn about the risks and how to minimize them.

Traveling Internationally for Medical Care

Each year, millions of US residents travel to another country for medical care which is called medical tourism. Medical tourists from the United States most commonly travel to Mexico and Canada, and to several other countries in Central America, South America, and the Caribbean.

The reasons people may seek medical care in another country include:

• Cost: To get a treatment or procedure that may be cheaper in another country
• Culture: To receive care from a clinician who shares the traveler’s culture and language
• Unavailable or unapproved procedures: To get a procedure or therapy that is not available or approved in the United States

The most common procedures that people undergo on medical tourism trips include dental care, cosmetic surgery, fertility treatments, organ and tissue transplantation, and cancer treatment.

Medical Tourism Can Be Risky

The risk of complications depends on the destination, the facility where the procedure is being performed, and whether the traveler is in good health for the procedure(s). Other issues that can increase a traveler’s risk of complications include:

Infectious Diseases.  All medical procedures have some risk of infection. Complications from procedures performed in other countries include wound infections, bloodstream infections, donor-derived infections (in the case of transplantations or transfusions), and diseases such as hepatitis B, hepatitis C, and HIV.

Antimicrobial resistance.   Highly drug-resistant bacteria and fungi have caused disease outbreaks among medical tourists. Antimicrobial resistance happens when germs develop the ability to not respond to drugs such as antibiotics used to treat infections. Antimicrobial resistance is a global problem. Healthcare facilities in another country may not have adequate infection control practices and medical tourists could be at risk for getting a drug-resistant infection.

Quality of Care. Some countries’ requirements for maintaining licensure, credentialing, and accreditation may also be less than what would be required in the United States. In some countries, counterfeit medicines and lower quality medical devices may be used.

Communication challenges. Communicating with staff at the destination and healthcare facility may be challenging. Receiving care at a facility where you do not speak the language fluently could lead to misunderstandings about your care.

Air Travel.  Flying after surgery can increase the risk for blood clots, including  deep vein thrombosis . Delaying air travel for 10-14 days following major surgeries, particularly those involving the chest, will minimize risks associated with changes in atmospheric pressure.

Continuity of Care.  Travelers may need to get health care in the United States if they develop complications after returning. Follow-up care for complications might be expensive. Treatment might be prolonged and might not be covered by your health insurance.

How You Can Minimize Medical Tourism Risks

Research the clinician and facility.

• Check the qualifications of the clinician who will be doing the procedure and the credentials of the facility where the procedure will be done. Accrediting groups, including Joint Commission International, DNV GL International Accreditation for Hospitals, and the International Society for Quality in Healthcare, have lists of standards that healthcare facilities need to meet to be accredited. Please note that all surgeries carry the risk of complications and accreditation does not guarantee a positive outcome.
• If you go to a country where you do not speak the language, determine ahead of time how you will communicate with your clinician and others who will be caring for you.

Before you travel

• Get a pretravel consultation. See your healthcare provider or a travel medicine clinician at least 4–6 weeks before the trip to discuss general information for healthy travel and learn about specific risks you may face because of your health status, the procedure, and travel before and after the procedure.
• Obtain international  travel health insurance  that covers medical evacuation back to the United States.
• Find out what activities are not recommended around the time of the medical procedure, such as swimming or hiking, and plan accordingly.

Maintain your health and medical records

• Bring copies of your medical records with you, including results of lab tests and other tests related to your condition and care. Inform the medical staff at your destination of allergies you may have.
• Pack a  travel health kit  with your prescription and over-the-counter medicines in their original packaging. Bring enough medicine to last your whole trip, plus a little extra in case of delays. Also, bring copies of all your prescriptions and a list of medications you take, including their brand names, generic names, manufacturers, and dosages.
• Get copies of all your medical records from the medical facility at your destination before you return home. You may need to get them translated into English.

Arrange for follow-up care before you travel

• Identify where you will be staying immediately after the procedure.
• Make sure you can get any needed follow-up care in the United States. Follow-up care for medical complications can be expensive and might not be covered by your health insurance. Travelers considering procedures outside the United States should understand the potential financial costs associated with follow-up care or emergency care in the event of complications, review their health insurance policies to determine what, if anything, is covered and plan for the possibility of paying for additional care out-of-pocket.
• Supplemental travel health insurance may also be available to cover follow-up or emergency care from procedures received abroad.

Related Resources

• CDC Yellow Book: Medical Tourism
• American Medical Association Ethical Guidance on Medical Tourism
• Organization for Safety, Asepsis, & Prevention's Traveler’s Guide to Safe Dental Care
• The International Society of Aesthetic Plastic Surgery guidelines for travelers
• International Travel (US Department of State)
• Your Health Abroad (US Department of State)

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The Astounding Growth of Medical Tourism

Disclaimer: Some posts on Tourism Teacher may contain affiliate links. If you appreciate this content, you can show your support by making a purchase through these links or by buying me a coffee . Thank you for your support!

Medical tourism is a type of tourism that is on the rise around the world. Coming in many different shapes and forms, medical tourism is often sought by people in search of reduced priced cosmetic surgery, better healthcare systems than what is available to them in their home country or to obtain access to facilities or procedures that are not available to them at home. But what exactly is medical tourism and what does it look like? Read on to learn more…

What is medical tourism?

Medical tourism definitions , types of medical tourism, medical tourism companies, medical tourism in india, medical tourism in turkey, medical tourism in brazil, medical tourism in thailand, medical tourism in the czech republic, further reading.

Ever heard of ‘Turkey teeth’? It seems like a lot of people have them, and that’s just one example of so-called medical tourism.

Medical tourism is when you travel to another country (or another part of your home country as a domestic tourist ) to undergo a particular medical procedure. More often than not this is purely cosmetic, although of course people do need to travel for life-saving medical treatment sometimes too.

In the past, this generally meant people travelling from third world or less developed countries to obtain medical treatment in countries that can provide better healthcare systems. Now, it is often the other way round – people will travel to ‘developing’ countries as they can often get this treatment cheaper.

There is also the need to travel to different countries sometimes as the treatment you may want or need might not be available in your home country. For example, some cancer drugs are only available in the US meaning people will often travel from other countries to try it.

The CDC website defines and describes medical tourism as follows:

Medical tourism is when a person travels to another country for medical care. Each year, millions of US residents participate in medical tourism. Medical tourists from the United States commonly travel to Mexico and Canada, as well as countries in Central America, South America , and the Caribbean.

People may travel to another country to get health care for many reasons, including:

• Cost: To get treatment or a procedure that may be cheaper in another country.
• Culture: To receive care from a healthcare provider who shares the traveler’s culture and language.
• Unavailable or Unapproved procedure: To get a procedure or therapy that is not available or approved in the United States.

The most common procedures that people undergo on medical tourism trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplantation, and cancer treatment.

Of course this definition uses Americans as an example, but it works broadly too. The World Health Organisation also have a similar definition of medical tourism:

Medical tourists elect to travel across international borders to receive some form of medical treatment  

• Treatments may span the full range of medical services  
• Most common: dental care, cosmetic surgery, elective surgery, and fertility treatment – OECD, 2010 

No agreed definition of medical tourism exist; as a result methods applied by countries vary substantially  

• Some countries count foreign patients’ visits to hospitals whereas others count the entry of individual patients into the country  
• Other countries record nationality but not place of residence of patients, can be problematic when migrants return to home country for treatment – WHO, 2011

There are different types of medical tourism to consider. As mentioned, some visits are for cosmetic treatment whereas some are for life-saving medical treatment. According to Madre Healthcare (an Indian company specialising in medical tourism), these are the top 10 types of medical tourism…

• Dental/dentistry
• Orthopedics
• Cosmetic/plastic surgery
• Bariatric surgery 
• Fertility treatment
• Eye surgery
• Ears, nose and throat
• Organ transplants
• Rehabilitation 

There are various companies who have capitalised on the increase in people travelling for medical purposes, offering overall package deals making it easier for you to book these trips. These specialist travel agencies will facilitate the whole process. This includes arranging access and appointments as well as travel, visas, accommodation and more. Some even sort out sightseeing and activities for the rest of your trip!

According to IMARC , the global medical tourism market is set to grow even more in the next 5 years. It is also becoming more regulated, meaning people can feel safer when travelling for medical purposes. There are so many different medical tourism companies operating from each country, meaning you can find the perfect company to help organise your trip without any language barriers or confusion.

Simply search for ‘medical tourism company based in’ followed by your home country if you are looking for someone to help you navigate booking medical treatment abroad!

Some well-renowned medical tourism company examples include:

• MedicalHeathCare (UK, facilitating treatment in Turkey, Belgium, Poland , Croatia, Hungary, and Czech Republic)
• Fortis Healthcare Limited (India, facilitating treatment in Dubai, Sri Lanka and India)
• American Medical Care (USA, facilitating treatment in Costa Rica, Mexico and Nigeria as well as the USA)

Medical tourism destinations 

There are certain places where medical tourism is most popular. These include many European countries as well as central America, Asia, the USA and more! Below you’ll see some of the leading destinations when it comes to medical tourism. Find out what makes them so popular!

• Czech Republic

Worth an estimated $5-6 billion (USD), medical tourism in India is a big business. Most people who travel to India for medical treatments do so from Southeast Asia, the Middle East and Africa as well as the SAARC region. The government also has an extended visa regime in order to include medical visas, with a maximum stay of 6 months. India has low costs and up-to-date medical technology, which is what makes it the ideal place for medical tourism. Many doctors have trained in the Western world and speak brilliant English too, so there is much less of a language barrier in place for travelling patients.

The top locations within India for medical tourism are Maharashtra, Chennai and Kerala. In terms of the most popular treatments available in India to medical tourists, they are as follows:

• Alternative medicine
• Bone-marrow transplants
• Cardiac bypass
• Hip replacements 

Costs tend to be around one tenth of what they would be in either the UK or the USA. This is why India is such a great choice: the low cost and solid regulations combined mean you’re getting the best of both worlds.

At the start of this article I mentioned so-called ‘Turkey teeth’. This is a popular phenomenon, especially in the UK – this excerpt from Dental Hygiene Studio sums it up…

‘Turkey Teeth’ is a new phrase to describe super-white, super-square teeth which millennials in particular are keen to get. Social media influencers are going abroad because they are impressed by slick looking clinics and cheaper prices.

Of course, other countries offer this service but it is particularly common in Turkey. With hot weather and plenty of beautiful places to see, bars to drink in and hotels to relax at, Turkey makes for an obvious choice. This is especially true for Brits as the flight isn’t too long! 

Hair transplants are another big one in Turkey. Medical tourism in the country is regulated and has been since 2017. In 2018 alone, around 178,000 people flew to Turkey specifically for medical tourism purposes. The industry is said to contribute around $4 billion (USD) to Turkey’s economy every year, too.

The world’s 5th largest country is popular with tourists for its weather and iconic landmarks, and now for its medical procedures. They have an incredibly reliable healthcare system, said to be the continent’s most efficient – according to the WHO. In many cases citizens of nearby, lesser-developed countries opt to undertake medical procedures in Brazil. But it is also now a global destination for medical tourism!

Treatments are 60-70% cheaper here in comparison to the US and UK. Although, in the case of cosmetic surgery this isn’t strictly true. Highly trained surgeons have been known to charge as much if not more as their US counterparts. But for other treatments you are definitely getting a better deal and a holiday.

Sao Paulo and Florianopolis are the two most popular destinations in Brazil for medical tourism. The government is aiming to make them the two most popular destinations in the whole of South America! Over 50,000 tourists visit these two cities for medical tourism purposes every year, so they’re well on their way to achieving this goal…

While studies from the Thai government may be inaccurate in terms of their numbers, Thailand is still a popular destination for medical tourism. This study shows how the numbers might be skewed. All data should be taken with a pinch of salt! 

Most people head over here for minor elective/cosmetic surgeries. Thailand also offers fantastic spine and orthopedic surgeries and treatment. Their technology is cutting edge, too. Medical tourists visit Thailand from all over the world, with many from Eastern-Med destinations as well as Southeast Asia and Europe. Stats from the past few years show the industry is worth around $600 million (USD) to the country.

Thailand is a fantastic tourist destination regardless. For minor surgeries with a quick recovery time, there are plenty of things to do. And if you’re on strict instructions to just relax after a medical procedure, what better way is there to do it than staying somewhere so beautiful?! 

When searching for medical tourism companies, you’ll find many options for the Czech Republic. With high standards, quality care and a beautiful setting, it is easy to see why Prague (the country’s capital) is such a popular destination for this type of travel.

For pre-and-post-op treatment, there are various spa facilities used in medical facilities. Czech medical teams have great results in terms of cardiology, orthopaedics and neurology as well as cosmetic surgery. Costs are much lower, they have the latest technology and the city has so much to see and do. For those in the UK and other eastern European countries, there is hardly any travel time too!

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World of Medical Tourism: Discover Healthcare Abroad

Medical tourism , or health tourism , means traveling abroad for medical reasons. People do this to save money, get better care, or have treatments they can’t find at home. Medical tourists may seek a wide range of services, including elective surgeries, dental treatments, fertility treatments, cosmetic procedures, and more. Medical travel often combines medical treatment with tourism or leisure activities.

Historical Origins

The historical origins of medical tourism date back thousands of years, with early examples found in ancient civilizations like Greeks and Romans . These societies often sought healing and health treatments in other regions, laying the foundation for the modern practice of medical tourism.

Over centuries, the concept evolved, and in recent decades, globalization and advancements in healthcare have fueled the growth of medical tourism into a global industry. Understanding this historical journey sheds light on the roots of a phenomenon that continues to impact health services worldwide.

Early Instances of Medical Travel

Early instances of medical travel , which can be considered precursors to modern medical tourism, can be traced back to ancient civilizations such as Greece and Rome . Here are some key early instances:

• Ancient Greece : The city of Epidaurus in ancient Greece was famous for its healing havens, devoted to the god of medicine, Asclepius . People from various regions would travel to Epidaurus seeking cures for their ailments. Temples like Epidaurus offered a form of religious medical travel, where patients hoped for divine healing.
• Roman Baths : The Romans had fancy bath houses that weren’t just for relaxing but also for people seeking relief from health issues. These Roman baths , such as those in Bath, England, and Aquisgranum (Aachen) in present day Germany, attracted visitors in search of medical benefits.
• Islamic Medicine : During the Islamic Golden Age (8th to 13th centuries), cities like Baghdad and Cordoba became famous centers for medical knowledge and practice. People traveled from distant lands to access the expertise of Muslim physicians and scholars.
• Spa Towns in Europe : In Europe during the 18th and 19th centuries, spa towns like Bath in England , Baden-Baden in Germany , and Karlovy Vary in the Czech Republic became popular destinations for people seeking the therapeutic benefits of mineral springs and hydrotherapy.
• Colonial Medical Tourism : In the colonial era, people from colonies often traveled to the colonial powers’ home countries for medical treatment. They sought care that wasn’t available or was of lower quality in their own regions.

Ancient medical travel was based on beliefs in healing places, water, or religious sites. This set the stage for modern medical tourism , where people go abroad for reasons like saving money, getting advanced care, and faster treatment. Today, people travel globally for medical treatments, including surgeries, special procedures, and wellness programs.

Emerging Trends in Modern Medical Tourism

Modern medical tourism is witnessing a shift as emerging trends reshape the industry. These changes are transforming how patients get health care, travel for treatments, and focus on their well being. Several factors and trends are reshaping the world of medical tourism:

• Telemedicine and Virtual Consultations: The COVID-19 pandemic sped up the use of online medical consultations . Medical tourism providers now offer remote discussions about conditions and treatments. This makes it easier to access care without in-person visits.
• Medical Tourism Agencies: Medical travel companies make things easier for patients. They offer comprehensive services, handling travel, lodging, treatment scheduling, and aftercare. Their goal is to simplify the experience for medical tourists, making it more convenient and less stressful.
• Wellness Tourism : Medical tourism is expanding beyond procedures to include wellness and prevention . Health-conscious travelers look for services like check-ups, rejuvenation therapies, weight management, and holistic wellness programs. These packages often blend medical care with relaxation and lifestyle improvement.
• Quality and Accreditation: Accreditation and quality assurance programs are more important now. International bodies and certifications help medical tourists find reputable hospitals and clinics. Many patients prefer facilities with recognized quality certifications for safe and effective care.
• Insurance Coverage: Certain insurance firms now provide coverage for medical tourism costs . This adds credibility to the practice and eases worries about unexpected issues or extra medical requirements.

Popular Medical Tourism Destinations

Medical tourism has gained immense popularity in recent years, with people traveling to foreign countries in pursuit of affordable, high quality health services and medical procedures. Here are some of the most desired medical tourism destinations:

• Medical Tourism in Mexico : The country draws patients from the United States and Canada for dental work, plastic surgery , weight loss surgery and orthopedic surgery . For medical travelers, Tijuana is a leading destination in Mexico.
• Medical Tourism in Turkey : Gaining popularity for its high quality medical care, especially in cosmetic surgery , hair transplants, and weight loss surgery .
• Thailand: Known for its affordable medical procedures, particularly in cosmetic surgery and dental care.
• India: Offers a wide range of medical treatments, including cardiac surgeries, orthopedic procedures, and advanced cancer treatments.
• Malaysia: Known for its modern medical facilities and highly skilled health care professionals.
• South Korea: Known for its advanced cosmetic and plastic surgery procedures.
• Singapore: Offers top notch medical facilities and is a hub for medical tourists seeking treatments in various specialties.
• Costa Rica: Known for its dental work and cosmetic surgery.
• Dubai, United Arab Emirates: Attracts medical tourists for procedures such as orthopedic surgeries, dermatology, and fertility treatments.
• Brazil: Famous for its cosmetic surgery, particularly in the field of plastic surgery and body sculpting.

Please note that the popularity of medical tourism destinations can change over time, and the choice of destination often depends on the specific medical procedure and individual preferences. It’s essential to thoroughly research and choose a destination that meets your medical needs and safety standards.

Emerging Destinations

Emerging destinations for medical tourism are gaining recognition for their health services, competitive pricing, and quality care. Some of these emerging destinations include:

• Colombia: Known for its skilled medical professionals and modern facilities, Colombia offers affordable healthcare with a focus on cosmetic and plastic surgeries.
• Poland: Rising in popularity for its dental treatments and orthopedic surgeries, Poland attracts patients seeking cost effective medical care in Europe.
• Hungary: Budapest, in particular, is celebrated for dental tourism, offering high quality dental treatments at lower costs compared to many Western countries.
• Greece: With its rich history and health services knowledge, Greece is becoming a destination for various medical procedures, including fertility treatments.
• Tunisia: Known for its cosmetic and plastic surgeries, Tunisia offers a blend of quality care and Mediterranean beauty.
• Ukraine: Emerging as a destination for fertility treatments and surrogacy, Ukraine provides advanced medical services.
• Jordan: Recognized for its medical experts and state-of-the-art hospitals, Jordan offers treatments across multiple specialties.
• Malta: Combining medical care excellence with a Mediterranean lifestyle, Malta attracts patients seeking various medical procedures.
• Czech Republic: Prague is becoming a hub for medical tourists seeking cosmetic surgeries and other treatments.
• Philippines: Known for its medical services professionals and cost effective procedures, the Philippines offers a range of medical services.

These upcoming locations are ready to play a significant role in the worldwide medical tourism sector. They offer various choices for people looking for high quality health services abroad.

Medical tourism has a rich history dating back to ancient civilizations and has now evolved into a thriving global industry. Well-known places like Mexico , Turkey , Thailand , and India offer affordable health care, while rising destinations like Colombia and Poland provide appealing options.

Modern trends like telemedicine and wellness tourism are transforming the way patients access medical services abroad. As the industry keeps growing and changing, it gives patients more options to focus on their well being across borders.

Jet Medical Tourism® helps patients access affordable laparoscopic bariatric surgery in Mexico and plastic surgery in Tijuana. We coordinate innovative and safe weight loss surgery in Tijuana Mexico. We also provide educational information on different topics related to medical tourism.

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Tourism Product Development in China, Asian and European Countries pp 189–197 Cite as

Medical Tourism in China: Traditional Medicine Serving as an Emerging Tourism Resource

• Yao Yan 5 , 4  
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The paper discusses the development of traditional Chinese medicine as a tourism product. More and more people are increasingly concerned about their health and seeking all kinds of forms to improve health and wellness. Many traditional or nature-based therapies in the healthcare sectors are being accepted by the public. Among them, the traditional Chinese medicine’s philosophy and therapeutic elements are earning high praise by the world public. This paper focuses on the development, current status and prospects of the tourism products based on the traditional Chinese medicine. The relationship of medical tourism and the traditional Chinese medicine tourism is analyzed. Special features and advantages of Chinese medicine tourism are introduced. The challenges and answers for developing the Chinese medicine tourism are presented in the paper.

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How a song from West Virginia ended up marketing tourism in Oklahoma

The redbuds are in full bloom at the Core Arboretum.

And so was the delighted laugh this past Thursday afternoon of a certain director of the old-growth expanse off Patteson Drive — as soon as he learned of the trajectory a certain local song that celebrates the colorful tree is now taking … in Oklahoma.

“Chris is out here a lot,” Zach Fowler said.

“That’s awesome. Great song. I’m gonna have to congratulate him.”

Fowler is a WVU biology professor who oversees the botanical doings of the place rescued from the development boom at the end of World War II, when soldiers-turned-students on the G.I. Bill began marching into Morgantown.

He’s referring to his university colleague Chris Haddox, a professor of sustainable design who also knows how to pick a guitar and write a song.

In 2021, Haddox, with the help of Mountain Stage musical director Ron Sowell, released a self-titled album of original tunes, heartfelt and hilarious, that are still netting solid play on the Americana charts, here and overseas.

Haddox is even currently tied with Willie Nelson on one of those charts.

We’ll get to that.

You can even hear an Earth Day connection in the current context of the tale of that certain tune.

We’ll get to that, also.

Redbud road trip

The Haddox-penned song that these days is catching the ears, and eyes, of all those Oklahoma wranglers, cowboys and two-steppers is, “Nothing Says It’s Springtime Like the Redbud.”

It’s a Western Swing-styled number that sounds like it would be right at home on a Bob Wills bandstand in a Tulsa dance hall.

Haddox wrote the song in his head while behind the wheel.

He was motoring back to Morgantown from Charleston on Interstate 79 when he was charmed by all the redbuds he kept seeing.

After the song was on CD, he decided to explore the marketing roots it might sprout.

“I started wondering how many states adopted the redbud as their state tree,” the professor and songwriter said.

Only one, as it turned out: Oklahoma.

So he pitched it — and not all that long after, he actually heard back.

The tourism marketers loved it and wanted to use it in a campaign video promoting state parks in, yes, their Redbud State.

Haddox even tweaked one lyric for an Oklahoma reference.

The edition by Discover Oklahoma, a weekly television spot about stay-at-home tourism, features jump-cuts of state parks.

Oklahoma state parks. With all those great Oklahoma state park names.

Robbers Cove.

Roman Nose.

Quartz Mountain and Texoma, too.

A bevy of school children sing along in this redbud take, with help from Lauren Nelson, a proud daughter of Lawton, who became Miss America 2007.

You can watch the video on the Discover Oklahoma Facebook page.

“Have a listen to Chris and his band, with some local Redbud fans joining in, as we pay tribute to the princess of spring, ‘Cercis canadensis,’” the page says, by way of introduction.

Don’t take it all

Fowler says he’s just glad that Irvin Stewart listened to Earl L. Core (yes, that one) when the two started talking in earnest in 1948.

Stewart was president of WVU and Core, a professor, was a star in the biology department, where his work in botany was already blooming international renown.

Three years after America’s victories in Europe and Japan, the Mountain State’s flagship university was a getting-bigger place in an even-bigger hurry.

Large parcels of land were being acquired in Suncrest, including the Krepps and Dille family farms, to establish an Evansdale campus.

Core knew how it could all come down, Fowler said.

River of fire

Monday is Earth Day, the eco-awareness happening founded in 1970, a year after Cleveland’s Cuyahoga River actually caught fire, so polluted as it was, with mounds of trash floating on an oil slick.

It also hit in the middle of West Virginia’s then-robust back-to-the-land movement, which, Fowler said, owes a bit of its debt to a biologist with a bent for botany and land preservation.

Core convinced Stewart to set aside 91 acres, tucked behind where the WVU Coliseum is now located, as a safe haven for nature that gets even more dense and green, the arboretum director said — as one treks down its sloping trails canopied by towering trees and punctuated by diverse shocks of wildflowers.

“There are trees down here that are 200 years old,” Fowler said, “and probably ones older than that.”

The arboretum, which WVU named in Core’s honor in 1975, is Earth Day with a Hallmark-movie happy ending.

“Earl L. Core is a hero,” Fowler said of the advocate of all things outdoors who died in 1984, “and this place is a treasure.”

Buds (with my bud)

Meanwhile, Haddox, the Core Arboretum frequenter, said he appreciates his song is now being used to inspire people to get out and about in Oklahoma.

Not that he takes his treasure of songwriting skills too seriously at times, he said.

As evidenced by his current association with the aforementioned Willie Nelson.

The Morgantown songwriter and the troubadour from Texas are both occupying the No. 14 spot on Folk Alliance International music chart at this moment.

Haddox, for “Nothing Says It’s Springtime Like the Redbud” and Nelson, for “The Border.”

“Hey, I’ll take a tie with Willie any day,” Haddox said.

“I’m now associated with the redbud and he’s always been associated with another kind of bud. Maybe we oughta go on tour.”

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New Delhi: The Indian Institute of Technology (IIT) Delhi has signed a memorandum of understanding (MoU) with the Armed Forces Medical Services (AFMS) to strengthen research and innovation in the field of medical devices.

Under the new MoU, a collaborative research programme will be launched to focus on developing novel medical devices for the soldiers serving in various terrains. The agreement also includes plans for faculty exchange programmes, joint academic activities, and the development of joint PhD programmes.

The signing ceremony of the MoU was held in the presence of Director General AFMS Lt. Gen. Daljit Singh, and IIT Delhi Director Prof Rangan Banerjee.

Both officials expressed confidence that the collaboration will expand the knowledge and expertise of the researchers in the field of medical devices and help address the health challenges faced by soldiers.

IIT Delhi has a strong biomedical research ecosystem that can provide technical expertise for research in the diverse medical challenges faced in the armed forces, including rehabilitation of amputees, said Prof Banerjee. The MoU is full of possibilities for research and training that will benefit not only the nation but also the armed forces, he added.

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Stock market today: Asian stocks track Wall Street gains ahead of earnings reports

The Associated Press

April 23, 2024, 3:08 AM

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HONG KONG (AP) — Asian share benchmarks were mostly higher Tuesday after U.S. stocks clawed back a chunk of their losses from the week before.

U.S. futures were mixed and oil prices rose.

Japan’s benchmark Nikkei 225 rose 0.3% to 37,552.16, despite the country’s manufacturing activity contracting for 11 straight months while approaching the break-even point in April.

A purchasing managers survey showed sentiment at 49.9, on a scale of up to 100 where 50 marks the break between expansion and contraction The yen weakened further, hitting a fresh 34-year low of 154.85 early Tuesday.

The Hang Seng in Hong Kong added 1.6% to 16,771.17 while the Shanghai Composite index slipped 0.8% to 3,019.64.

Australia’s S&P/ASX 200 climbed 0.4% to 7,683.50. South Korea’s Kospi dropped 0.2% to 2,624.73.

On Monday, the S&P 500 gained 0.5% to 5,010.60 to recover more than a quarter of last week’s rout. The Dow Jones Industrial Average added 0.7% to 38,239.98, and the Nasdaq composite jumped 1.1% to 15,451.31.

The rally was widespread, and most stocks across Wall Street rose. In the S&P 500, technology stocks led the way to bounce back from their worst week since the COVID crash of 2020.

Nvidia leaped 4.4%, and Alphabet climbed 1.4% as Treasury yields stabilized in the bond market. Last week, a jump in yields cranked up the pressure on stocks, particularly those seen as the most expensive and making their investors wait the longest for big growth.

Bank stocks were also strong following some encouraging profit reports. Truist Financial rallied 3.4% after its profit for the start of the year topped analysts’ expectations.

They helped offset a 3.4% drop for Tesla , which announced more cuts to prices over the weekend. Elon Musk’s electric vehicle company has seen its stock drop more than 40% already this year, and it will report its first-quarter results later in the day.

It’s a big week for earnings reports generally, with roughly 30% of the companies in the S&P 500 scheduled to say how much they made during the year’s first three months. That includes companies that have come to be known as part of the “Magnificent Seven,” beyond Tesla and Alphabet.

The difference in growth between the Magnificent Seven and the rest of the S&P 500 should close by the end of the year, strategists Ohsung Kwon and Savita Subramanian said in a BofA Global Research report.

Verizon Communications helped kick off this week’s reports by disclosing a drop in profit that wasn’t as bad as analysts expected. It cited price increases and other measures to support its revenue. Verizon’s stock swung from an early gain to a loss of 4.7% after it reported weaker revenue for the first quarter than expected and kept its forecast for full-year profit the same.

Even more pressure than usual is on companies broadly to deliver fatter profits and revenue. That’s because the other big factor that sets stock prices, interest rates, looks unlikely to offer much help in the near term.

Top officials at the Federal Reserve warned last week that they may need to keep interest rates high for a while in order to ensure inflation is heading down to their 2% target. That was a big letdown for financial markets, dousing hopes that had built after the Fed signaled earlier that three interest-rate cuts may come this year.

Lower rates had appeared to be on the horizon after inflation cooled sharply last year. But a string of reports this year showing inflation has remained hotter than expected has raised worries about stalled progress.

In oil trading, U.S. benchmark crude picked up 16 cents to $82.06 per barrel. Brent crude, the international standard, gained 18 cents to $87.18 per barrel.

The U.S. dollar slipped to 154.78 Japanese yen from 154.84 yen. The euro fell to $1.0646 from $1.0653.

Copyright © 2024 The Associated Press. All rights reserved. This material may not be published, broadcast, written or redistributed.

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