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Medical Tourism

Open heart surgery is carried out on a baby at the Narayana Hrudayalaya Institue of Cardiac Sciences in Bangalore, India.

Earlier this month, the insurance company WellPoint announced a program that will allow employees of a Wisconsin printing company to get coverage for non-emergency surgeries in India. It's a first for WellPoint, but puts the insurer in good company. Over the past few years, some U.S. insurance companies — dismayed at losing income from uninsured Americans who get cheap surergies abroad or clients who choose to pay out of pocket for discount foreign surgeries rather than expensive in-network co-pays — have announced plans to include foreign medical procedures among those covered by health plans.

It's no wonder. The medical tourism industry has experienced massive growth over the past decade. Experts in the field say as many as 150,000 U.S. citizens underwent medical treatment abroad in 2006 — the majority in Asia and Latin America. That number grew to an estimated 750,000 in 2007 and could reach as high as 6 million by 2010. Patients are packing suitcases and boarding planes for everything from face lifts to heart bypasses to fertility treatments. ( See The Year in Health, from A to Z .)

People have been traveling for centuries in the name of health, from ancient Greeks and Egyptians who flocked to hot springs and baths, to 18th and 19th century Europeans and Americans who journeyed to spas and remote retreats hoping to cure ailments like tuberculosis. But surgery abroad is a fairly modern phenomenon. As health costs rose in the 1980s and 1990s, patients looking for affordable options started considering their options offshore. So-called "tooth tourism" grew quickly, with Americans traveling to Central American countries like Costa Rica for dental bridges and caps not covered by their insurance. (A large percentage of today's medical tourism is for dental work, as much as 40% by some estimates.)

Many U.S. doctors and dentists were appalled at the idea of their patients turning to foreign hospitals for care that they considered dangerously cheap. But where many U.S. medical professionals saw great peril, countries like Cuba saw opportunities. Beginning in the late 1980s, the island country started programs to lure foreigners from India, Latin America and Europe for eye surgeries, heart procedures and cosmetic procedures. The Cuban government said it welcomed 2,000 medical tourists in 1990. ( See pictures from an X-Ray studio .)

After Thailand's currency collapsed in 1997, the government directed its tourism officials to market the country as a hot destination for plastic surgery, hoping to boost revenues. Thailand quickly became the go-to country for comparatively inexpensive sex-change operations, where patients faced fees as low as $5,000, as well as looser requirements for pre-surgery psychological counseling. Thailand is now a destination spot for all types of plastic surgery as well as a host of routine medical procedures. Bumrungrad International Hospital in Bangkok is probably Thailand's best-known mecca for medical tourists, boasting patients from "over 190 countries" and an "International Patient Center" with interpreters and an airline ticket counter.

In recent years, companies all over the U.S. have sprung up to guide Americans through the insurance and logistical hurdles of surgery abroad, including many in U.S. border states affiliated with medical facilities in Mexico. The physician-managed MedToGo in Tempe, Arizona, founded in 2000, says its clients save "up to 75% on medical care" by getting it in Mexico. The Christua Muguerza hospital system — located in Mexico, but run by U.S.-based Christian hospital group since 2001 — includes a scrolling text box on its web site informing visitors how "very close to you" its Mexican facilities are. ("from Houston 1 hr 37 mins!" "from Chicago 3hrs 15 mins!") Meanwhile, New Zealand is trumpeting its expertise in hip and knee replacements and South Korea is enticing medical travelers with high-end non-medical amenities like golf.

For those who wrinkle their noses at the thought of going under the knife in a foreign, let alone still-developing, country, the American Medical Association introduced a set of guidelines in June for medical tourism. The AMA advocates that insurance companies, employers and others involved in the medical tourism field provide proper follow-up care, tell patients of their rights and legal recourse, use only accredited facilities, and inform patients of "the potential risks of combining surgical procedures with long flights and vacation activities," among other recommendations. Joint Commission International, a non-profit that certifies the safety and record of hospitals, has accredited some 200 foreign medical facilities, many in Spain, Brazil, Saudi Arabia, Turkey and the United Arab Emirates.

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Medical Tourism: An Introduction

• First Online: 05 November 2019

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• Anu Rai 3  

Part of the book series: Global Perspectives on Health Geography ((GPHG))

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Travelling away from your own jurisdictional territory with a desire to get to faster, affordable and reliable medical care facilities is defined as medical tourism. Medical tourism is an ancient social practice of healthcare that dates thousands of years back. Sacred sites of Greece, Egypt, India and Persia have long tied history with healthcare travellers. The changing nature of civilisation and advancement of technology have made a crucial impact on healthcare travel to seek either holistic (i.e., through prayers, relaxation, exercise, visits to mineral springs, sea water or holy river, sacred temple baths) or biomedical (diagnosis, hospitalisation and surgical operations) cures. Globally, migration of patients is increasing every year. While on the one hand, patients migrate to get access to medical facilities inaccessible in their own country or are costlier, on the other hand, there are countries empowered to provide such amenities and cash on this distinct tourist segment. Medical tourism-generating regions are known as MTGRs and countries catering to their medical needs are termed as medical tourism destination regions or MTDRs (Gyu Ko 2011 ). This chapter highlights medical tourism as the commodity of services. It explores factors working behind the growth of this giant industry, drawing different estimates of market segmentation. It also brings about the gap present in existing knowledge of literature as revealed from an extensive survey of existing literature including patients’ guidebook, case studies, reports and articles.

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Rai, A. (2019). Medical Tourism: An Introduction. In: Medical Tourism in Kolkata, Eastern India. Global Perspectives on Health Geography. Springer, Cham. https://doi.org/10.1007/978-3-319-73272-5_1

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The History of Medical Tourism

Medical tourism history - ancient times.

• The Sumerians (circa 4000 BC) constructed the earliest known health complexes that were built around hot springs. These healthcare facilities included majestic elevated temples with flowing pools.
• During the Bronze Age (circa 2000 BC), hill tribes in what is now known presently as St. Moritz, Switzerland recognized the health benefits in drinking and bathing in iron-rich mineral springs. The same bronze drinking cups that they used were found in thermal springs in France and Germany, which could signify health pilgrimages within these cultures.
• The Ancient Greeks were the first to lay a foundation for a comprehensive medical tourism network. In honor of their god of medicine, Asclepius, the Greeks erected the Asclepia Temples, which became some of the world's first health centers. People from all over, traveled to these temples to seek cures for their ailments.
• By the year 300 BC, other therapeutic temples flourished under the Greek domain. One facility called the Epidaurus was the most famous and included services like a gymnasium, a snake farm, a dream temple, and thermal baths. Other temple spas included the Sanctuary of Zeus in Olympia and the Temple of Delphi.
• In India, the history of medical tourism was also slowly unfolding with the popularity of yoga and Ayurvedic medicine. As early as 5000 years ago, constant streams of medical travelers and spiritual students flocked to India to seek the benefits of these alternative-healing methods.
• When Rome became a global power, several hot-water baths and springs called thermae came into existence and gained popularity among the elite. These baths were not only healthcare facilities, but became commercial and social networking centers for the rich and the elite.

Medical Tourism History - The Middle Ages

• In Medieval Japan, hot mineral springs called onsen became popular throughout the nation due to their healing properties. The warrior clans soon took notice of these springs and began using them to alleviate pain, heal wounds, and recuperate from their battles.
• Many early Islamic cultures established health care systems that also catered for foreigners. In 1248 AD, the Mansuri Hospital was built in Cairo and became the largest and most advanced hospital in the world of that time. With the capacity to accommodate 8,000 people, this hospital became a healthcare destination for foreigners regardless of race or religion.

History of Medical Tourism - The Renaissance Period

• A village known as Ville d'Eaux or Town of Waters, became famous throughout Europe in 1326 when iron-rich hot springs were discovered within the region. Prominent visitors like Peter the Great and Victor Hugo visited these wellness resorts. The word “spa”, derived from the Roman term “salude per aqua” or health through waters, was first used here.
• During the 16 th century, the rich and the elite of Europe rediscovered Roman baths and flocked to tourist towns with spas like St. Mortiz, Ville d'Eaux, Baden Baden, Aachen and Bath in England. Bath or Aquae Sulis enjoyed royal patronage and was famous throughout the known world. It became the center of fashionable wellness and became a playground for the rich and famous.
• The most noteworthy traveler in the history of Medical Tourism was Michel Eyquem de Montaigne. He was the French inventor of the essay, and was believed to be the father of luxury travel. He helped write the earliest documented spa guide in medical tourism history.

History of Medical Tourism - The Post-Renaissance Period

• In the 1720s, Bath became the first city in England to receive a covered sewage system and was ahead of London for several years. The city also received technological, financial, and social benefits. Roads were paved, streets had lights, hotels, and restaurants were beautified – all because of Medical Tourism.
• The discovery of the New World brought new destinations for European medical travelers. During the 1600s, English and Dutch colonists started building log cabins near mineral springs rich with medicinal properties. During this time, it was noted that the Native Americans in the New World were adept in the healing arts. Knowledge in herbal medicine was exceptional and rivalled those in Europe, Asia or Africa.
• During the 18 th and 19 th century, several Europeans and Americans continued to travel to remote areas with spas and health retreats hoping to cure various ailments like tuberculosis.

Medical Tourism History from the 1900s to 1997

• In 1933, the American Board of Medical Specialties (ABMS) was established and became the umbrella organization for the medical specialist boards in the United States. The ABMS established educational and professional policies, which became the blueprint of standards around the world.
• In 1958, the European Union of Medical Specialties (UEMS) was formed. The UEMS is made up of different National Medical Associations from member nations of the European Unions.  
• During the 1960s, India became a destination of choice for pilgrims when the New Age movement began in the USA. The flower child movement, which drew the elite and socialites of America and the UK, eventually developed into a fully-fledged medical tourism industry, with yoga and Ayurvedic medicine rediscovered.
• With the cost of healthcare rising in the 1980s and 1990s, American patients started considering offshore options, like dental services in Central America. Whilst US doctors were appalled at the idea of seeking healthcare in foreign hospitals during these periods, Cuba started programs luring foreigners for eye surgeries, heart and cosmetic procedures.

History of Medical Tourism from 1997 to 2001

Medical tourism from 2001 to 2006, medical tourism in 2007 and beyond, medical tourism information:, browse by specialty.

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Medical Tourism: Where it Began and Where it is Now

The Mesopotamians are the people who originally established medical tourism on planet earth.Medical tourism can be traced back to the third millennium B.C. The evidence shows that Mesopotamians traveled to the temple of a healing god or goddess at Tell Brak Syria in search of a cure for eye disorders.

Thousands of years later the traveling continued the Greeks and Romans would travel to spas and cult centers on the Mediterranean.In more recent times yet still approximately 15 years ago wealthy individuals from regions such as Europe Middle East and Latin America were traveling to the United States in search of the best medical procedures available.

After the tragedy of September 11th that type of travel slowed down due to stricter visa regulations making it more difficult to enter the U.S. A time after that U.S. citizens were the ones starting to travel. They would travel to destinations in Latin America Europe and Asia for dental care and plastic surgery procedures primarily.

A short time later U.S. citizens started scaling it up and traveling for more essential procedures such as organ transplants and heart surgery price being the main motivating factor. Around this time Canadians also caught onto the concept and started traveling for procedures like knee replacements and geriatric procedures.

They opted to travel rather than wait months or years for the procedures to take place at home. Another thing to note around this time and for many years Europeans were crossing the border into other EU countries to seek healthcare they needed. ‍

Medical Tourism Industry Today

What is the difference between the medical tourism industry today compared with years ago? The medical tourism industry today is more prominent and well-known. People are traveling for essential procedures and it is not just individuals traveling for care. Nowadays employers are sending employees overseas governments are sending their citizens and insurance companies are offering overseas or even domestic medical tourism as an option.

Before the individuals would contact hospitals themselves and plan their own medical trip. Travel agents and others started to realize that this was happening and started to make a business out of it medical tourism facilitation. Many facilitators have sprung up over the last 10 years many have died out but the ones that have lasted are the companies with strong business plans and industry reputations.

With all of these entities involved the industry has become more organized and efforts are being made to promote the high quality and safety of hospitals around the world. The competition amongst hospitals has increased due to international accreditations and certifications such as Joint Commission International and the Medical Tourism Associations certification programs.

Many of the entities involved in selecting a hospital are looking at who has international accreditations. The Medical Tourism Association (MTA) and others involved have been fighting for education communication and transparency within the industry. With these efforts in place the medical tourism industry has become a global phenomenon and continues to grow in a healthy direction.

Exploring the Surge of Cosmetic Tourism: Trends and Considerations in Aesthetic Procedures Abroad

Holistic healing: exploring integrative medicine and wellness retreats, meeting the surge: the growing demand for knee replacement surgeries and advances in the field, innovations in medical technology: how cutting-edge technology drives medical tourism, stem cells have powerful anti-aging properties, transforming healthcare through innovation: ceo spotlight interview with matthew a. love, new shift for thailand’s medical travel landscape as mta launches new moves, breakthrough stem cell treatment for autism, continue reading, informed decision-making in medical tourism: the significance of clinical outcome reports, avoiding pitfalls: top 5 mistakes medical tourism startups should steer clear of, reshaping cataract surgery with advanced technology, featured reading, dominican republic’s giant strides to becoming a global leader in medical tourism, medical tourism magazine.

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.

The future of health tourism in the industrial revolution 4.0 era

Journal of Tourism Futures

ISSN : 2055-5911

Article publication date: 22 May 2020

Issue publication date: 2 June 2021

The technological advances in the Industrial Revolution (IR) 4.0 era escalate the advancement of the healthcare industry, including the health tourism phenomenon. Based on the current trend in connected health care (e.g. mobile healthcare technology; digital health, etc.), this paper aims to propose that the distance between healthcare providers around the globe and its potential patients can be vastly reduced to almost on a real time basis.

Design/methodology/approach

A secondary literature review is conducted to identify the key development of IR 4.0 technologies in the healthcare industry and its possible trend leading the health tourism sector.

The adoption of IR 4.0 technologies is expected to make seeking treatments overseas more affordable, accessible and health records readily available on a real-time and secured basis. However, it is worth to note that the growth of health tourism raises the eyebrows of society from the security, social and economic perspectives.

Originality/value

This paper contributes to our understanding that the emergence of IR 4.0 technologies changes the landscape of the health care and health tourism industry. Continuous technology advancement is expected to further shape the future trend and escalate the commercialization aspect of the health tourism industry.

• Future trends
• Industrial revolution
• Technologies
• Health tourism

Wong, B.K.M. and Sa’aid Hazley, S.A. (2021), "The future of health tourism in the industrial revolution 4.0 era", Journal of Tourism Futures , Vol. 7 No. 2, pp. 267-272. https://doi.org/10.1108/JTF-01-2020-0006

Emerald Publishing Limited

Copyright © 2020, Brian Kee Mun Wong and Sarah Alia Saaid Hazley.

Published in Journal of Tourism Futures . Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) license. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this license may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

Healthcare is a robust industry, which is tightly related to other sectors such as travel and tourism, wellness and information, communication and technology. The merging of health care and travel sectors has seen it become a prominent movement in the past decade or so. It has created a phenomenal enhancement in human mobility worldwide. In fact, the concept of healthcare travel has its history dating back to the ancient times when people travelled places, searching far and wide, for the best healthcare services.

Ancient civilizations conceded the therapeutic effects of thermal medicine, hot springs and sacred temple baths ( Gianfaldoni et al. , 2017 ). The earliest health complexes within a hot springs’ vicinity were built by the Sumerians (about 4000 BC), whereas the ancient Greeks built the Asclepia Temple in honour of their God of Medicine, Asclepius ( Health-Tourism.com, 2020 ). The temple formed one of the world’s first health centers where people from different parts of the world travelled to seek solutions for their medical ailments. The ancient Greeks laid the first foundation of a comprehensive healthcare travelling network ever since.

In the modern era, healthcare traveling has evolved to include well-being enhancement and leisure, as patients require time to recuperate and recover. The evolution has obligated destination marketers to relook into the purpose of healthcare travelers when visiting a destination. The combination of health care, travel, tourism and wellness concepts eventually created the concept of health tourism. The term, “health tourism” or “medical tourism” has been used since the 17th century ( Yusof et al. , 2019 ). In fact, health tourism, medical tourism and wellness tourism are commonly used interchangeably, and perhaps it is essential to note that each of the terminologies is, in fact, different ( Wong and Musa, 2013 ). Health tourist, thus, in this context, is defined as tourist who travel elsewhere to seek and receive health, medical and/or wellness services for different reasons.

Health care has always been evolving gradually with its medical technologies ( Allen, 2019 ; Lobo, 2020 ), however new diseases are always demanding for new treatments and these treatments are not always offered at one’s preferred area or location. Hence, the technology advancement is not only enhancing medical precision and quality but also bringing healthcare services closer and faster to the patients, revolutionizing the healthcare travelling requirements. Health tourism has gradually integrated the demand for sophisticated and cultivated medical treatments and of the devices above par the personalized ones ( Bhattacharyya, 2020 ; Hong, 2016 ; Medical Technology, 2020 ). The Industrial Revolution 4.0 (IR 4.0) is a much talked about term in this current technology-dominated economy.

While the first IR introduced the use of steam-powered and mechanics to increase production, the Industry 2.0 popularized the electricity and mass-production processes. The third IR brought the first wave of digitalization of technology, enhancing economies to go beyond political and geographical boundaries and at a faster speed. The latest, fourth IR, is an advancement of Industry 3.0 where the physical, digital and biological spheres are connected ( Bernasconi, 2016 ), continues to disrupt business practices and the society’s ways of life. Among the IR 4.0 technologies include Internet of Things (IoT), automation, robotics, virtual reality, artificial intelligence (AI), cloud solutions and big data analytics. Despite the technology advancements not only benefits the development of health tourism industry but also the tourism industry, in general; this paper focuses on the earlier context.

IR 4.0 is shaking the healthcare industry by storm with a robust transformation within the mobility enhancement concept ( Landman, 2018 ). This mobile health care is expected to make health care more affordable, accessible and health records readily available and secure. Some of mobile healthcare devices and infrastructure that helps to shape the future include telemedicine, wearables, digital sensors and biotelemetry, remote patient monitoring, virtual rehabilitation and intelligent fabric. It has not only benefited many patients but also enabled healthcare providers to streamline processes, synthesize information and provide real-time updates. The latest innovation in healthcare technologies will provide a much competitive advantage, especially in developing faster and more effective treatment ( Bernasconi, 2016 ).

Telemedicine is among the initial stage of IT-enabled collaboration within the healthcare industry. The benefit of implementing telemedicine has been widely appreciated by healthcare professionals particularly in managing chronic diseases. It enhances patients’ mobility virtually, making geographical location less of a factor in obtaining healthcare services. This enables patients from remote areas to access the best health care from a touch of their smart phone. A research conducted at Mayo Clinic, USA, revealed an astonishing acceptance level of mobile technology, where more than 80% of the patients indicated interest in using mHealth applications. In 2011, the US Secretary of Health and Human Services recognized mHealth services as one of the biggest health-related technology ( Nehra et al. , 2017 ).

The technology is very much relevant and useful for health tourism, particularly in enhancing the process of pre- and post-operative care, in both medical and customer service perspectives ( Medical Tourism Magazine , 2020 ). Tele-consultations can be performed remotely by anesthesiologists and surgeons to assess health tourists’ healing and wound recovery process even when they reside in their home country. Healthcare professionals at the health tourism destination can follow-up with the patients’ local primary care providers in their home country via teleconferencing and/or telehealth applications. For example, the online-based Chinese American Physicians E-Hospital was launched in 2015, providing health tourists the tele-consultation services and international transfer from their home country to the USA for treatment. This enables more convenient and hassle-less health tourism experience to the USA ( Hong, 2016 ).

The mobile health care further innovates into related digitalized products such as wearables, digital sensors and biotelemetry. Among the diagnostic procedures to perform digitally via wearable devices and sensors include blood glucose levels, electrocardiogram, pulse and blood pressure checking and blood oxygen saturation levels. The data collected digitally will then connect to the mobile application installed in the user’s (i.e. health tourist) smart phone. Regular health progress can be transmitted to the health care professionals and in return proactive measures for better health control can then be recommended to the users, digitally and remotely.

IoT is conquering every aspect of human life and work environment. This is no exception to the healthcare industry. In fact, the term of Internet of Medical Things was highlighted by the Department of Health, Abu Dhabi (2020) during the 12th annual World Medical Tourism & Global Healthcare Congress in 2019. The wearables and sensors that form part of IoT are indicated to be beneficial to healthcare professionals are gaining effective benefits ( Junata and Tong, 2018 ). The use of fitness-tracking bands, smart watches and smart textile can easily collect data on patients’ health conditions and connect with the healthcare professionals in other parts of the world. While these technological devices may apply to any individuals, the usage is prominent for health tourists who may opt to have follow-up with their doctors in another country remotely, as data can be transmitted to them on real-time basis ( Psiha and Vlamos, 2017 ).

The data from the sensor was then transmitted via IoT sensor platform, to a dedicated android app developed on a Google Nexus 5X smart phone. However, the development is yet to be compatible with smart phone options. An example of such technology usage in health care is the cloud-based wearable IoT sensor systems that measure asthma patients’ exposure to aldehydes, in real-life settings ( Li et al. , 2019 ). The recent 5G medical technology development further enhances the patterns of production and consumption of health tourism services, such as smart wearables (e.g. clothes that measure heart rate, blood pressure, body temperature, skin moisture, etc.) and active device location tracking ( Psiha and Vlamos, 2017 ). Such development is highly applicable and useful for health tourism, as it allows continuous communication and data updates through cloud computing between the health tourists (at home country) and the healthcare professionals (at health tourism destination).

Next, the virtual rehabilitation application will also be benefiting the health tourism industry. It is a system that integrates wearable sensors and records range of motion. The data are analyzed for the therapists to guide the patients in real time via a mobile device (e.g. tablet, smart phone). The National University of Singapore has launched an IoT-based rehabilitation program for stroke patients in 2016. However, there are very few studies on the adoption rate of these innovations among local communities and health tourists, seeing Singapore as among the top health tourism destinations globally.

Other rehabilitation technologies include robotics ( Department of Health, Abu Dhabi, 2020 ; Mann, 2013 ) (e.g. Cleveland Clinic Abu Dhabi implemented robotic surgery since 2017) and assistive technology (AT) ( Carlson and Ehrlich, 2005 ). In fact, AT plays an intermediary role where it enables disabled individuals (e.g. severe paralysis) to transmit their messages/intentions to other devices (e.g. computers) within their surrounding environment ( Ghovanloo and Huo, 2014 ). These technologies further upscale the offerings and competitiveness of health tourism destinations to lure health tourists.

Despite AI has existed sometimes back, the application of it in the healthcare industry is still at the infant stage. The behavioural and mental healthcare fields use AI to learn, understand and reason to make better clinical decisions, diagnostics, testing and patient care management. Besides, AI technologies and techniques also enhance patients’ lives via advance self-care tools. For example, the interactive mobile health applications study the patterns and preferences of users. By doing so, the AI may improve public health through the detection of health risks and recommending interventions.

The use of AI enables the interactions between health professionals and care seekers at a distant, providing necessary treatment recommendations ( Luxton, 2016 ), a very useful communication and interaction tool between health tourists and the healthcare professionals overseas. In stepping up Abu Dhabi as a unique health tourism destination, the United Arab Emirates (UAE) has taken AI seriously in regulating the development of its healthcare industry by introducing the first AI policy, tabling out the UAE Artificial Intelligence Strategy and announcing it world’s first Minister of State for Artificial Intelligence.

The integration of IR 4.0 technologies in general healthcare industry will benefit health tourism development as it will revolutionize patients’ travel options and patterns, particularly for the initial checking and later follow-up stages. Such benefit becomes more significant among the elderlies and those who may have mobility issue to travel. Digitalized and connected health care saw increased investment over the past few years and the widespread use of technology-enabled health care further making the idea of “Smart Hospital” a reality (Frost and Sullivan, 2017 ). The call for the use of blockchain technology to enhance the safety and effective use of health data within the health tourism industry gained attention in the recent years ( Iryo.network, 2018 ). The use of technology may free up face-to-face appointments for health tourists, particularly for follow-up sessions after returning to their home country, and thus generate more convenient and cost-effective experience.

The freer mobility of health tourists around the globe has relatively changed the requirements of demand and supply of healthcare products and services. It is no longer the developed nations that can reap the commercial benefits of the health tourism growth but also the developing nations. Though health tourism remains a niche contribution to the total tourism receipts of many destinations, the direct and indirect effects on the overall tourism industry is well appreciated ( NaRanong and NaRanong, 2011 ). For example, the multiplying effects of health tourism towards other tourism sectors (e.g. hotels, airlines, food and beverages) have been reported to be between three to four times in Malaysia ( Yusof, 2017 ). Thus, the growth of health tourism should be given ample attention for nations with a strong and competitive healthcare services.

Healthcare know-how and technologies are available in many parts of the world. The availability of IR 4.0 technologies also enhances expert mobility (e.g. doctors, nurses, professors and care takers) virtually and further enhances the readiness of developing nations to receive its health tourists with an open hand. Perhaps, with the adoption of IR 4.0 technologies among the health tourism facilities, health tourists may not necessarily require physical movement elsewhere anymore in seeking and receiving health services, such as simple health checks or health advice.

While it is believed that these technologies benefit patients in terms of precision and timeliness, the key concerns raised by critics include the absence of empathy and lack of trust in a robot’s decision-making ( Lobo, 2020 ; Tim, 2018 ). Other concerns of incorporating technologies into health tourism specifically may include data leakages, privacy matters, cybersecurity and over-commercialization concerns ( Medical Technology, 2020 ). While the growth of health tourism is prominent, it is also essential to take note of its impact on the local healthcare system, healthcare resources management, cost-containment strategies and post-humanism matters.

The recent corona virus pandemic that puts global travelling almost to a halt is a good example of why the future of health tourism should evolve through the technology advancement, specifically the IR 4.0 technologies as available currently. Health care is no longer just about local accessibility but cross-national borders, be it physically or virtually.

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Acknowledgements

The authors would like to appreciate UOW Malaysia KDU University College for providing Research Grant to conduct this study.

Corresponding author

About the authors.

Brian Kee Mun Wong is based at the School of Business, UOW Malaysia KDU University College, Shah Alam, Malaysia.He is an Associate Professor and has a PhD in Tourism Management from the University of Malaya, Kuala Lumpur. He currently heads the School of Business at the UOW Malaysia KDU University College. He is a marketing, management and entrepreneurship research enthusiast, particularly in the area of travel, tourism and hospitality.

Sarah Alia Sa’aid Hazley is based at the School of Business, UOW Malaysia KDU University College, Shah Alam, Malaysia. She is an Undergraduate and a Research Assistant at the UOW Malaysia KDU University College. She has an interest in cross-discipline research such as fintech, marketing and tourism.

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New supports for allied health, clinical support workers will boost workforce.

Honourable Adrian Dix

Minister of Health and Minister responsible for Francophone Affairs

Email: [email protected]

Translations

News release, media contacts, ministry of health.

• Visit Ministry Website

Featured Topics

• Coronavirus (COVID-19)
• Health & Drug Coverage
• Accessing Health Care
• Health Forms
• Office of the Provincial Health Officer
• Office of Indigenous Health

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• Medical Services Plan
• HealthLink BC
• Vital Statistics
• Health Care Complaints

People accessing health care will benefit from a stronger workforce as the Province further invests in recruitment, retention and training initiatives for allied health and clinical support workers.

“Supporting the allied health-care workforce is critical to strengthening our public health-care system,” said Adrian Dix, Minister of Health. “By investing in recruitment and retention initiatives for allied health professionals and clinical support staff, we are ensuring that people have access to the vital health-care services this workforce delivers, no matter where they live in B.C.” 

To support the implementation of B.C.’s Health Human Resources Strategy and the Allied Health Strategic Plan, the Province is investing up to $155.7 million in initiatives that will retain and recruit allied health and clinical support staff.

This includes up to $73.1 million for retention and recruitment incentives to expand the Provincial Rural Retention Incentive and provide signing bonuses for those who fill high-needs vacancies.

Effective April 1, 2024, the Provincial Rural Retention Incentive for health-care workers living and working in rural and remote communities was expanded. All occupations working in eligible communities, including those represented by the Health Sciences Professionals Bargaining Association (HSPBA/HSA), Facilities Bargaining Association (FBA) and Community Bargaining Association (CBA) will receive the incentive, totalling up to $8,000 per year per person.

To support recruitment of allied health and clinical support workers, signing bonuses will be available for staff who fill high-needs vacancies in priority occupations in rural and remote areas, difficult-to-fill vacancies in urban and metro communities, and for medical lab technologists who join GoHealth BC, a travel health-care program that sends health-authority staff on short-term deployments to rural and remote communities.

These recruitment initiatives will support bringing in new allied health and clinical support health-care staff to fill vacancies, ensuring more people around B.C. can access the care they need.

To support retention and career development, the Province is providing up to $15 million over three years for allied health clinical mentorship, peer support and transition-to-practice support for allied health new entrants, including new graduates and internationally educated allied health professionals.

In addition, the Province is providing $20 million each to the HSPBA, CBA and FBA for a total investment of $60 million to deliver supports for professional development, mental health and wellness to their members.

Up to $7.6 million will be provided for training initiatives, including tuition credits, bursaries to offset licensing exam fees for new graduates and new employer-sponsored earn-and-learn opportunities.

This work is part of the Allied Health Strategic Plan, which highlights 42 actions from B.C.’s Health Human Resources (HHR) Strategy and introduces 15 new actions to advance retention, recruitment, training and innovation initiatives that directly benefit the allied health workforce in B.C.

The HHR Strategy advances 70 actions to retain, recruit and train health-care workers in B.C., while supporting innovative health-system redesign and optimization.

Learn More:

To learn more about how B.C.’s Health Human Resources Strategy is strengthening health care, visit: https://news.gov.bc.ca/releases/2023HLTH0150-001930

For more information about what the Province is doing to support allied health professionals, visit: https://news.gov.bc.ca/releases/2023HLTH0149-001926

Four backgrounders follow.

Backgrounders

What people are saying about new supports for allied health professionals.

Jennifer Rice, Parliamentary Secretary for Rural Health –

“By incentivizing allied health professionals to settle and practice in rural regions, we can improve access to medical services for people living there. It means people won’t have to travel as far for medical services, improving access to care and health equity for people living in rural and remote areas across B.C.”

Kane Tse, president, Health Sciences Association (HSA) –

“I hear every day from CT technologists, lab technologists, radiation therapists, PET technologists, respiratory therapists and many other specialized health professionals struggling through dire shortages and crushing workload. On their behalf, HSA welcomes these initiatives, developed by Health Minister Adrian Dix and his team after many front-line meetings. We believe they will help increase health-science professional recruitment in rural communities and in urban facilities facing the most severe shortages.”

Stephanie Smith, president, BC General Employees’ Union (BCGEU) –

“Representing over 25,000 workers in B.C.’s health-care sector, the BCGEU welcomes the ministry’s initiatives to strengthen the long-term sustainability of our province’s public health-care system. The investments will ensure more people have access to health care in remote communities. It’s also critical that staff have the mental-health and professional-development supports that this will help deliver for workers across the province.”

Lynn Bueckert, interim secretary-business manager, Hospital Employee’s Union –

“We applaud the Ministry of Health’s expanding efforts to support public health-care services through the new measures announced today. These additional tools, along with the government’s recent expansion of the provincial rural-retention incentives program to attract and retain workers from across the health-care team and the health-care access program that has brought 7,000 more care aides into the system, will continue to have a positive impact on the working and caring conditions in B.C.’s hospitals and long-term care homes.”

What to know about retention and recruitment initiatives

The Province is investing up to $133.1 million in retention and recruitment of allied health and clinical support workforce.

This includes providing $60 million ($20 million each) to the Facilities Bargaining Association (FBA), Community Bargaining Association (CBA) and the Health Sciences Professionals Bargaining Association (HSPBA). The funding is intended to support members in the areas of mental wellness and professional development, aligned with the Health Human Resources Strategy and Allied Health Strategic Plan.

To support retention and career development, the Province is providing up to $15 million over three years for allied health clinical mentorship, peer support and transition-to-practice support for allied health new entrants, including new grads and internationally educated allied health professionals.

To continue supporting retention and recruitment efforts, the Province is investing up to $73.1 million in one-time funding, which will help with the unique staffing challenges faced in rural communities, as well as staffing difficulty to fill vacancies in urban and metro communities. The incentives will be retroactive to April 1, 2024, and are focused on:

• This incentive provides up to $2,000 per quarter, pro-rated to productive hours, to health-care workers working in eligible rural and remote communities to a maximum of $8,000/year, from April 1, 2024, until March 31, 2025.
• This incentive was previously introduced as the Prototype Rural Retention Incentive by the Province in several rural communities in the north in 2021. The incentive was then expanded to several rural and remote communities in Interior Health and Island Health in 2022 and 2023 respectively.
• The PRRI will be expanded to include 56 new communities across the province, bringing the total number of communities supported to 74.
• All health-care workers are eligible for this program, provided they are employed in regular positions by a health authority or Providence Health Care (HAs/PHC) in eligible communities.

List of eligible communities include:

• Kootenay Lake
• Arrow Lakes
• 100 Mile House
• Williams Lake
• Cache Creek
• Grand Forks*
• Kettle Valley*
• Salt Spring
• Port Alberni
• Mt Waddington*
• Port Alice*
• Port Hardy*
• Port McNeill*
• Fort St. James
• Fraser Lake
• Daajing Giids*
• Port Clements*
• Prince Rupert*
• Port Edward*
• New Hazelton*
• Dawson Creek*
• Tumbler Ridge*
• Fort St. John*
• Hudson’s Hope*
• Fort Nelson*
• Bella Coola
• Bella Bella
• Powell River City

*previously eligible for the incentives.

Recruitment incentives:

• GoHealth BC is B.C.’s innovative travel health-care service in partnership with Northern Health Authority (NHA), as part of B.C.’s Health Human Resources Strategy - Action 34.
• In March 2024, NHA and HSA signed a memorandum of understanding (MOU) to start hiring HSPBA members into GoHealth BC. Medical-lab technologists will be the first allied health profession to be launched in select communities.
• GoHealth BC deploys HA-employed travel staff to rural and remote communities across B.C.
• By providing staff with the opportunity to take flexible, short-term deployments, GoHealth BC provides an alternative to agency work and supports sites in B.C. to stay open and sufficiently staffed.
• join the GoHealth BC program from outside of B.C.; or
• are new to the public sector (have not been employed by a B.C. health authority or any other Health Employers Association of BC employer, or by a First Nation service provider or the First Nations Health Authority, or by a private/affiliate long-term care/assisted-living employer in B.C.) for a minimum of 12 months prior to joining GoHealth BC.
• Health-care workers who are employed by third-party staffing agencies are eligible for the incentive if they meet the eligibility criteria above.
• Eligible health-care workers will receive up to $10,000 in signing bonuses.
• To support the unique needs and challenges of working in remote communities, eligible health-care workers in priority occupations could receive up to $30,000 for filling identified high-needs vacancies in rural and remote communities.
• Starting April 1, 2024, priority occupation health-care workers filling eligible positions will receive up to $30,000 in Northern Health, and up to $20,000 in rural and remote areas in other health authorities.
• Eligible health-care workers will be required to sign a two-year return-of-service agreement.
• The Province is focusing on staffing difficult-to-fill vacancies in urban and metro communities.
• Health-care workers in priority occupations may receive up to $15,000 should they choose to accept a permanent position in eligible difficult-to-fill or high-needs vacancies, starting April 1, 2024.
• Eligibility for the incentive focuses on health-care workers who are new to B.C.’s public-health system and those who may be returning to the system.
• Anesthesia assistant
• Biomedical engineering technologist 
• Cardiac technologist
• Clinical counselor
• Community health worker
• Community support worker (mental health and addictions)
• Environmental health officer
• Medical laboratory assistant
• Medical laboratory technologist
• Medical radiation technologists (magnetic resonance imaging technologist, radiation therapist, radiological technologist, nuclear medicine technologist, PET technologist, CT technologist)
• Occupational therapist
• Perfusionist
• Pharmacy technician
• Physiotherapist
• Psychologist
• Rehabilitation assistant
• Respiratory therapist
• Social worker
• Sonographer
• Speech language pathologist 

What to know about training and licensing investments for allied health

To bolster and support the growth of the health workforce in B.C., the Province is investing up to $7.6 million to:

• Programs include perfusionist, medical lab technologist, medical radiological technologist, magnetic resonance imaging technologist, nuclear medicine technologist, radiation therapist, respiratory therapist, environmental health officer, advanced care paramedics, primary care paramedics, clinical counsellors, biomedical engineering technologists and rehabilitation assistants.
• Programs include physiotherapist, occupational therapist, speech language pathologist and dietitian.
• New allied health graduates will be provided with a $500 bursary to help cover the costs associated with their licensing or certification exams. This funding will be made available on an ongoing basis, retroactively applied to Jan. 1, 2023.
• The ministry is funding the seat cost, tuition, books, fees and pre-requisites to support the education and training of combined lab and x-ray technologists in partnership with the Northern Alberta Institute of Technology and health authorities/Providence Health Care, which are funding an employee stipend and moving expenses.
• The ministry will support kinesiology graduates with an interest in public health-care settings through grants that support them to complete the Clinical Exercise Physiologist certification.
• Other high-demand employer-sponsored earn and learn programs are in development.

What to know about allied health recruitment progress in the province

Since 2017, the government has been working hard to increase the supply of allied health professionals in the province. A key component of these efforts is the development and implementation of the Health Human Resources (HHR) Strategy.

Supports for internationally educated physiotherapists (IEPTs) was launched in June 2023, with the addition of internationally educated medical laboratory technologists (IEMLTs) and IE occupational therapists (IEOT) in January 2024. Additional programs are under development.

The IEPT bursary program launched on June 12, 2023. Data to date:

• IEPT bursary applicants - 261
• applicants with signed ROS - 194
• financial rewards distributed - 138 totalling $93,719.13

The IEMLT bursary program launched on Jan. 15, 2024. Data to date:

• IEMLT bursary applicants - 288
• applicants with signed ROS - 114
• financial rewards distributed - 3 totalling $1,602.95

The IEOT bursary program launched on Jan. 15, 2024. Data to date:

• IEOT bursary applicants - 34
• applicants with signed ROS - 22
• financial rewards distributed - 34 totalling $41,756.34
• NewSupportsAlliedHealth_Chinese(simplified).pdf
• NewSupportsAlliedHealth_Chinese(traditional).pdf
• NewSupportsAlliedHealth_Tagalog.pdf

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