Medical tourism

Medical tourism is a category of travel where people go to another country for medical treatment, often for lower costs or to enjoy a vacation along with their treatment.

Typically, medical tourism involves residents of high-income countries seeking medical treatment in low-income countries; often the costs are much lower. The reverse also happens; residents of less-developed countries may travel to a place with more modern hospitals and better-trained staff.

Residents of countries with national health care schemes – such as Canada and Great Britain – may travel to avoid the long waiting times which elective procedures sometimes have in those countries. Others may travel for work not covered by insurance; many insurance schemes do not cover cosmetic surgery or gender reassignment operations, Canadian health care does not include dental, and so on. Also, couples are increasingly seeking fertility treatments abroad.

Residents of countries with heavily-regulated pharmaceutical and healthcare systems may seek treatments not approved within their home countries, but approved in countries with different regulatory systems. This includes exotic treatments with limited to no scientific backing. These instances of medical tourism can be highly risky, or serve as a last-ditch effort when other treatment options have been exhausted.

Availability of good low-cost medical services can also be a factor in selecting a destination for working abroad, studying abroad and especially retiring abroad.

Possible benefits
The most obvious benefit is lower cost of treatment. All the professional services &mdash; doctors, dentists, optometrists, physiotherapy, lab tests, hospitals, etc. &mdash; are generally cheaper in low-income countries. Many related items, such as eyeglasses, dentures or common drugs, are also usually cheaper. However items that have to be imported, such as dental implants or certain drugs, may actually be more expensive.

Many travelers incorporate a holiday along with the treatment as they may need time to recover after surgery or have their progress monitored through other treatment, and vacations also tend to be cheaper than vacations in their home country. Some even retire abroad in an area where they can get good cheap treatment.

Medical tourists sometimes can avail themselves of the best doctors and hospitals of a foreign country. The hospitals/clinics in medical tourist destinations may also be credentialed in first world countries and doctors are sometimes graduates of first-world medical schools.

Waiting lists are sometimes shorter in another country, for those with the means to pay. For example well-heeled Canadians may jump the queue at home by buying treatment in U.S. private hospitals, where specialised care can be had quickly – if money is no object.

Residents of jurisdictions which criminalise abortion may find their options less restricted elsewhere; for example, after the 2022 U.S. Supreme Court decision upholding state laws severely limiting the legality of abortion in some U.S. states, residents of the affected states immediately started traveling to other states for legal abortions. The same is happening across national borders.

Medical tourism also gives people a chance to incorporate local therapies &mdash; India's yoga and Ayruvedic medicine, Thai massage, traditional Chinese medicine, etc. &mdash; with their ongoing treatments.

Childbirth
If your country, or the country you're visiting, uses jus soli as a basis for citizenship, your child's birthplace will affect their eligibility for a passport. For instance, a citizen of Point Roberts, Washington who rushes to the nearest hospital to give birth is free to apply for baby's first Canadian passport with little more than their newly-minted British Columbia birth certificate ― even if they are not themselves Canadian. They may also want to visit their home country's embassy or high commission (in this case, the US consulate in Vancouver) to register a birth abroad. Conversely, if a Mexican girl espouses a Canadian boy who was born abroad to parents serving in Canada's Cold War NATO deployment to Lahr, West Germany any of their children born abroad will not be Canadian citizens.

Birth tourism may allow a way around immigration laws or circumvention of mainland China's one-child or two-child policies; jus soli countries (where anyone born in the country without diplomatic immunity is entitled to birthright citizenship) are the preferred destinations. The number of countries offering jus soli, especially on an unconditional basis, is dropping, but notably includes the United States and Canada. Australia for example abandoned unconditional jus soli in 1986, as did Ireland and France. Outside the Americas, jus sanguinis (citizenship by "blood" or descent) is most common. Some countries offer conditional jus soli; Australia and the United Kingdom offer jus soli if at least one parent is a legal permanent resident at the time of the child's birth, while China offers jus soli if both parents are stateless and legally settled in China at the time of the child's birth.

In some cases, the foreign hospital or medical facility is actually geographically closer. This can have unintended consequences; many Campobello Island (New Brunswick) kids have Maine birth certificates as it's the only point reachable year-round by bridge, but that dual citizenship leaves these "border babies" liable for U.S. income taxes for life while living as Canadian citizens in Canada. A few decades back when the US military used conscription, these kids could be drafted.

Generic medications
Another reason for seeking treatment abroad can be the lower cost or better availability of some medications.

One conspicuous example is Americans going to Canada to obtain insulin at roughly a tenth of the US price. There may be complications; getting a prescription from a Canadian doctor may not be either quick or cheap, getting a Canadian pharmacy to fill a US prescription might require extra documentation, a prescription might not cover a long-term supply, and if you do get, say, a six-month supply then you need to worry about shelf life. Your doctor is likely the best source of advice.

As a general rule common drugs, e.g. most things on the WHO list of essential medicines, will be considerably cheaper in low-income countries. On the other hand, imported items such as dental implants and newer or more unusual drugs are often more expensive. There may also be differences in prescription rules; for example in China, Viagra (or a Chinese copy?) and many antibiotics are available over-the-counter.

In the Philippines, Viagra and Cialis are often sold by vendors walking around tourist areas; the same guys have items with obviously bogus Rolex and Rayban labels, so while they are cheap (about a dollar a pill if you bargain well), buying drugs from them may be quite risky. Caution is required here since these drugs affect the circulatory system and can be quite dangerous for some men; talk to a doctor if you are considering them.

One blatant example of an enormous price difference is Harvoni (ledipasvir/sofosbuvir) for treating Hepatitis C. Previous treatments involved injections, often had quite nasty side effects, and gave only about a 60% chance of curing the disease; Harvoni was the first (about 2011) of a new generation of drugs that are taken by mouth, have fewer side effects, and cure well over 90% of patients. Unfortunately, in the US it is patented and sells for about $1000 a pill, over $80,000 for the usual treatment of 12 weeks at one pill a day. At least two other drugs with similar properties are now on the market and cost less, but still in the tens of thousands. Many insurance schemes &mdash; including the British National Health, Canadian provinces, and many insurers in the U.S. &mdash; will not pay for these treatments unless you are desperately ill, so some patients go untreated and may spread the disease.

India refused to grant the Harvoni patent on grounds it contained no significant original work &mdash; the key part of the research was done at a British university &mdash; and in India the whole 12-week course of treatment costs about $1000. This is not some dubious knock-off from a 'pirate' vendor; the Indian companies involved are large and reputable, and are licensed by the original developer. A 12-week vacation in India, including air fare, good hotels, and Harvoni treatment might cost roughly what the treatment alone would in the US or Europe, and other countries such as Egypt and Bangladesh also have Harvoni at low cost.

For other things, the issue may be availability rather than cost. It can take years for a new or experimental treatment to prove its worth and obtain regulatory approval, and it may be approved in some countries long before others. The dengue fever vaccine, for example, was approved in Mexico, Brazil and the Philippines in late 2015 but in the US not until 2019. Cuba has a lung cancer treatment called CimaVax that (as of mid-2017) is available only there and in a few other Latin American countries; other countries are running tests but are unlikely to approve it soon. Such treatments do have some scientific evidence of safety and effectiveness, but they should be considered risky since they have not yet undergone the full analysis required for worldwide approval. Again, consult your own doctor or an appropriate specialist at home.

Beware of bogus treatments which may be on offer in countries with weak regulations, poor enforcement, or easily bribed officials. A conspicuous example is laetrile or amygdalin, a purported cancer cure that is both ineffective and dangerous but vigorously marketed. Some quacks offering it have been prosecuted in the US, and at least one has set up a clinic in Mexico. A general rule is that if any "miracle cure" makes claims that seem too good to be true, then it is almost certain that they are indeed not true. Beyond that, check with your own doctor.

Destinations
Some popular medical tourism destinations worldwide are:
 * Argentina: Russian birth tourists who used to take Miami, Florida for granted as a flag of convenience have started turning up in Buenos Aires as one of the few Western locations where Russian flights (and their passengers) are not rapidly becoming persona non grata in the wake of the Russian Federation's unprovoked 2022 invasion of Ukraine. Visa requirements are lax in comparison to Canada, the United States of America or other popular destinations; the medical care is good and an Argentine-born child gives the parents an easier path to applying to immigrate to Argentina.
 * Costa Rica: Joint Commission International accredited private hospitals, state-of-the-art-equipment, proximity to the United States and Canada, English-speaking medical personnel, highly trained doctors, dentists, oral surgeons, and cosmetic surgeons with costs generally up to 70% of what would be paid in the United States.
 * Greece: Greece is becoming increasingly popular as a destination for high-quality cosmetic surgery especially for patients from the United Kingdom. Because Greece is a member of the European Union, its health industry is kept to a good standard and under thorough checks and safety regulations.  In the private sector the Metropolitan Hospital in Athens is regarded as being the best in Greece, and the plastic surgeons associated with that hospital are among the best.  Greece is also traditionally regarded as a popular tourist destination and therefore its tourism and service sectors are well-developed. The widespread knowledge of English language among the general population is also an advantage.
 * India: Especially for heart surgery, hip resurfacing, dental, cosmetic surgery and high end surgeries. English as a primary language is also an advantage.
 * Singapore: Has highly accredited hospitals and a very high-quality infrastructure, but more expensive than its neighbours Malaysia and Thailand
 * Thailand: Low labour costs resulting in lower treatment costs. Some Thai hospitals have a lot of experience with gender reassignment surgery.
 * Hong Kong: High quality infrastructure and good quality doctors with high English proficiency.
 * Mexico: Dental care is the best deal here. Because Mexico borders the United States, Americans in border states visit for dental care and minor checks out of convenience. The quality in Private Clinics and Hospitals is just about the same as in the U.S. Los Algodones, on the border with Arizona and California, is so well-known for dental tourism that it's been nicknamed "Molar City". Prescriptions, eyeglasses, cosmetic surgery, and even major surgeries will all cost significantly less in Mexico than in the U.S. (or other countries). Pharmacies catering to Americans are common in Tijuana and border cities near Texas. Mexican pharmacies often charge 90% less than U.S. pharmacies. The Farmacias Similares chain specializes in even cheaper generics. Some medications that require prescriptions in the U.S. can be purchased over the counter in Mexico.
 * Turkey: Istanbul is inexpensive by US and European standards for in vitro fertilization, optometry, cardiology and cosmetic procedures such as hair transplants.
 * South Korea: Known for being the world leader in cosmetic surgery.
 * United States: By far the world's leading nation in medical research, with the most cutting-edge treatment methods and infrastructure available to those who can afford it. The downside is that consultation and treatment costs are the highest in the world. Also a popular birth tourism destination due to the fact that all people born in the U.S. (other than those whose parents are on diplomatic posting) are automatically granted citizenship under the US 14th Amendment. Saipan, Northern Mariana Islands is popular for visitors from China as its visa policies are more lax than the continental US.
 * United Kingdom: If you can afford it, Harley Street in London remains an area where medical specialists can be consulted for a substantial fee.
 * Canada: With a high standard but significantly lower cost, Canada is a popular medical tourism destination for Americans living near the border. While foreigners are not covered by Canada's universal healthcare system, the cost of drugs in Canada, even uninsured, can be as low as $1/10$ the price in the United States.

– and more recently, Brazil, Brunei, Colombia, Cuba, Malaysia, the Philippines, South Africa, Qatar and the United Arab Emirates

Important considerations
First, consider whether the treatment you are planning is the right for you. If you were denied the treatment, the denial may have had a good reason. Are you sure it will help you? What risks are there? Have you gone through all preliminary examinations or will they be done at the destination? Will the hospital back off if they find that you, in fact, shouldn't be treated in the planned way? Do you need to commit to lifestyle changes or training programmes that will continue after your return? If so, you should have the needed support at home.

Be sure you are allowing enough time in your travel to receive follow up care. You may need to stay days or weeks beyond the date of the medical procedure itself. Be realistic about the finances of medical tourism. Sure the medical treatment itself may be cheap. But when you add on airfare, hotels, taxis, restaurants – all in an unfamiliar city – the actual cost may be close to what you would pay at home.

Next, involve your home doctor in your plans! Having major surgery in a faraway country is not a decision you should take lightly. Research – what sort of questions should you ask your doctor about this procedure? How is the procedure typically performed, and will it be done this way where you travel? Who credentials doctors and hospitals in your destination country, and what credentials do your intended providers have? You should also determine what level of follow up care your procedure may require – in the days, weeks, and even years after the procedure. Who will provide this follow up care?

If a specialised procedure entails possible medical complications, your budget should permit a follow-up trip to your distant specialist.

Not all medical tourism is enjoyed by patients travelling away from their home country, or travelling to a third world region. For instance, migraine surgery is performed only in the US, and attracts patients from the Middle East and Africa, since their surgeons aren't able to perform this. If you are considering travel from within your country or outside of it, be sure to explore all of your options. Seek assistance from many sources in locating the right doctor and the right country.

Don't be surprised if insurance which would have fully paid for a medical procedure at home refuses to cover (or only partially covers) the same treatment abroad. Even within the same country, some provincial health insurance plans only reimburse what they would have paid in-province, leaving the traveller out-of-pocket. Insurers are also likely to refuse to cover transportation. Border crossing can also be complicated by the need to carry prescribed medicines; a prescription validly issued by a practitioner in one country may be meaningless in another.

Patients seeking treatment for mental health conditions, communicable disease or street drug addiction may encounter issues with immigration authorities if travelling internationally. "I'm Toronto mayor Rob Ford and I'd like to see a Chicago doctor about my crack cocaine problem" is the wrong thing to tell the US border patrol, unless the intention is to immediately turn back to seek medical treatment in-province. Gravenhurst is charming this time of year?

Consider the languages you speak and what is spoken in your country. In some countries, such as Singapore, Malaysia, India, the Philippines and South Africa, most educated people speak English. This can be an important consideration. Having a common language is not necessarily enough, though, if it is not the native tongue for both of you ("fluently" can mean different things), or you or the personnel speak it with a strong accent or with a strange jargon. There may be subtle nuances you'd better be able to convey and understand.

Make sure that you will get sufficient documentation on the treatment, such that it can be used for follow-up care at home.

Lastly confirm, and double check, your plans. How can you contact family members while abroad? Do you need a special visa or proof of ability to afford treatment in order to enter your destination country?

Stay safe
In the past, some discredited or bogus doctors set up shop outside U.S. borders to promote dubious or dangerous treatments or outright scams (alleged cures for cancer, lengthening body parts, etc.). Medical tourism today is far removed from these scammers but one must still be vigilant. At the very least, see a trusted doctor in your home country and discuss your plans for overseas treatment.

Reputation counts in medical treatment overseas. Look for top quality hospitals and clinics with well known doctors.

If anything goes wrong, don't be surprised if your local doctor is reticent to do anything to attempt to "fix" the work done by your foreign practitioner. This is a medical liability issue; local doctors fear lawsuits if an attempt to repair another surgeon's bungled procedure makes things worse.

Realize that, should a worst-case scenario occur, your legal avenues for making a malpractice claim or filing a lawsuit will be greatly reduced and often nonexistent. Freedom from frivolous lawsuits and huge insurance premiums are one reason why some doctors choose to practice overseas and can offer low cost treatments. On the other hand, this type of legal environment makes seeking doctors of good reputation all the more important.

Travellers might be impaired during recovery; see travellers with disabilities.