Medical Tourism 2019 – A Gap Analysis

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Introduction

Medical tourism, as an individual industry distinguished by special economic implications, is the direction that is becoming increasingly popular and promising. Many countries provide foreign citizens with services in various fields, including cardiac examinations, dental treatment, prosthetics, and other procedures. Medical tourism develops dynamically and has an increasing influence on national healthcare systems and the activities of insurance companies. Unable to solve specific problems in their own countries, patients choose a state, a physician, and a clinic where they can be offered the most relevant examination and treatment. Such an approach allows building national and regional socially-oriented healthcare systems, thereby improving the quality of medical personnel training and patient care and introducing modern technologies more efficiently. According to Behrmann and Smith (2010), this direction of tourism is similar to many industrial sectors in the context of globalization since an ever-growing number of interested parties cause the “interconnectedness of transnational economies” (p. 81). However, not only positive implications exist but also significant barriers that manifest themselves in domestic and world healthcare systems.

In particular, the problems affect citizens’ access to the services of the specialists of a certain profile within their countries since medical centers that are ready to earn on foreign patients are heavily loaded. Other issues also raise concerns and threats to national healthcare systems, such as the leakage of professional staff to other countries, the cost of treatment, and other nuances. In order to consider all the potential gaps that arise as a result of growing interest in medical tourism, existing studies in this area should be considered. A detailed literature review aimed at describing the challenges and barriers associated with the industry in question will help identify trends in this area and link the main factors that affect the quality and popularity of foreign treatment.

As a base for the review, valuable academic sources will be involved as resources related to the topic under consideration and raising questions about the impact of medical tourism on the national healthcare system of the United States and other states. The use of relevant studies will provide an opportunity to consider such topics as problems for importing and exporting systems, general barriers arising from the regulation of this sector, examples from world practice, and potential positive implications. As de la Hoz-Correa and Muñoz-Leiva (2019) note, in their optimal expression, private and public organizations contribute to the development of national healthcare systems. This literature review is aimed at identifying problems and barriers arising from the expansion of interest in medical tourism.

Literature Review

The use of a literature review to analyze and synthesize valuable information regarding the topic under consideration may facilitate the search for relevant data and confirm or refute the hypothesis of the difficulties and barriers that medical tourism entails. The division of the sources utilized in the relevant sections will provide an opportunity to assess the stated topics as deeply as possible and evaluate how advanced the studies in these areas are. In the future, these findings may be applied as a basis for identifying interventions aimed at improving the situation in national and global healthcare systems. All the sources used are scholarly peer-reviewed articles and contain the research of different profiles. Based on the proposed work plan, to start, it is essential to consider what challenges arise for importing healthcare systems as a result of medical tourism and its increasing influence and why these issues are relevant to national economies.

Importing Systems Issues

National health resources allow estimating not only the level of medical services in a particular country but also its economic development since the growth of this industry requires stable financing and the government’s interest in improvement and innovation. Nevertheless, when considering the features of this sphere in the USA, one can note some difficulties that are expressed in importing systems and entail issues within the country. According to Béland and Zarzeczny (2018), despite the fact that only 9% of the US population is uninsured, many citizens are forced to seek medical help in other countries because of the high cost of care (p. 68). The authors emphasize that the globalization of tourism associated with treatment creates favorable conditions in some states, thereby encouraging the rejection of domestic services (Béland & Zarzeczny, 2018). Bustamante (2014) confirms these challenges and notes that traveling south is a common practice for US residents. This, in turn, has a negative effect on the development of the private healthcare industry and minimizes budget revenues through taxes.

Another potential challenge that may manifest itself is legal difficulties. Cochran (2018) argues that there is a certain risk in organizing financial relationships between stakeholders concerned due to the large number of conventions that the parties assume. When a non-resident applies to local health care institutions, there are characteristic procedures that determine the order for applying for medical services, which differs from those provided for citizens. Cochran (2018) compares the relationship between the United States and Canada in the context of medical tourism and notes that both countries are faced with the issues related to fees among lay-owned brokers, which, in turn, may have negative consequences in accordance with the laws established. As a result, both states may lose potential customers, and those funds that are spent on creating an appropriate innovation base may be unjustified. Such an outcome is highly undesirable in the context of the globalization of medical tourism and offers from other countries. Therefore, legal nuances may have severe implications for the sustainability of a given industry at the national level.

As a result, the findings confirm that the spread of medical tourism may have a negative impact on importing healthcare systems. Access to the services of the specialists of different profiles among low-income citizens is the issue that entails dissatisfaction with the existing order (Béland & Zarzeczny, 2018; Bustamante, 2014). In addition, valuable and talented employees often prefer to leave abroad, thus having more favorable prospects for professional and financial growth due to the constant influx of patients. Even referral programs that are stimulated by national healthcare institutions cannot guarantee a steady income due to the globalization of tourism and potentially better opportunities offered in other states (Cochran, 2018). The lack of experienced specialists and too high prices for services hamper the development of this sector and force local providers to look for additional measures to engage foreign citizens. At the same time, problems not only in the importing but also the exporting system may be observed, and the assessment of the corresponding academic resources can make it possible to identify the key challenges that the spread of medical tourism entails.

Exporting Systems Issues

The findings applied for this literature review prove that exporting healthcare systems may also be affected negatively by increasing interests in medical tourism. In particular, Esiyok, Çakar, and Kurtulmuşoğlu (2017) argue that difficulties with follow-up caring for patients upon their return are a frequent challenge. Medical records, treatment programs, and other nuances fall under the jurisdiction of the state in which the procedures have been conducted. As a result, people who come from abroad with certain diagnoses and recommendations are often forced to prove the legitimacy of the specific results of interventions by healthcare providers in other countries. Connell (2015), in turn, analyzes the shortcomings of increased demand for medical services abroad and notes that US residents are faced with such a nuance as “long waiting lists for non-priority procedures” (p. 398). This challenge arises from the aforementioned importing difficulties and is due to the fact that priority in providing complex and narrowly focused diagnostic studies is increasingly given to foreign guests who are willing to spend money in local clinics. As a result, the residents of the state do not have comprehensive access to relevant services.

All the problems accompanying the expansion of medical tourism are caused by additional factors. When analyzing this topic, de la Hoz-Correa and Muñoz-Leiva (2019) note that, for instance, difficulties for medical providers are caused by globalization and integration policies, and the insufficient influx of guests to local clinics is due to the high degree of information accessibility. As the authors state, today, people all over the world have access to the information base of almost any healthcare institution, which allows them to choose the best services in their opinion in terms of value for money (de la Hoz-Correa & Muñoz-Leiva, 2019). This, in turn, has negative manifestations in the US healthcare system that, as mentioned above, is characterized by the high cost of medical care and narrow-profile treatment procedures. In addition, according to Connell (2015), even in states with underdeveloped economies, the introduction of modern innovative technologies helps to ensure demand for health services. As a result, high prices are a challenge for local medical providers.

When integrating the findings, one can note that the authors agree on the impact of medical tourism on clinics’ work schedule. For instance, according to Béland and Zarzeczny (2018), the activities of specialists responsible for providing services to foreign patients is in positive correlation with demand for specific procedures. By an empirical method, the authors prove that “brain drain” and other related problems are the result of appropriate coordinating work and policies maintained at the national level (Béland & Zarzeczny, 2018, p. 68). Accordingly, if local clinics count on profits from foreign visitors, they need to ensure that medical services are not only high-quality but also affordable. When not only US residents cannot rely on specialized medical interventions at any time but also tourists, this creates negative conditions for maintaining a high level of exporting systems and entails a fall in demand (Connell, 2015). Therefore, the negative implications of medical tourism are observed in the US healthcare system that, in turn, is not adapted comprehensively to supporting this industry.

General Barriers

When evaluating the scope of medical tourism not in terms of implications for importing and exporting systems but in relation to more general features, a number of barriers may be identified by reviewing relevant sources. In their research, Behrmann and Smith (2010) argue that this industry has not been studied comprehensively and deeply in order to make accurate conclusions and in-depth analysis. In particular, the authors note that the motivation that drives patients and their satisfaction with the quality of services provided are the variables that need to be taken into account when planning the development of this sphere (Behrmann & Smith, 2010). However, according to Kim, Sheppard, de Gara, Karmali, and Birch (2016), in addition to estimating the income received by the healthcare system at the expense of foreign patients, no additional research is conducted, which is an omission. Moreover, as Behrmann and Smith (2010) remark, it is sometimes challenging to obtain financial information from private foreign clinics since their reporting falls under local jurisdiction. As a result, an insufficient amount of research data may slow down the progress of medical tourism and give misconceptions about patients’ global movements.

The financial issue is also often a barrier to the sustainable development of medical tourism in the United States. Skountridaki (2017) considers this area from the perspective of funds that provide the work of clinics involved in the provision of services to foreign patients. The author notes that although money in private healthcare comes from both private and public sources, the latter category of resources is significantly lower (Skountridaki, 2017). In other words, medical institutions that operate not for the state but individual companies are forced to seek funds for the development and promotion of tourism on their own, almost not counting on financial revenues from the public sector. Considering that “only 2.1% of total health expenditure is covered by private insurance,” state authorities should be interested in supporting this industry (Skountridaki, 2017, p. 260). Therefore, as Behrmann and Smith (2010) state, the desire to raise the cost of specific services is a natural step towards profit preservation, while potential patients, conversely, look for the least high prices. As a result, the dependence of supply and demand is erased, which creates a barrier to the normal development of medical tourism.

Finally, another common problem that may be acute is a moral issue. Behrmann and Smith (2010) note that today, many foreign clinics are ready to provide a variety of services, including both standard treatment, for instance, dental prosthetics, cardiac diagnostics, and other common practices, and complex forms of healing, such as reproductive therapy. This, in turn, raises the issue of morality since some procedures are performed confidentially and cannot be monitored by local healthcare authorities. Due to the fact that clients are willing to pay money, medical providers conclude agreements with them, which often contradicts the domestic laws of the countries from which guests come. The intentional termination of pregnancy is one of the most pressing issues because this procedure is prohibited in many healthcare institutions, while in the world, there are many clinics that are ready to accept females anonymously (Behrmann & Smith, 2010). Therefore, the problem of morality and ethics is also one of the factors hindering the free expansion of medical tourism.

Examples from the World Practice

In order to understand how the medical tourism system works and what gaps exist, it is necessary to consider some examples from global practices where this industry is promoted. Hanefeld, Smith, Horsfall, and Lunt (2014) examine this sphere in the UK and analyze selected issues, in particular, the most popular services for which the British prefer to travel abroad, the existing gaps in the local system for working with foreign patients, and potentially priority areas for development. According to the authors, dental prosthetics, cosmetology, and bariatric procedures are among the most sought-after by the country’s citizens (Hanefeld et al., 2014). The main reason is the high cost of such services within the state. At the same time, Hanefeld et al. (2014) remark that the UK as a destination for medical tourism is also popular because its level of healthcare is high. However, according to the authors, the research of this issue contains gaps, and additional activities are needed to evaluate a specific treatment environment in British clinics (Hanefeld et al., 2014). This is an obstacle to a comprehensive assessment of this area in the country.

As an example of the country where the maintenance of medical tourism is a pressing issue, one can cite Canada where healthcare workers and patients themselves make many efforts and pay much attention to the barriers and factors hindering the industry. Snyder, Johnston, Crooks, Morgan, and Adams (2017) consider the actions of this state in terms of creating a solid base for providing the conditions to maintain the sphere effectively and note that difficulties in separating the private and public health systems are a key issue. Specific conventions, in particular, the legislation that determines the direction of Canadian medicine, and legal regulations hinder the development of inbound tourism. Despite the fact that the course for the development of this direction is supported, the authors argue that the local authorities consider medical tourism primarily as “a means to generate revenue for the public health system” (Snyder et al., 2017, p. 140). This desire indicates that the government is interested in strengthening the public but not the private sector, which is a barrier.

Finally, one of the main issues that are associated with medical tourism and can inhibit its development is safety. Horowitz, Rosensweig, and Jones (2007) argue that the risk of complications after procedures in foreign clinics is a serious concern because, unlike treatment in domestic healthcare institutions, medical providers in other countries cannot guarantee unhindered access to their services at any time. The authors focus on postoperative patients and note that their rehabilitation in their home state is an unresolved issue (Horowitz et al., 2007). Accordingly, in order to maintain the sector of medical tourism system at a proper level, it is essential for those who choose this method of treatment to have an opportunity to count on competent and comprehensive assistance from domestic providers. Otherwise, too high risks may cause significant reduction in traveling abroad and slow down the globalization of tourism.

Potential Positive Influences

In addition to the barriers and challenges that impede the development of medical tourism, it is also essential to note the positive factors that this activity provides. As Jang (2018) remarks, one of the main advantages is the profit that receiving parties extract. In addition, the author mentions an increase in educational attainments as one of the beneficial implications (Jang, 2018). When foreign guests come for treatment, local medical providers have an opportunity to get acquainted with the practices and peculiarities of work in other states. Moreover, specialists themselves have to be highly qualified in order to provide relevant services. Jang (2018) considers immigrants in the United States as one of the categories of people involved in medical tourism and notes a high percentage of services provided to the citizens of neighboring countries. As a result, local healthcare providers improve their skills in this mode and make a profit.

Another significant advantage that medical tourism provides is patients’ quality of life. Suess, Baloglu, and Busser (2018) conduct a study aimed at describing the merits and positive implications of this trend. The authors argue that in case of the successful implementation of accessibility and quality principles, “the desirability and enjoyment of living in a community” increase (Suess et al., 2018, p. 235). Also, the authors note positive opinions that their respondents express regarding medical tourism and its importance in the world practice (Suess et al., 2018). The inability to obtain appropriate healthcare services in a specific environment is not an obstacle if a special assistance program is offered in other states. The idea that Americans are less likely to seek help from foreign medical professionals than immigrants is promoted by Jang (2018) who states that this may be due to sufficiently high standards of the local system. Therefore, such a positive implication is an incentive for the development of medical tourism.

As a positive implication of the development of medical tourism, one can note easing pressure on local providers. Zolfagharian, Rajamma, Naderi, and Torkzadeh (2018) remark that the American healthcare system is loaded due to high demand for non-emergency services, which creates additional difficulties and increases the intensity of work. Despite the fact that potential earnings are lost, specialists have an opportunity to concentrate on more urgent tasks, while citizens who want to undergo specific procedures, for instance, plastic surgery, can utilize the services of foreign providers. In addition, as the authors state, the possibility of saving money is one of the main advantages that people value in medical tourism (Zolfagharian et al., 2018). Choosing a particular clinic with cheaper services is important for many citizens. Therefore, due to rising prices for treatment in the US, people can benefit and undergo the necessary procedures for less money.

Gaps in the Literature

The conducted literature review shows that the field of medical tourism is a topical industry, in which, however, there are some significant problems that impede its activities. The academic sources used provide valuable information regarding the integration of this sector into healthcare systems and, in particular, the American model. However, when evaluating these resources from the standpoint of the completeness of information and theme coverage, one can note some gaps that are not affected and do not allow assessing this topic comprehensively. For instance, specific studies on the analysis of medical tourism applied to the United States are based on the comparison of the local healthcare system with those of neighboring countries. Some authors prefer to research the interaction of American and Mexican providers and patients, while the globalization of the phenomenon under consideration requires comprehensive evaluation (Kim et al., 2016; Jang, 2018). This omission affects the quality of the findings and reduces the credibility of these studies in relation to the overall assessment of medical tourism and its barriers.

Also, regarding gaps in the reviewed literature, it is crucial to mention the lack of information about the role of medical tourism in case of its acceptance as an official state program. For instance, Behrmann and Smith (2010) cite various issues that are associated with this phenomenon and argue that the satisfaction of the population and people’s motivation are the driving forces behind the spread of access to certain services for foreign patients. Nevertheless, all the implications are considered in the context of interaction between private and public systems, and little attention is paid to the topic of adopting such tourism as a formal healthcare development program. The analysis of such information could allow bringing relevant data to the responsible authorities for the consideration and evaluation of potential bonuses that increased cooperation with foreign clinics might bear. Conversely, the greatest emphasis is placed on difficulties and barriers, while the ways of overcoming these challenges are as a significant topic as the features of the integration of medical tourism into the current system.

Finally, another gap that is an omission in the assessment of barriers to medical tourism is the lack of the description of legislative procedures. There may be the discussions of the methods that could simplify the system of processing documents for patients’ traveling abroad and the engaging foreign guests. Some authors describe the challenges that people face when making requests to clinics in other countries and follow-up care in domestic healthcare institutions (de la Hoz-Correa & Muñoz-Leiva, 2019; Esiyok et al., 2017). At the same time, to make the study of this industry more valuable, it is essential to provide information on how people can establish interaction with foreign providers and what measures may be taken to simplify legal barriers to visa and other issues. This topic is relevant because, due to the absence of health insurance among some citizens, they have limited access to the healthcare system and, therefore, cannot count on comprehensive assistance from the responsible authorities. A detailed study of this topic may allow finding the ways of solving this problem and helping interested parties to obtain the necessary services both abroad and within their state.

Suggestions for Further Research

The analysis of relevant information on barriers and challenges in medical tourism makes it possible to identify those topics that may be valuable for further research. When taking into account the gaps revealed in the reviewed literature, it is essential to pay more attention to the legal conventions related to the problems of access to treatment abroad and subsequent follow-up care in domestic healthcare institutions. In particular, the issues of visa processing and networking with foreign clinics can be useful topics for research as the mechanisms to help those concerned.

Also, in relation to the US healthcare system, more attention should be paid to cooperation with different regions in order to identify potential improvements and borrow valuable practices. In addition to interaction with neighboring countries, it is crucial to assess the ways of communication with other states under the globalization of medical tourism and the constant expansion of the innovation base. If relevant studies are carried out, it is important to affect not only the mechanisms for introducing current methodologies but also the possibilities of expanding access for people from different social classes. This will contribute to solving the problem of contradictions between private and public healthcare systems and provide an opportunity to reduce pressure on local medical providers.

Recommendations for further research may also include the analysis of the most sought-after areas in medical tourism to determine the potential ways of development within the American healthcare system. The assessment may relate to the procedures for which local residents leave abroad, as well as those services that attract foreign visitors to the United States. Such research will provide an opportunity to identify the optimal areas for interventions and funding as the spheres in demand. In general, the literature review offers relevant information, and the goal of the study aimed at identifying barriers and gaps in medical tourism has been achieved.

Conclusion

The conducted literature review presents current findings on the barriers and gaps in medical tourism in relation to the US healthcare system and the world practice in general. Through the evaluation of academic resources, valuable information is obtained regarding the challenges faced by both clinics and patients in establishing interaction. Among the most significant issues, it is necessary to mention such problems as access to the services of medical specialists, follow-up care, the leakage of valuable and talented employees, the ambiguity of private and public healthcare institutions’ work, as well as moral and ethical nuances. As the gaps in the reviewed literature, there are such omissions as the insufficient assessment of the legal framework, the importance of medical tourism in relation to innovations, and the interaction of American medical providers with guests from different states. Further research may address the ways of building cooperation, the methods of facilitating visa and other legal issues, as well as the merits of providing greater access to relevant services to the population.

References

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Béland, D., & Zarzeczny, A. (2018). Medical tourism and national health care systems: An institutionalist research agenda. Globalization and Health, 14(1), 68. Web.

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Cochran, R. G. (2018). Health law: Canadian medical tourism: Expanding opportunities and reducing legal risks for American healthcare providers. The Judges’ Book, 2(12), 65-72.

Connell, J. (2015). From medical tourism to transnational health care? An epilogue for the future. Social Science & Medicine, 124, 398-401. Web.

de la Hoz-Correa, A., & Muñoz-Leiva, F. (2019). The role of information sources and image on the intention to visit a medical tourism destination: A cross-cultural analysis. Journal of Travel & Tourism Marketing, 36(2), 204-219. Web.

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Horowitz, M. D., Rosensweig, J. A., & Jones, C. A. (2007). Medical tourism: Globalization of the healthcare marketplace. Medscape General Medicine, 9(4), 33.

Jang, S. H. (2018). Here or there: Recent US immigrants’ medical and dental tourism and associated factors. International Journal of Health Services, 48(1), 148-165. Web.

Kim, D. H., Sheppard, C. E., de Gara, C. J., Karmali, S., & Birch, D. W. (2016). Financial costs and patients’ perceptions of medical tourism in bariatric surgery. Canadian Journal of Surgery, 59(1), 59-61. Web.

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Zolfagharian, M., Rajamma, R. K., Naderi, I., & Torkzadeh, S. (2018). Determinants of medical tourism destination selection process. Journal of Hospitality Marketing & Management, 27(7), 775-794. Web.

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