medical tourism united states

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• Diet & Nutrition
• Supplements
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

Why Patients Are Turning to Medical Tourism

Statistics, Benefits, and Risks

Planning Ahead

Frequently asked questions.

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

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

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

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

Medical Tourism Benefits

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

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

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

Lower Costs

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

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

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

Popular Countries for Medical Tourism

Dominican Republic

South Korea

Culture and Language

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

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

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

Insurance Incentives

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

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

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

Luxury and Privacy

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

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

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

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

Vacation in a Foreign Country

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

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

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

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

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

Bypassing Rules and Regulations

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

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

Talented Surgeons

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

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

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

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

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

Medical Tourism Risks

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

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

Poorly Trained Surgeons

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

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

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

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

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

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

Quality of Staff

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

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

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

Quality of the Facility

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

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

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

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

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

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

Flying Home After Surgery

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

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

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

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

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

Unplanned Illness

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

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

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

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

Language Barriers

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

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

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

A Word About Transplant Tourism

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

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

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

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

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

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

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

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

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

What are popular countries for medical tourism? 

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

How safe is medical tourism?

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

What countries have free healthcare? 

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

A Word From Verywell

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

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

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

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

Patients Beyond Borders. Facts and figures .

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

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

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

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

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

The Joint Commission. For consumers .

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

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

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

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

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

You are using an outdated browser. Upgrade your browser today or install Google Chrome Frame to better experience this site.

• Section 6 - Perspectives : Avoiding Poorly Regulated Medicines & Medical Products During Travel
• Section 7 - Pregnant Travelers

Medical Tourism

Cdc yellow book 2024.

Author(s): Matthew Crist, Grace Appiah, Laura Leidel, Rhett Stoney

• Categories Of Medical Tourism

The Pretravel Consultation

Risks & complications, risk mitigation, additional guidance for us health care providers.

Medical tourism is the term commonly used to describe international travel for the purpose of receiving medical care. Medical tourists pursue medical care abroad for a variety of reasons, including decreased cost, recommendations from friends or family, the opportunity to combine medical care with a vacation destination, a preference to receive care from a culturally similar provider, or a desire to receive a procedure or therapy not available in their country of residence.

Medical tourism is a worldwide, multibillion-dollar market that continues to grow with the rising globalization of health care. Surveillance data indicate that millions of US residents travel internationally for medical care each year. Medical tourism destinations for US residents include Argentina, Brazil, Canada, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, Germany, India, Malaysia, Mexico, Nicaragua, Peru, Singapore, and Thailand. Categories of procedures that US medical tourists pursue include cancer treatment, dental care, fertility treatments, organ and tissue transplantation, and various forms of surgery, including bariatric, cosmetic, and non-cosmetic (e.g., orthopedic).

Most medical tourists pay for their care at time of service and often rely on private companies or medical concierge services to identify foreign health care facilities. Some US health insurance companies and large employers have alliances with health care facilities outside the United States to control costs.

Categories of Medical Tourism

Cosmetic tourism.

Cosmetic tourism, or travel abroad for aesthetic surgery, has become increasingly popular. The American Society of Plastic Surgeons (ASPS) reports that most cosmetic surgery patients are women 40–54 years old. The most common procedures sought by cosmetic tourists include abdominoplasty, breast augmentation, eyelid surgery, liposuction, and rhinoplasty. Popular destinations often are marketed to prospective medical tourists as low cost, all-inclusive cosmetic surgery vacations for elective procedures not typically covered by insurance. Complications, including infections and surgical revisions for unsatisfactory results, can compound initial costs.

Non-Cosmetic Medical Tourism

Cancer treatment.

Oncology, or cancer treatment, tourism often is pursued by people looking for alternative treatment options, better access to care, second opinions, or a combination of these. Oncology tourists are a vulnerable patient population because the fear caused by a cancer diagnosis can lead them to try potentially risky treatments or procedures. Often, the treatments or procedures used abroad have no established benefit, placing the oncology tourist at risk for harm due to complications (e.g., bleeding, infection) or by forgoing or delaying approved therapies in the United States.

Dental Care

Dental care is the most common form of medical tourism among US residents, in part due to the rising cost of dental care in the United States; a substantial proportion of people in the United States do not have dental insurance or are underinsured. Dentists in destination countries might not be subject to the same licensure oversight as their US counterparts, however. In addition, practitioners abroad might not adhere to standard infection-control practices used in the United States, placing dental tourists at a potential risk for infection due to bloodborne or waterborne pathogens.

Fertility Treatments

Fertility tourists are people who seek reproductive treatments in another country. Some do so to avoid associated barriers in their home country, including high costs, long waiting lists, and restrictive policies. Others believe they will receive higher quality care abroad. People traveling to other countries for fertility treatments often are in search of assisted reproductive technologies (e.g., artificial insemination by a donor, in vitro fertilization). Fertility tourists should be aware, however, that practices can vary in their level of clinical expertise, hygiene, and technique.

Physician-Assisted Suicide

The practice of a physician facilitating a patient’s desire to end their own life by providing either the information or the means (e.g., medications) for suicide is illegal in most countries. Some people consider physician-assisted suicide (PAS) tourism, also known as suicide travel or suicide tourism, as a possible option. Most PAS tourists have been diagnosed with a terminal illness or suffer from painful or debilitating medical conditions. PAS is legal in Belgium, Canada, Luxembourg, the Netherlands, Switzerland, and New Zealand, making these the destinations selected by PAS travelers.

Rehab Tourism for Substance Use Disorders

Rehab tourism involves travel to another country for substance use disorder treatment and rehabilitation care. Travelers exploring this option might be seeking a greater range of treatment options at less expense than what is available domestically (see Sec. 3, Ch. 5, Substance Use & Substance Use Disorders , and Box 3-10 for pros and cons of rehab tourism).

Transplant Procedures

Transplant tourism refers to travel for receiving an organ, tissue, or stem cell transplant from an unrelated human donor. The practice can be motivated by reduced cost abroad or an effort to reduce the waiting time for organs. Xenotransplantation refers to receiving other biomaterial (e.g., cells, tissues) from nonhuman species, and xenotransplantation regulations vary from country to country. Many procedures involving injection of human or nonhuman cells have no scientific evidence to support a therapeutic benefit, and adverse events have been reported.

Depending on the location, organ or tissue donors might not be screened as thoroughly as they are in the United States; furthermore, organs and other tissues might be obtained using unethical means. In 2009, the World Health Organization released the revised Guiding Principles on Human Cell, Tissue, and Organ Transplantation, emphasizing that cells, tissues, and organs should be donated freely, in the absence of any form of financial incentive.

Studies have shown that transplant tourists can be at risk of receiving care that varies from practice standards in the United States. For instance, patients might receive fewer immunosuppressive drugs, increasing their risk for rejection, or they might not receive antimicrobial prophylaxis, increasing their risk for infection. Traveling after a procedure poses an additional risk for infection in someone who is immunocompromised.

Ideally, medical tourists will consult a travel medicine specialist for travel advice tailored to their specific health needs 4–6 weeks before travel. During the pretravel consultation, make certain travelers are up to date on all routine vaccinations, that they receive additional vaccines based on destination, and especially encourage hepatitis B virus immunization for unvaccinated travelers (see Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis & General Principles , and Sec. 5, Part 2, Ch. 8, Hepatitis B ). Counsel medical tourists that participating in typical vacation activities (e.g., consuming alcohol, participating in strenuous activity or exercise, sunbathing, swimming, taking long tours) during the postoperative period can delay or impede healing.

Advise medical tourists to also meet with their primary care provider to discuss their plan to seek medical care outside the United States, to address any concerns they or their provider might have, to ensure current medical conditions are well controlled, and to ensure they have a sufficient supply of all regular medications to last the duration of their trip. In addition, medical tourists should be aware of instances in which US medical professionals have elected not to treat medical tourists presenting with complications resulting from recent surgery, treatment, or procedures received abroad. Thus, encourage medical tourists to work with their primary care provider to identify physicians in their home communities who are willing and available to provide follow-up or emergency care upon their return.

Remind medical tourists to request copies of their overseas medical records in English and to provide this information to any health care providers they see subsequently for follow-up. Encourage medical tourists to disclose their entire travel history, medical history, and information about all surgeries or medical treatments received during their trip.

All medical and surgical procedures carry some risk, and complications can occur regardless of where treatment is received. Advise medical tourists not to delay seeking medical care if they suspect any complication during travel or after returning home. Obtaining immediate care can lead to earlier diagnosis and treatment and a better outcome.

Among medical tourists, the most common complications are infection related. Inadequate infection-control practices place people at increased risk for bloodborne infections, including hepatitis B, hepatitis C, and HIV; bloodstream infections; donor-derived infections; and wound infections. Moreover, the risk of acquiring antibiotic-resistant infections might be greater in certain countries or regions; some highly resistant bacterial (e.g., carbapenem-resistant Enterobacterales [CRE]) and fungal (e.g., Candida auris ) pathogens appear to be more common in some countries where US residents travel for medical tourism (see Sec. 11, Ch. 5, Antimicrobial Resistance ).

Several infectious disease outbreaks have been documented among medical tourists, including CRE infections in patients undergoing invasive medical procedures in Mexico, surgical site infections caused by nontuberculous mycobacteria in patients who underwent cosmetic surgery in the Dominican Republic, and Q fever in patients who received fetal sheep cell injections in Germany.

Noninfectious Complications

Medical tourists have the same risks for noninfectious complications as patients receiving medical care in the United States. Noninfectious complications include blood clots, contour abnormalities after cosmetic surgery, and surgical wound dehiscence.

Travel-Associated Risks

Traveling during the post-operative or post-procedure recovery period or when being treated for a medical condition could pose additional risks for patients. Air travel and surgery independently increase the risk for blood clots, including deep vein thrombosis and pulmonary emboli (see Sec. 8, Ch. 3, Deep Vein Thrombosis & Pulmonary Embolism ). Travel after surgery further increases the risk of developing blood clots because travel can require medical tourists to remain seated for long periods while in a hypercoagulable state.

Commercial aircraft cabin pressures are roughly equivalent to the outside air pressure at 6,000–8,000 feet above sea level. Medical tourists should not fly for 10 days after chest or abdominal surgery to avoid risks associated with changes in atmospheric pressure. ASPS recommends that patients undergoing laser treatments or cosmetic procedures to the face, eyelids, or nose, wait 7–10 days after the procedure before flying. The Aerospace Medical Association published medical guidelines for air travel that provide useful information on the risks for travel with certain medical conditions.

Professional organizations have developed guidance, including template questions, that medical tourists can use when discussing what to expect with the facility providing the care, with the group facilitating the trip, and with their own domestic health care provider. For instance, the American Medical Association developed guiding principles on medical tourism for employers, insurance companies, and other entities that facilitate or incentivize medical care outside the United States ( Box 6-07 ). The American College of Surgeons (ACS) issued a similar statement on medical and surgical tourism, with the additional recommendation that travelers obtain a complete set of medical records before returning home to ensure that details of their care are available to providers in the United States, which can facilitate continuity of care and proper follow-up, if needed.

Box 6-07 American Medical Association’s guiding principles on medical tourism 1

• Employers, insurance companies, and other entities that facilitate or incentivize medical care outside the United States should adhere to the following principles:
• Receiving medical care outside the United States must be voluntary.
• Financial incentives to travel outside the United States for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients or restrict treatment or referral options.
• Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or the International Society for Quality in Health Care).
• Prior to travel, local follow-up care should be coordinated, and financing should be arranged to ensure continuity of care when patients return from medical care outside the United States.
• Coverage for travel outside the United States for medical care should include the costs of necessary follow-up care upon return to the United States.
• Patients should be informed of their rights and legal recourse before agreeing to travel outside the United States for medical care.
• Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the United States.
• The transfer of patient medical records to and from facilities outside the United States should be consistent with Health Insurance Portability and Accountability Action (HIPAA) guidelines.
• Patients choosing to travel outside the United States for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.

1 American Medical Association (AMA). New AMA Guidelines on Medical Tourism . Chicago: AMA; 2008.

Reviewing the Risks

Multiple resources are available for providers and medical tourists assessing medical tourism–related risks (see Table 6-02 ). When reviewing the risks associated with seeking health care abroad, encourage medical tourists to consider several factors besides the procedure; these include the destination, the facility or facilities where the procedure and recovery will take place, and the treating provider.

Make patients aware that medical tourism websites marketing directly to travelers might not include (or make available) comprehensive details on the accreditations, certifications, or qualifications of advertised facilities or providers. Local standards for facility accreditation and provider certification vary, and might not be the same as those in the United States; some facilities and providers abroad might lack accreditation or certification. In some locations, tracking patient outcome data or maintaining formal medical record privacy or security policies are not standard practices.

Medical tourists also should be aware that the drugs and medical products and devices used in other countries might not be subject to the same regulatory scrutiny and oversight as in the United States. In addition, some drugs could be counterfeit or otherwise ineffective because the medication expired, is contaminated, or was improperly stored (for more details, see the previous chapter in this section, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel ).

Table 6-02 Online medical tourism resources

Checking credentials.

ACS recommends that medical tourists use internationally accredited facilities and seek care from providers certified in their specialties through a process equivalent to that established by the member boards of the American Board of Medical Specialties. Advise medical tourists to do as much advance research as possible on the facility and health care provider they are considering using. Also, inform medical tourists that accreditation does not guarantee a good outcome.

Accrediting organizations (e.g., The Joint Commission International, Accreditation Association for Ambulatory Health Care) maintain listings of accredited facilities outside of the United States. Encourage prospective medical tourists to review these sources before committing to having a procedure or receiving medical care abroad.

ACS, ASPS, the American Society for Aesthetic Plastic Surgery, and the International Society of Aesthetic Plastic Surgery all accredit physicians abroad. Medical tourists should check the credentials of health care providers with search tools provided by relevant professional organizations.

Travel Health Insurance

Before travel, medical tourists should check their domestic health insurance plan carefully to understand what services, if any, are covered outside the United States. Additionally, travelers might need to purchase supplemental medical insurance coverage, including medical evacuation insurance; this is particularly important for travelers going to remote destinations or places lacking medical facilities that meet the standards found in high-income countries (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ). Medical tourists also should be aware that if complications develop, they might not have the same legal recourse as they would if they received their care in the United States.

Planning for Follow-Up Care

Medical tourists and their domestic physicians should plan for follow-up care. Patients and clinicians should establish what care will be provided abroad, and what the patient will need upon return. Medical tourists should make sure they understand what services are included as part of the cost for their procedures; some overseas facilities and providers charge substantial fees for follow-up care in addition to the base cost. Travelers also should know whether follow-up care is scheduled to occur at the same facility as the procedure.

Health care facilities in the United States should have systems in place to assess patients at admission to determine whether they have received medical care in other countries. Clinicians should obtain an explicit travel history from patients, including any medical care received abroad. Patients who have had an overnight stay in a health care facility outside the United States within 6 months of presentation should be screened for CRE. Admission screening is available free of charge through the Antibiotic Resistance Laboratory Network .

Notify state and local public health as soon as medical tourism–associated infections are identified. Returning patients often present to hospitals close to their home, and communication with public health authorities can help facilitate outbreak recognition. Health care facilities should follow all disease reporting requirements for their jurisdiction. Health care facilities also should report suspected or confirmed cases of unusual antibiotic resistance (e.g., carbapenem-resistant organisms, C. auris ) to public health authorities to facilitate testing and infection-control measures to prevent further transmission. In addition to notifying the state or local health department, contact the Centers for Disease Control and Prevention at [email protected] to report complications related to medical tourism.

The following authors contributed to the previous version of this chapter: Isaac Benowitz, Joanna Gaines

Bibliography

Adabi K, Stern C, Weichman K, Garfein ES, Pothula A, Draper L, et al. Population health implications of medical tourism. Plast Reconstr Surg. 2017;140(1):66–74.

Al-Shamsi, H, Al-Hajelli, M, Alrawi, S. Chasing the cure around the globe: medical tourism for cancer care from developing countries. J Glob Onc. 2018;4:1–3.

Kracalik I, Ham C, Smith AR, Vowles M, Kauber K, Zambrano M, et al. (2019). Notes from the field: Verona integron-encoded metallo-β-lactamase–producing carbapenem-resistant Pseudomonas aeruginosa infections in U.S. residents associated with invasive medical procedures in Mexico, 2015–2018. MMWR Morb Mortal Wkly Rep. 2019;68(20):463–4.

Pavli A, Maltezou HC. Infectious complications related to medical tourism. J Travel Med. 2021;28(1):taaa210.

Pereira RT, Malone CM, Flaherty GT. Aesthetic journeys: a review of cosmetic surgery tourism. J Travel Med. 2018;25(1):tay042.

Robyn MP, Newman AP, Amato M, Walawander M, Kothe C, Nerone JD, et al. Q fever outbreak among travelers to Germany who received live cell therapy & United States and Canada, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(38):1071–3.

Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P, Westphal LM, et al. Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review). J Assist Reprod Genet. 2018;35(7):1277–88.

Schnabel D, Esposito DH, Gaines J, Ridpath A, Barry MA, Feldman KA, et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with medical tourism to the Dominican Republic, 2013–2014. Emerg Infect Dis. 2016;22(8):1340–7.

Stoney RJ, Kozarsky PE, Walker AT, Gaines JL. Population-based surveillance of medical tourism among US residents from 11 states and territories: findings from the Behavioral Risk Factor Surveillance System. Infect Control Hosp Epidemiol. 2022;43(7):870–5.

File Formats Help:

• Adobe PDF file
• Microsoft PowerPoint file
• Microsoft Word file
• Microsoft Excel file
• Audio/Video file
• Apple Quicktime file
• RealPlayer file
• Zip Archive file

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Global Health

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

Daniel béland.

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

Amy Zarzeczny

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

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

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

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

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

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

Medical tourism in comparative perspective

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

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

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

How national health care systems shape demand for medical tourism

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

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

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

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

How medical tourism impacts national health care systems

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

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

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

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

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

Policy implications

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

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

Research agenda

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

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

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

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

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

Conclusions

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

Acknowledgements

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

Authors’ contributions

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

Authors information

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

Ethics approval and consent to participate

Not applicable.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

Publisher’s Note

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

Contributor Information

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

Amy Zarzeczny, Email: [email protected] .

• Share full article

Advertisement

Supported by

Medical tourism is drawing patients, even in a pandemic.

By Ceylan Yeginsu

The coronavirus pandemic has pushed millions of Americans into poverty and stripped more than 5.4 million of them of their health insurance, according to a study by Families USA, a nonpartisan consumer advocacy group.

Many people have put off medical procedures, and seen their health deteriorate significantly. The fear of large medical bills has outweighed fear of contagion for some, giving rise to an increased number of patients seeking medical treatment in a foreign country.

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

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

In 2019, 1.1 percent of Americans traveling internationally did so for health treatments, according to the National Travel and Tourism Office , although that figure accounts only for those who went by air.

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

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

Division Administrative Assistant - Department of Pediatrics

• Madison, Wisconsin
• SCHOOL OF MEDICINE AND PUBLIC HEALTH/PEDIATRICS-GEN
• Health and Wellness Services
• Partially Remote
• Staff-Full Time
• Opening at: Mar 21 2024 at 11:40 CDT
• Closing at: May 27 2024 at 23:55 CDT

Job Summary:

The Department of Pediatrics is seeking a Medical Program Assistant to provide direct support to divisional faculty and staff. This position will be responsible for the coordination of complex daily clinical, academic, and administrative activities, as well as the coordination and organization of the faculty's communications, meeting planning, and both domestic and international travel. The Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health is a vibrant academic department comprising more than 200 faculty in 16 subspecialty divisions. The department promotes and enhances the health of children through outstanding clinical care, exemplary education of pediatric trainees, performance of cutting-edge research, and vigorous advocacy. To learn more about the department's work and accomplishments, please visit: https://www.pediatrics.wisc.edu/ . 

Responsibilities:

• 25% Performs administrative tasks including telephone customer service, word processing, transcribing, filing, and calendaring
• 10% Acts as the primary liaison for providers or programs and refers stakeholders to providers, agencies, patients, and staff
• 15% Assists in coordinating the complex daily activities of providers or program(s) by entering information into databases, maintaining files and materials, and preparing reports
• 5% Serves as the primary contact and subject matter expert for specified program policies and procedures
• 5% Coordinates with senior management to define program goals and fiscal objectives
• 5% Identifies opportunities for program improvements and makes recommendations to the appropriate entities
• 25% Schedules logistics and secures or distributes resources for program meetings, department events, conferences, and travel
• 5% Assists in completion of annual review packets and scheduling of mentor committee meetings (i.e. Updates Curriculum Vitae, NIH biographical sketches, PubMed identification numbers & MyNCBI)
• 5% Division delegate for travel and expense reimbursements in Oracle and E-Reimbursement

Institutional Statement on Diversity:

Diversity is a source of strength, creativity, and innovation for UW-Madison. We value the contributions of each person and respect the profound ways their identity, culture, background, experience, status, abilities, and opinion enrich the university community. We commit ourselves to the pursuit of excellence in teaching, research, outreach, and diversity as inextricably linked goals. The University of Wisconsin-Madison fulfills its public mission by creating a welcoming and inclusive community for people from every background - people who as students, faculty, and staff serve Wisconsin and the world. For more information on diversity and inclusion on campus, please visit: Diversity and Inclusion

Preferred H.S. Diploma

Qualifications:

Required: - Proficiency in Microsoft Office Suite and other relevant software applications. - Excellent organizational and time-management skills with a keen attention to detail. Ability to plan and carry out work without direct supervision. - Strong communication and interpersonal skills, capable of interacting with individuals at all levels of the organization. - Ability to prioritize tasks, multitask effectively, and adapt to changing priorities in a fast-paced environment. Preferred: - Experience providing administrative support in an office setting is strongly preferred. Coursework or training in project and/or organizational management may be considered in lieu of direct work experience. - Experience in a medical setting, preferably with scheduling or administrative duties. - Training in and knowledge of HIPAA regulations. - Experience providing office or administrative support in the UW or UW Health System.

Work Schedule:

Business hours are Monday-Friday, specific hours will be determined upon hire.

Full Time: 100% This position may require some work to be performed in-person, onsite, at a designated campus work location. Some work may be performed remotely, at an offsite, non-campus work location.

Appointment Type, Duration:

Ongoing/Renewable

Minimum $22.00 HOURLY Depending on Qualifications Actual pay will depend on experience and qualifications. Employees in this position can expect to receive benefits such as generous vacation, holidays, and paid time off; competitive insurances and savings accounts; retirement benefits. Benefits information can be found at: - https://hr.wisc.edu/benefits/   - SMPH University Staff Benefits flyer: https://uwmadison.box.com/s/656no0fcpy2tjg86s4v0chtxx25s3vsm  

Additional Information:

The selected applicant will be responsible for ensuring their continuous eligibility for employment in the United States on or before the effective date of the appointment. University sponsorship is not available for this position. UW-Madison is not an E-Verify employer, and therefore, is not eligible to employ F1-OPT STEM Extension participants.

How to Apply:

To apply for this position, please click on the "Apply Now" button. You will be asked to upload a current resume/CV and a cover letter briefly describing your qualifications and experience.

Ashley Mueller [email protected] 608-265-3961 Relay Access (WTRS): 7-1-1. See RELAY_SERVICE for further information.

Official Title:

Medical Program Assistant(HS009)

Department(s):

A53-MEDICAL SCHOOL/PEDIATRICS/GPAM

Employment Class:

University Staff-Ongoing

Job Number:

The university of wisconsin-madison is an equal opportunity and affirmative action employer..

You will be redirected to the application to launch your career momentarily. Thank you!

Frequently Asked Questions

Applicant Tutorial

Disability Accommodations

Pay Transparency Policy Statement

Refer a Friend

You've sent this job to a friend!

Website feedback, questions or accessibility issues: [email protected] .

Learn more about accessibility at UW–Madison .

© 2016–2024 Board of Regents of the University of Wisconsin System • Privacy Statement

Do I Need Additional Health Coverage if I Travel Internationally?

Y ou will likely need additional health coverage if you plan on traveling outside of the United States since Affordable Care Act (ACA) Marketplace health plans are not required to include international travel coverage. Multiple insurance carriers sell separate travel insurance that can cover emergency health care services and potentially other treatments you need while in a foreign country.

Keep reading to find out how you can know when your health insurance covers international travel and what types of coverage can protect you as you travel abroad.

On This Page

Does my health insurance cover international travel, what won’t be covered by health insurance during international travel, how much does it cost to get medical insurance for international trips, how do i know if an international medical facility is in my network, how to get medical coverage when you travel internationally, how to file a claim for medical care during international travel.

ACA-compliant health insurance plans aren’t required to cover you during international travel, so you should contact your insurer before you leave to find out if any out-of-country medical services you receive would be covered. Keep in mind that some health plans don’t cover out-of-network care at all, meaning you would be fully on the hook for medical expenses you incur while visiting a foreign hospital that isn’t in your plan’s network.

Meanwhile, plans that do cover out-of-network care will usually require you to pay a greater portion of the costs through coinsurance or copays . As a result, there’s a good chance you will have to pay more for international treatments even if your health insurance company agrees to cover them.

Fortunately, numerous companies sell supplemental health insurance products that can provide more comprehensive health coverage while you are traveling abroad. For example, medical evacuation insurance can cover the costs of transportation to a medical facility that can provide you with appropriate care in an emergency. This type of coverage may automatically be included in a travel health insurance plan, which can also cover the emergency care itself and potentially even regular treatments related to a preexisting condition. [1]

Does Medicare Cover International Travel?

Medicare only covers treatments at foreign hospitals in specific situations where they are closer to you than an American health care facility. For example, if you live in the United States near the border of Mexico or experience a medical emergency near the border, Medicare may cover treatments at a Mexican hospital. Similarly, you may be covered if you visit a Canadian hospital after experiencing a medical emergency on your way to Alaska. [2]

Meanwhile, Medicare will only cover care you receive on a cruise ship if the ship is within six hours of an American port. Conversely, some Medicare Advantage plans and most Medigap plans include international travel coverage. [2]

Specifically, a Medigap plan can cover 80% of the costs for medically necessary care in foreign countries that Original Medicare won’t cover as long as you have met a $250 deductible and receive the care within 60 days of starting your trip. Note that Medigap foreign travel emergency coverage comes with a $50,000 lifetime limit. [2]

Does Medicaid Cover International Travel?

Medicaid generally doesn’t cover medical expenses you incur overseas. [1] In fact, you may have limited coverage anywhere outside of your home state since Medicaid benefits are largely determined at the state level. For example, North Carolina Medicaid only covers out-of-state routine care if you receive it in Georgia, South Carolina, Tennessee or Virginia within 40 miles of the North Carolina border, exclusively covers medically necessary care elsewhere in the United States and doesn’t provide any coverage outside of the country. [3]

Even if you purchase a separate travel health insurance plan, your insurer likely won’t cover preventive services and other kinds of routine care. [4] You may need to purchase a long-term international health plan to receive coverage for these kinds of services outside of the United States.

Instead, travel medical insurance predominantly provides coverage for emergency situations such as slipping and breaking your leg while rock climbing, getting sick after a spider bites you on a hike or requiring a medevac helicopter after you have a heart attack in a remote location.

The average cost of health insurance for international travel ranges from $40 to $80, with factors like the length of your trip and the coverage limits you select influencing your rates. [4] Meanwhile, you will usually have to pay 5% to 7% of the cost of your entire trip for a trip insurance package that includes coverage for emergency medical care, canceled flights, trip interruption and lost or damaged luggage. [5]

The best way to know if a medical provider is in your network or if your insurance company will otherwise cover care from that provider is to contact your insurer in advance to get your treatment preapproved.

Keep in mind that many American insurance carriers don’t contract with international medical facilities at all.

Nevertheless, there are some health insurance companies with networks that extend beyond the United States. For example, Cigna ’s network includes 1.5 million hospitals and health care professionals throughout the world, while Blue Cross Blue Shield ’s GeoBlue contracts with more than 1.7 million medical providers globally. [6][7]

You may be able to buy coverage for your vacation from either a company that specializes in travel insurance or a traditional health insurance carrier that offers international coverage. It’s recommended that you obtain quotes from three to five different companies so you can compare all of your options to find the best deal.

To make this process as simple as possible, consider using an online insurance marketplace like SmartFinancial. We can take information about your coverage needs and budget from a brief questionnaire and match you up with insurance agents who may be able to help you find a health plan with built-in travel coverage. If you’re interested in receiving free health insurance quotes today, simply enter your zip code below.

Claim filing processes can vary from company to company but you will generally need to fill out your insurer’s designated claim form and provide an itemized bill listing all of the treatments you were charged for along with other documents showing information such as where you were treated and what injury or sickness you were treated for.

You should be aware that foreign health care providers generally don’t accept American insurance and won’t file claims on your behalf. [4] As a result, even if your health plan covers international care, you will likely have to pay for your treatments out of pocket initially and then file an insurance claim yourself to be reimbursed by your insurer.

Do I need additional medical insurance when traveling abroad?

ACA-compliant health plans are not required to cover you while you’re traveling abroad, so you may need to purchase additional travel medical insurance.

Does Medicare cover international travel?

Medicare covers international travel in extremely limited circumstances such as when you are on a cruise ship less than six hours away from an American port. However, you may be able to get broader travel health coverage through a Medicare Advantage or Medicare Supplement plan. [2]

Do I need travel insurance if I have health insurance?

Many American health insurance plans don’t cover out-of-network care and don’t include foreign hospitals in their networks, so you may need separate travel health insurance to receive coverage for international care.

• United States Department of State. “ Insurance Providers for Overseas Coverage .” Accessed Nov. 8, 2023.
• Centers for Medicare & Medicaid Services. “ Medicare Coverage Outside the United States ,” Pages 1-4. Accessed Nov. 8, 2023.
• North Carolina Department of Health and Human Services. “ NC Medicaid: Out of State Services ,” Page 1. Accessed Nov. 9, 2023.
• Travelers Insurance. “ How Does Travel Medical Insurance Work? ” Accessed Nov. 9, 2023.
• International Association for Medical Assistance to Travellers. “ Travel Health Insurance 101 .” Accessed Nov. 9, 2023.
• Cigna Global. “ International Health Insurance & Global Medical Cover .” Accessed Nov. 9, 2023.
• GeoBlue. “ International Travel Health Insurance Coverage .” Accessed Nov. 9, 2023.

Our Response to COVID-19 →

Economics & Investments

Economic report: inbound medical tourism in the united states.

A s medical tourism continues to grow, developed nations, such as the United States, see large number of Americans traveling abroad for medical procedures.  However, there continues to be a growing interest in inbound medical tourism in the U.S.  There are an increasing number of international patient departments in U.S. hospitals marketing to these patients.  

These hospitals and clinics are offering inbound medical tourism services to patients who come to the U.S. for higher quality than they can receive in their home country, access to procedures that are not available in their country’s healthcare facilities, freedom from long wait times or the rationing of procedures because of national governmental regulations, because of the ability to combine tourism opportunities in the U.S., and/or (believe it or not!) because the price differential- paying for services in cash in the U.S. may be less expensive than in their home country. ‍

Some Case Examples

Back in the 90s, the Methodist Healthcare System (which was the employer of one of the authors at the time), a multi-billion dollar subsidiary of HCA in South Texas, was engaging in leading-edge Medical Tourism marketing to recruit (particularly affluent) Mexican nationals to San Antonio, Texas to receive various medical procedures.  

These foreign nationals would typically pay in cash and offered an additional, profitable, and non-traditional revenue stream for their flagship urban hospital.  Since then, many U.S. facilities have expanded their marketing to attract international patients and have developed international patient departments. ‍

As recently as October of 2008, a group of hospitals in Southeastern Michigan (including The University of Michigan Health System, Detroit Medical Center, Henry Ford Health System and St. John Health System) announced an advertising program to try and recruit foreign patients to that region.  Since 2004, using nothing other than their website for advertising, these facilities were able to attract patients from 11 different countries and so they felt it was time to become more aggressive in their marketing.  

They are pushing back against foreign hospitals that have been heavily advertising in the U.S. to offer patients lower-cost medical care.  Calling it ‘reverse medical tourism,’ these facilities began a national advertising campaign intended to attract patients from the U.S. and around the world to some of its ‘centers of excellence’ medical programs. ‍

In another example, the Shady Grove Fertility Center, which is the Washington/Baltimore area’s largest in vitro fertilization (IVF) and fertility clinic gave IVF treatment to more than five dozen British patients in 2008 (a 350% increase from 2007).  This is a reversal of the medical tourism flow of Americans going overseas in search of less costly elective medical procedures.  

In just a little over a year, Shady Grove Fertility Center has set up innovative partnerships with three fertility clinics in the UK.  In addition, they held informational seminars hosted in the UK for potential donor egg patients.  These British fertility patients, who need to use donor eggs rather than their own, were flocking to the Shady Grove Fertility Center because, in the UK, egg donors are neither paid nor guaranteed anonymity and donor eggs are scarce.  

Wait times in the U.K. can be as long as three years and choice of donor is often limited.  In contrast, Shady Grove Fertility not only pays donors, but also offers an innovative way to reduce waiting. ‍

1Southeast Michigan hospitals advertise for international patients retrieved on June 29, 2009 from http://www.crainsdetroit.com/article/20090626/HEALTH/906269974#

time and cost for donor eggs.  This center was looking to replicate this success and was going to explore similar relationships in potential partner clinics in the country of Ireland2.

A n American academic center that is focusing on inbound medical tourism is the University of Central Florida (UCF).  Local tourism officials hope the university and its medical city at Lake Nona will also attract people from around the world.  Inbound medical tourism is considered a goal for the hospital and Central Florida as a whole.  

Following UCF’s lead, other Central Florida hospitals (such as the two large hospital systems- Florida Hospital and Orlando Health) and clinics have begun encouraging patients from abroad to come to Orlando for medical treatment. ‍

In a very recent Orlando Business Journal article  and a Fox News Orlando  report, local physician Dr. Kirti Kalidas, discussed the $17 million USD expansion of his Center for Natural & Integrative Medicine in Southwest Orange County.  By late 2010, he will have expanded his clinic to include an 87,000 square foot, 126 room Cambria Suites hotel so out-of-town and out-of-country patients can stay the week, get health screenings, enjoy the spa, and engage in detoxification (also he is hoping to attract other healthcare providers to a 20,000-square-foot medical office building as well).  

He is one of only around 30 doctors in the country that has both a traditional M.D. and a Naturopathic license and his clinic offers various alternative and integrative procedures such as Vitamin IVs, Hyperbaric Oxygen Therapy, Ozone Therapy among its alternative wellness programs. ‍

To increase the state’s reputation as a medical destination, several Florida cities are also looking to increase their share of the lucrative medical meetings market.  Orlando, the nation’s top-ranked medical meeting hub for the past decade, played host to more than 215 medical meetings with 170,000 attendees in 2008.”  

Dr. Rolando D. Rodriguez is spearheading the effort for the Greater Miami Chamber of Commerce to make South Florida the world’s No. 1 international gateway for healthcare (the Baptist system in Miami is one of the most popular destination for international patients.  It had 12,000 foreign patients from 100 foreign countries in 2008).  Six years after the death of an ambitious joint effort to make Miami a major healthcare destination for wealthy foreigners, a new group has formed to try to do the same thing.

This group expects that these efforts could be a boost to the local economy (hurt by the decline in the housing sector and the global recession) and also lead to improved healthcare for local residents as providers upgrade services to compete on a global scale.  The University of Miami had started an ambitious program to attract foreigners wanting quality care and since its expansion, international traffic has gone up about 20 percent.  

The City of Jacksonville also boasts of having the Mayo Clinic and the University of Florida Proton Therapy Institute at Shands that attract thousands of international patients every year. ‍

Many of these Florida hospitals that cater to international patients offer concierge services (e.g., picking them up at the airport, finding hotels, showing relatives where to shop while the patient is recovering, etc.).  These hospitals go out of their way to be much more customer-friendly oriented in order to attract foreign patients.  

It was suggested by the president of a Florida public hospital that handles their international business that all aspects of the hospital have to be aligned with the marketing image.  The lobby has to be nice, things have to look good, and even a public hospital can’t look like a typical public hospital. ‍

2A Growing Number of Brit Cross the Atlantic for Donor Egg IVF Treatment at Shady Grove Fertility Center retrieved on June 25, 2009 from http://au.sys-con.com/node/1004094 3Orlando doc plans $17 million ‘medical tourism’ development retrieved on June 29, 2009 from http://orlando.bizjournals.com/orlando/stories/2009/05/11/story3.html 4Orlando’s medical tourism retrieved on June 29, 2009 from http://www.myfoxorlando.com/dpp/health/062209_Orlando_medical_tourism 5Sun. Sand. Surgery. Retrieved on June 29, 2009 from http://today.ucf.edu/blog/2009/05/28/sun-sand-surgery/

Economic Facts

In its 2008 report on medical tourism , Deloitte and Touche (D&T) suggested that in 2008 there would be more than 400,000 non-U.S. residents that would receive care in the United States and spend almost $5 billion for health services.  International patients currently make up almost 3.5% of all inpatient procedures performed in the U.S.  

By 2011, D&T suggested that those numbers could rise to as much as 800,000 patients annually.  Some of the most common treatments that international patients are seeking are: Cancer/Oncology; Orthopedic; Cardiovascular; and Cosmetic. ‍

Some of the advantages for hospitals that have inbound medical tourism are that medical tourists tend to pay commercial charges or higher for medical services, and that they tend to be more affluent than general patient populations.  

Some of the most commonly known hospitals listed in the report are (Note: total patient visits include domestic and international patients): Texas Medical Center (around 5.5 million total patient visits); the University of Pittsburgh Medical Center (over 3 million total patient visits); Harvard Medicine (over 2 million total patient visits in the Boston location); John Hopkins Hospital (over half a million total patient visits); the Cleveland Clinic (over 3 million total patient visits); Cornell Medical School (around 2 million total patient visits); Duke University School of Medicine (almost 1.5 million total patient visits); Memorial Sloan-Kettrering Cancer Center (around half a million total patient visits); and the Mayo Clinic (only around 150,000 total patient visits). ‍

According to the D&T report, several initiatives have been helpful in promoting clinical programs related to U.S. inbound medical tourism: ‍

1) the establishment of international partnerships and the formation of international health care projects have increased awareness of the opportunities for foreign patients to travel the U.S. for care;

2) listing their services in international medical directories;

3) having foreign physicians and U.S. physicians training abroad (helps to increase the number of referrals to the U.S.); and

4) U.S. medical centers making an effort to serve embassy contacts and the relatives of ethnic groups within their own communities (to increase referrals among family members internationally).

Some Future Trends

Hospitals typically offer discounts on their gross charge rates for uninsured foreigners if they pay in advance.  But currently, popular inbound patient venues are reporting that more of their foreign patients have insurance coverage than ever before (the Cleveland Clinic reports 90%, Mount Sinai says 60%, and Baptist Health International Center in Miami has about 70%).  

It is stated that “even wealthy people would rather pay an insurance premium than $500,000 in cash”.   This will be a future trend with less international patients paying in cash and instead utilizing a more diverse slate of financing alternatives (including U.S. health insurance programs). ‍

In addition, Complementary and Alternative Medicine (CAM), which is even more popular in some areas of the world than in the U.S. (all 18 hospitals named by U.S. News as “America’s Best Hospitals” provide some type of CAM services; and according to the American Hospital Association’s Annual Survey of Hospitals- 19.8% offered CAM in 2006), are expected to be integrated as part of the traditional procedures offered for these patients.  

Although initially, inbound medical tourism had been dominated by large teaching institutions (typically ones that enjoy positive national and/or international reputations).  Expect that in the future, more non-teaching and for profit hospitals and clinics (retail clinics, a non-traditional competitor, have increased by almost four times in the last 2 years, from just 250 clinics in 2006 to close to 1,000 in 2008) will enter the market as the population of affluent people rises worldwide. ‍

6Medical Tourism: Consumers in Search of Value retrieved on June 29, 2009 from http://www.deloitte.com/dtt/cda/doc/content/us_chs_MedicalTourismStudy(1).pdf 7South Florida hospital compete for international patients retrieved on June 29, 2009 from http://www.miamiherald.com/103/story/1085748.html

Finally, as the movement towards more government intervention and reimbursement impacts U.S. facilities in the near future, expect that more hospitals and clinics will begin to market to these higher-margin patients. ‍

David G. Vequist IV, Ph.D. is the founder and Director of the Center for Medical Tourism Research ( www.medicaltourismresearch.org ) – the very first Medical Tourism research center in the world.  He is also an Associate Professor of Management in the H-E-B School of Business & Administration at the University of Incarnate Word in San Antonio, Texas, USA.  He is also a consultant, author and speaker on topics such as medical tourism, healthcare trends, and technologies.  He can be reached at [email protected].

Erika Valdez, a native of Mexico, and just graduated from the MBA program (May 2009) in the H-E-B School of Business & Administration at the University of Incarnate Word in San Antonio, Texas, USA.  She is a Graduate Assistant at the Center for Medical Tourism Research ( www.medicaltourismresearch.org ) and a promising speaker and author in the area of medical tourism and economic development in developing nations.  She can be reached at [email protected].

Korea: Turning the Focus to an Emerging Global Leader in Medical Tourism

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, south korea, a medical tourism leader pioneering the future of medicine  , surgical solutions for obesity and weight management ~ a team effort, south korea ~ stepping into the spotlight in global healthcare, south africa ~ making great strides in healthcare, reusables give northwestern memorial a sharp edge on safety and sustainability, continue reading, the new silk road: deconstructing china's luxury healthcare market, the boomers are coming the boomers are coming, financial savings in medical tourism, featured reading, guide to choosing korea for medical travel, transforming healthcare through innovation: ceo spotlight interview with matthew a. love, 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.

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Immigrant and Refugee Health
• Intercountry (International) Adoption Health Guidance
• Laws and Regulations for the Medical Examination of Aliens
• Health Education and Communication Tools
• Technical Instructions for Civil Surgeons
• Refugee Health Overseas Guidance
• Refugee Health Domestic Guidance
• Refugee Immunization Information Systems Exchange (RIISE) Project
• Technical Instructions for Panel Physicians
• Electronic Disease Notification System

At a glance

Each year, parents in the United States adopt more than 5,000 children from all over the world. Adopting a child is a wonderful and exciting event for families. The health of the child who has been adopted is one of many issues that parents need to address during the process of intercountry adoption, also known as international adoption.

Children born in other areas of the world may have different health problems from those of children raised in the United States. Children may have been exposed to vaccine-preventable diseases that are rare in the United States. Some children are adopted from countries with high rates of diseases, such as tuberculosis, hepatitis, and HIV/AIDS. For all these reasons, knowing as much as possible about a child's health will help parents get the right treatment and care for their child. Ensuring that children who have been adopted are healthy will also help prevent the spread of disease in families and communities in the United States.

Be Prepared‎

Before you travel overseas to bring your child home.

CDC recommends that you try to collect health information about your child who has been adopted before you travel to bring him or her home. Any available medical and vaccination records should be shared and discussed with your medical provider here in the United States so that they can be better prepared once your child arrives.

Many vaccine-preventable diseases are more common in the countries of origin of children who have been adopted from other countries. Therefore, family members traveling to pick up the child, as well as close contacts of the child in the United States (e.g., other family members, babysitters) should make sure they are fully vaccinated according to the recommendations of the Advisory Committee on Immunization Practices (ACIP). CDC's Travelers' Health homepage has more information on vaccines you may need and other healthy travel tips.

Overseas Medical Exam Process

The medical examination process for your child who has been adopted begins overseas with a visit to a panel physician . A panel physician is a Department of State-designated medical doctor who performs medical exams overseas for immigrants (including children who have been adopted from other countries), refugees, and migrants coming into the United States. Panel physicians, who are located in many countries in the world, must refer to CDC guidelines (technical instructions) on medical exams.

The purpose of the overseas medical exam is to identify applicants, including children who have been adopted, with Class A conditions . Children with these conditions must be treated or get a waiver before they can get a visa to come to the United States.

The visa medical exam differs from a normal physical that you may be used to. The visa medical exam includes:

• a physical exam
• a series of vaccines
• a screening for tuberculosis/TB (skin test/chest x-ray examination)
• a blood test for syphilis (not routinely done for children under 15 unless there is reason to suspect infection)

Once the medical exam is completed, the panel physician will give you a sealed packet containing the medical exam forms. When you arrive in the United States, give the sealed packet to the Customs and Border Protection (CBP) officer. The CBP officer is an immigration official who will process your paperwork when you first enter the United States.

During the medical exam , you should ask for an extra copy of the medical exam forms and give them to your child's medical provider in the United States. Children should also receive a medical exam once they enter the United States.

Vaccinations

Vaccinations are an important part of the overseas medical examination. The Immigration and Nationality Act requires that all immigrant visa applicants, including children who have been adopted, show proof of having received certain vaccinations named in the law, as well as others recommended by the Advisory Committee on Immunization Practices, before they may be granted an immigrant visa. Vaccination requirements depend on the age of your child. The age-appropriate vaccinations your child may require can be found in the vaccination schedules for children. Some children who have been adopted can receive an affidavit to have their vaccinations delayed until after they arrive in the United States. Children who receive an affidavit must receive the required vaccines once they arrive in the United States. For more information, please see the affidavit .

Finding a Medical Provider in the United States

Once you have brought your child into the United States, you need to find a medical provider with whom you feel comfortable taking your child for medical care. CDC encourages parents to schedule their child’s medical visit within a few weeks of arrival. Your child’s first medical visit in the United States will be more detailed than his or her visa medical exam. Since the visa medical exam only screens for certain diseases, it may not give you a complete picture of your child’s health. The first U.S. medical exam will help you find out about any other health issues your child may have and allow for timely treatment, if needed.

During your child’s first medical visit in the U.S., the doctor may

• Check growth and development
• Test hearing and vision
• Screen for these diseases, if needed:
• Hepatitis B
• Illnesses caused by parasites
• Tuberculosis

For more information on your child's first medical visit:‎

Your child must also get vaccines if he or she did not receive them overseas. Parents are required to get their children vaccinated within 30 days of arrival.

Your child's medical provider may also want to learn about your child's medical history. If you have any forms or papers with details about your child's medical background, bring them to the first visit.

If you are looking for a medical provider, you may want to consider pediatricians who focus on treating children who have been adopted from other countries. They tend to have more experience with medical conditions seen in children adopted overseas.

Class A Conditions

Class A conditions are illnesses of public health significance that prohibit a person from entering the United States. Many children who have been adopted come from countries where Class A conditions are more common than in the United States.

The Class A condition that is most relevant for children who have been adopted from other countries is tuberculosis (TB). TB is a disease that is caused by bacteria which are spread from person to person through the air. Tuberculosis is considered infectious (active) when the TB bacteria overcome the defenses of the body and begin to multiply. People with active TB can spread TB bacteria to others. Most TB can be treated with antibiotics.

Waiver Process

In certain instances, waivers can be granted so that a child with a Class A condition can enter the United States. A waiver request may also be filed on religious or moral grounds (for vaccinations only). CDC's role in the waiver process is only to review and provide an opinion. The final decision to approve or deny a waiver is made by U.S. Citizenship and Immigration Services (USCIS) in the Department of Homeland Security (DHS).

Here is the process to apply for a waiver :

• If a child is found to have a Class A condition, parents should talk to the panel physician and the U.S. Consulate to find out if it is possible to get a waiver.

You cannot apply for a waiver before the child is found to have an inadmissible condition. Thus, all tests must be completed and read by the panel physician before a class can be assigned.

• Parents will have to complete a waiver request form ( Form I-601 ) with USCIS.

Finding a U.S. doctor or health-care provider is a vital step in the waiver process.‎

• The panel physician will send the child's medical forms to the U.S. Consulate (American Embassy).
• The I-601 will be sent to USCIS, and then USCIS will send the I-601 to CDC for review.
• CDC will check the I-601 and medical forms to make sure they are correct and complete.
• CDC will then provide an opinion to USCIS about the case.
• USCIS will make the final decision to approve or deny the waiver. This decision will be reported to the U.S. Consulate and CDC.
• USCIS will tell the parents whether the waiver was granted. If the waiver is granted, the child will receive a visa.

CDC's Intercountry (International) Adoption Goals

• To ensure that children receive proper medical screening overseas, so they can receive timely treatment and care
• To provide information to parents so they can understand their children's health conditions
• To communicate with adoption organizations and physicians treating children
• To encourage safe and healthy travel for parents going overseas to adopt children
• To respond to disease outbreaks in children who have been adopted
• To work with countries and partners to streamline the visa medical examination process while maintaining the quality of medical exams

More Information

Cdc resources.

• Healthy travel for intercountry adoptions
• International travel with infants and children
• Blood lead levels in children adopted from other countries

External Resources

• Find pediatricians who specialize in adoptions
• Department of State information on the intercountry adoption process
• U.S. Citizenship and Immigration Services information on adoptions
• U.S. Department of Health and Human Services information on adoption

CDC works to promote and improve the health of immigrants, refugees, and migrants globally.

For Everyone

Health care providers, public health.