Title:Unpacking Medical Tourism

Issues in Bioethics

A passport opens up a world of options for those seeking medical care. What are the ethical implications around this burgeoning industry?

Medical tourism occurs when an individual crosses a national border to receive medical services. While the lack of patient data due to health privacy regulations makes sizing the medical tourism industry challenging, some estimates place the global value at over $70 billion.

Though many of today’s medical tourists travel for plastic surgery and dental procedures, a study by PricewaterhouseCoopers projects that pricier, riskier, and more invasive procedures such as cardiac and orthopedic surgery will grow in popularity and double the value of the medical tourism industry. The Medical Tourism Association cites major price differences internationally for procedures like liposuction and knee replacement. For example, a heart bypass in the United States costs approximately $123,000 compared to $14,000 in Poland or $7,900 in India. Top specialties for medical tourism are dentistry, cosmetic surgery, and reproductive care, and popular destinations for procedures span the globe, from Thailand to Hungary to Costa Rica.

The burgeoning trade raises numerous ethical concerns for patients, practitioners, and policymakers.

“First and foremost, what is the reason for your travel?” asks California neurologist Michael McQuillen (C’53, M’57, R’60). “Is it to obtain a treatment not available near your home? If that is so, why is it so? Is it too expensive at home, or is the waiting time for the treatment unreasonably long? Is it ethical to prolong waiting times for residents of your destination by entering what is (or should be) essentially their waiting line for those services?”

Patients often become medical tourists due to prohibitive costs or poor quality of care in their home country. With its reputation for low costs, high standards of care, and use of cutting-edge medical technologies, Asia has historically been the prime destination for such tourists, especially for cosmetic surgery procedures, now closely followed by the United Arab Emirates and Greece. Perhaps by accident, America has stepped into the ring, with the most controversial example being the wave of Chinese women participating in birth tourism in Saipan to gain American citizenship for their children.

To address some of these ethics issues, we consult James Giordano, PhD, Chief of Neuroethics Studies and Scholar-in- Residence in the Pellegrino Center for Clinical Bioethics and Professor of Neurology and Biochemistry.

What is your forecast for medical tourism?

Without doubt, medical tourism— and research tourism—will increase during the coming decades, as biomedical science and technological enterprises become ever more multinational, and the relative parameters and policies regulating practices in different countries become more varied. This might encourage vigorous discussion and pursuit of guidelines that ensure patient safety and continuity of sound patient care in and between nations. Guidelines may establish minimum criteria for research efforts, and address the translation of research findings, tools, and methods to clinical care. Not a simple task, but it is important and necessary.

What’s your advice for the prospective medical tourist?

Seek assurances regarding the safety of any procedure. Has the technique been evaluated and demonstrated for safety and effectiveness in clinical use? What personnel resources and services are available during preparation, articulation, and recovery?

Also, find out if care for any latent effects incurred by techniques administered outside of the United States would be treatable, and covered by insurance once the patient returns here. This is of particular concern if such techniques are not approved in the U.S., or if they or the follow-up care do not fall under an existing or accepted procedure code.

How is Georgetown involved in the medical tourism ethics arena?

Our responsibilities are threefold. First is the need to remain apace with developments in international biomedical research and its translation into medical practices that are viable and valuable for generating and sustaining research tourism and medical tourism. Georgetown’s ongoing educational and research projects in international health and clinical and translational science are notable in their efforts to this regard.

Second, it is important to know what types of medical treatments are being offered to medical tourists and what the manifest effects of such treatments might be. This knowledge helps to establish medical readiness for conditions that may be encountered in patients returning from treatments in other countries.

Finally, Georgetown is engaging in proactive discourse in international forums to address the scope and conduct of research and medical practices, with an aim to develop ethical guidelines and policies that will be important for safety and patient health.