A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries

Abstract

Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient’s social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional ways of thinking about public health and the notion of health systems contained within the nation state. Further research is needed to better understand the effects of patient travel, and how to harness the benefits of patient travel without exacerbating existing health inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-017-0287-8) contains supplementary material, which is available to authorized users.

Cross-border healthcare and prognosis of HIV infection in the triple border Brazil-Paraguay-Argentina

“…There are many reasons that lead patients to cross international borders from low or middle income to high income countries to seek healthcare. Some of them are the possibility of enhancing the chances of prolonging life in cases of severe diseases, the culture of looking for a better perceived care regardless of the location, escaping from medical professionals perceived as arrogant and mistrustful to look for more friendly and qualified physicians, easier access to reproductive medicine, greater ease of border crossing in comparison to going to the capital city of the country of residence, and gaining citizenship 7 . This international health-seeking behavior can lead patients to different types of mobility: permanent change of country of residence, characterizing immigration 8 ; longer but not permanent stay abroad for seasonal work, characterizing circular migration, which almost always demands healthcare 9,10 ; and daily mobility in which patients return to their homeland in the same day or within a few days, characterizing pendulum migration 11 .…”

Construction and validation of a matrix for normative evaluation of the integrated health system of the borders

“…and the CVR was 0.96 and, in the second round, a CVI of 100% and a CVR of 1.0 were obtained, and the items The mobility of patients to other countries for the purpose of health treatment, although it has always existed, has considerably increased in the last decade due to the greater commercial integration between different countries of the world. However, the main causes for patients crossing borders seeking health care are the difficulty of access or the lack of necessary services in their countries of origin (21) .…”

Health and Wellness–Related Travel: A Scoping Study of the Literature in 2010-2018

“…Lately, research has started paying attention to the South-South patient movement, namely the travels of patients from one developing country to another. Durham and Blondell (2017) have reviewed these studies in their realist synthesis. They argue that the South-South patient travel is mainly motivated by the lack of services in one's home country and/or the unacceptability of local services.…”

“…Furthermore, improved living standards, more mobile lifestyles and individualistic ideals related to self-care have contributed to the popularity of traveling for reasons related to health and wellness (M. Cohen, 2008;. Thus, although health and wellness-related travel is not a new phenomenon, the global trade around it has grown exponentially in recent decades (Connell, 2013;Durham & Blondell, 2017;Kaspar et al, 2019). Deepening our understanding of this phenomenon is important for recognizing both the individual and collective effects of this type of mobility and for effectively addressing contemporary health challenges in the local and transnational contexts.…”