The potential for bi-lateral agreements in medical tourism: A qualitative study of stakeholder perspectives from the UK and India

Abstract

BackgroundGlobalisation has prompted countries to evaluate their position on trade in health services. However, this is often done from a multi-lateral, rather than a regional or bi-lateral perspective. In a previous review, we concluded that most of the issues raised could be better addressed from a bi-lateral relationship. We report here the results of a qualitative exercise to assess stakeholders' perceptions on the prospects for such a bi-lateral system, and its ability to address concerns associated with medical tourism.Methods30 semi-structured interviews were carried out with stakeholders, 20 in India and 10 in the UK, to assess their views on the potential offered by a bi-lateral relationship on medical tourism between both countries. Issues discussed include data availability, origin of medical tourists, quality and continuity of care, regulation and litigation, barriers to medical tourism, policy changes needed, and prospects for such a bi-lateral relationship.ResultsThe majority of stakeholders were concerned about the quality of health services patients would receive abroad, regulation and litigation procedures, lack of continuity of care, and the effect of such trade on the healthcare available to the local population in India. However, when considering trade from a bi-lateral point of view, there was disagreement on how these issues would apply. There was further disagreement on the importance of the Diaspora and the validity of the UK's 'rule' that patients should not fly more than three hours to obtain care. Although the opinion on the prospects for an India-UK bi-lateral relationship was varied, there was no consensus on what policy changes would be needed for such a relationship to take place.ConclusionsWhilst the literature review previously carried out suggested that a bi-lateral relationship would be best-placed to address the concerns regarding medical tourism, there was scepticism from the analysis provided in this paper based on the over-riding feeling that the political 'cost' involved was likely to be the major impediment. This makes the need for better evidence even more acute, as much of the current policy process could well be based on entrenched ideological positions, rather than secure evidence of impact.

Use of cross-border healthcare services among ethnic Danes, Turkish immigrants and Turkish descendants in Denmark: a combined survey and registry study

“…Patient mobility is increasing worldwide and is high on the agendas of national healthcare systems and health authorities [7,22]. Immigrants and their descendants have a background from (at least) two countries, and more affluent members of this group in particular may possess greater knowledge and capability of navigating different healthcare systems, making them better able to exploit services that are most beneficial to them.…”

“…Although cross-border patient mobility still comprises a relatively small proportion of all elective care [5], it raises a concern regarding patient safety and continuity of care [5-7], which is an essential element of quality treatment and outcome. Special concern for the continuity of care and interference of medicine from abroad has been raised with regard to immigrants, as they may have stronger links to healthcare services abroad/in their home countries.…”

“…So far, a review has pointed at major gaps in the evidence base for use of cross-border healthcare, including the patient profile of those seeking care abroad [6], and researchers have highlighted that there is an imperative for more empirical data on use of cross-border healthcare to be collected, in particular on the size of the use [7]. To our knowledge, the use of cross-border healthcare by Turkish immigrants has hitherto not been addressed in scientific literature, and no European studies have quantified immigrants’ cross-border healthcare use.…”

A challenging entanglement: health care providers’ perspectives on caring for ill and injured tourists on Cozumel Island, Mexico

“…Here, researchers have offered important insights regarding the potential drawbacks and benefits of care abroad. These include concerns about the safety and quality of medical care outside of one’s home country (Gan & Frederick, 2015; Hudson et al, 2016), language and cultural tensions with health workers abroad (Hudson et al, 2016; Whittaker & Chee, 2015), and inadequate continuity of care due to disruptions in the continuing medical record (Martínez Álvarez, Chanda, & Smith, 2011). …”

“You’re dealing with an emotionally charged individual…”: an industry perspective on the challenges posed by medical tourists’ informal caregiver-companions

“…Patients receive care while surgeons and other physicians provide it, facilitators aid with connecting patients to hospitals and making travel bookings, and policy-makers and government officials work to ensure that destination countries have adequate infrastructure to receive these bookings [33,34]. International patient coordinators (IPCs) constitute yet another such group.…”