Understanding medical travel from a source country perspective: a cross sectional study of the experiences of medical travelers from the Maldives

Abstract

BackgroundThe resolution adopted in 2006 by the World Health Organization on international trade and health urges Member States to understand the implications of international trade and trade agreements for health and to address any challenges arising through policies and regulations. The government of Maldives is an importer of health services (with outgoing medical travelers), through offering a comprehensive universal health care package for its people that includes subsidized treatment abroad for services unavailable in the country. By the end of the first year of the scheme approximately US$11.6 m had been spent by the government of Maldives to treat patients abroad. In this study, affordability, continuity and quality of this care were assessed from the perspective of the medical traveler to provide recommendations for safer and more cost effective medical travel policy.ResultsDespite universal health care, a substantial proportion of Maldivian travelers have not accessed the government subsidy, and a third reported not having sufficient funds for the treatment episode abroad. Among the five most visited hospitals in this study, none were JCI accredited at the time of the study period and only three from India had undergone the National Accreditation Board for Hospitals (NABH) in India. Satisfaction with treatment received was high amongst travelers but concern for the continuity of care was very high, and more than a third of the patients had experienced complications arising from the treatment overseas.ConclusionSource countries can use their bargaining power in the trade of health services to offer a more comprehensive package for medical travelers. Source countries with largely public funded health systems need to ensure that medical travel is truly affordable and universal, with measures for quality control such as the use of accredited foreign hospitals to make it safer and to impose measures that ensure the continuity of care for travelers.Electronic supplementary materialThe online version of this article (10.1186/s12992-018-0375-4) contains supplementary material, which is available to authorized users.

Chikungunya resurgence in the Maldives and risk for importation via tourists to Europe in 2019–2020: A GeoSentinel case series

“…Their size and the lack of resources induce more trade, facilitating the importation of vectors and introduction and establishment of viruses [20]. Frequent human migration between the Maldives and chikungunya-endemic countries, including travel to Sri Lanka and India, increase the risk of CHIKV re-introduction and spread [21]. Moreover, the unstable geological structure exposes the island chains to natural storms, hurricanes and cyclones, which can result in mass destruction and an abundant vegetation, which complicates vector-control strategies.…”

An Integrative Review of Patients’ Experience in the Medical Tourism

“…Five studies indicated that patients from the Maldives and other developing countries such as Macedonia/ Kosovo seek care abroad because the procedures were either unavailable or illegal in their local origins. 19,27,34,37,38 For instance, medical abortion is illegal in selected areas in Western Europe. For certain specific procedure such as fertility treatment, donor's availability in destination country was the leading motivator for planning medical travel.…”

“…8 Moreover, certain medical tourists solely depended on facilitators or brokers when selecting a destination hospital abroad. 6,8,37,38 These medical tourists rarely adopted their physician's advice and did not inform their physicians of overseas treatment. Drinkert and Singh 6 and Han and Hyun 22 showed that familiarity and cultural similarity were other important factors for tourists planning a medical trip.…”

Developing Regional Healthcare Facilities in Maldives through Mudharabah Perpetual Sukuk

“…The geographical dispersion of the islands leads to limited availability of skilled healthcare workforce in the smaller islands (Ministry of Health, 2014) and thus it is not uncommon for patients to travel overseas to seek medical care. On average, 66% of domestic travel between the islands was for medical purposes (Suzana et al, 2018). In order to address this matter, the government of Maldives established fully functional primary health centres in every inhabited island, backed by sea and land ambulance fleets (WHO, 2017).…”

“…Introduced in 2012 and revised in 2014, Aasandha provides free healthcare to all Maldivian citizens. Although healthcare is free for all citizens, a huge number of citizens choose to pay out of pocket for their medical treatments (Suzana et al, 2018) As depicted in Table 1, out-of-pocket spending is considerably high while external sources such as donations is insignificant compared to out-of-pocket spending (Ministry of Health, 2013). The "employer funds" in Table 1 refers to the amount employers contribute to the system in order to cover the health insurance of their employees.…”