NR_552 Week 5 Discussion, Medical Tourism

Medical Tourism NAME Chamberlain College of Nursing NR552: Economics of Healthcare Policy DATE After reading the assigned article by Turner (2010), define medical tourism and discuss how medical tourism has benefited or harmed access to care for the citizens of developing countries. What are the legal, ethical and human-caring principles that can be identified on both sides of this issue? Week 5 Medical Tourism Medical tourism is when consumers elect to travel across international borders with the intention of receiving some form of non-emergency medical interventions abroad. According to the World Health Organization, medical tourism "may span the full range of medical services, but most commonly includes dental care, cosmetic surgery, elective surgery, and fertility treatment” (2015). Hospitals positioning themselves as leading medical tourism destinations are largely found within lower and middle-income countries. Countries such as India and Thailand have positioned themselves as leaders in this international industry. For developing countries, medical travel may increase access to certain treatments for local communities through improved infrastructure and higher demand (WHO, 2015). For example, a two-tiered approach utilized in some hospitals in India resulted in improved services for local patients and tailored services for medical travelers (Ruggeri et. al., 2015). Revenue from medical tourism may provide opportunities to improve access and quality for local residents. Another positive outcome is that for developed countries, medical travel may result in small reductions in national health costs. In contrast, access to health care for local residents might be adversely affected if local health professionals devote their time to the treatment of foreigners rather than local communities (Ruggeri et. al., 2015; WHO, 2015). The focus on wealthier foreign patients may undermine resources for impoverished local residents who may have less access to care. The development of private clinics serving foreigners may encourage the movement of trained physicians from the public to the private sector, thus decreasing equity in access to health care for the local population (Snyder, Crooks, Johnston, Adams, & Whitmore, 2015). This phenomenon is already occurring in Thailand and India. Another worry is medical tourism may shift services from preventive public health measures to less effective, and more expensive, clinical interventions for local communities. Effective communication is essential to any medical practice and informed consent is a dimension of effective communication. Informed consent is the process whereby the patient is informed of the risks, benefits and treatment alternatives available to allow the patient to make an informed decision electing the care and treatment provided. Informed consent carries with it two levels of moral responsibility on the part of the health professional; adequate information must be communicated to the patient and the patient must understand the information they receive in order to make an informed decision regarding treatment. One research study looked at the issue of medical tourist ability to provide informed consent after being properly educated on the risk of seeking treatment internationally. Participants in the study identified uninformed decision-making as a significant problem among medical tourists, especially among patients that obtain dental or cosmetic procedures internationally (Crooks ., 2013). The participants reported they believe patients seeking medical treatment abroad do so hastily and with minimal thought due to the appeal of low-cost medical care (Crooks ., 2013). Participants in the study suggested if medical tourists are not able to fully understand the risks of the procedure they plan to purchase abroad, then it is questionable whether they are in a position to give informed consent (Crooks et. al., 2013). It is possible that medical tourists do not know what questions to ask to better understand their risks of seeking medical treatment abroad. References Crooks, V.A., Leigh Turner, Cohen, I.G., Bristeir, J., Snyder, J., Casey, V., Whitmore, R. (2013). Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives. BMJ Open, 3(2). Retrieved on August 4, 2018, from Ruggeri, K., Záliš, L., Meurice, C. R., Hilton, I., Ly, T.-L., Zupan, Z., & Hinrichs, S. (2015). Evidence on global medical travel. Bulletin of the World Health Organization, 93(11), 785–789. Snyder, J., Crooks, V. A., Johnston, R., Adams, K., & Whitmore, R. (2015). Medical tourism’s impacts on health worker migration in the Caribbean: five examples and their implications for global justice. Global Health Action, 8, 10.3402/gha.v8.27348. World Health Organization. (2015, September 18). Evidence on global medical travel. Retrieved on August 3, 2018, from RESPONSE TO PROFESSOR AND STUDENT POST: Dr. Poirier and classmate, After researching medical tourism, I was shocked to find that even a country such as Canada which has a universal health-care system have companies that promote medical tourism. The Canadian healthcare basically works like Medicare, but for everyone. Medical care is free, and it covers almost everything other than prescription drugs, glasses, and dental care. It keeps its drugs cheap by negotiating at a federal level with pharmaceutical companies. And yet, it is reported that at least 18 medical tourism companies operate in Canada to promote travel to medical facilities in other countries (Turner, 2011). It was reported that Canadians traveling abroad for medical treatment spent $447-million in 2013 (Brent, 2017). Once upon a time, only wealthy Canadians had the option of traveling outside Canada for treatment, but now Medical tourism companies have even the playing field. Medical tourism companies offer healthcare travel packages that include air and ground transportation, travel visas, hotel accommodations, assistance from a local company representative in the destination country, transfer of medical records to treating physicians, and negotiated rates for whatever medical procedures clients decide to purchase (Turner, 2007). These companies also advertise tours advertise tours, side trips, and other holiday excursions in addition to medical care to attract clients (Turner, 2011). Even with universal health care, Canadians experience delays in medical interventions such as hip and knee replacements, spinal surgery, and ophthalmologic procedures (Turner, 2007). Patients often wait months to obtain appointments with family physicians, specialists, undergo diagnostic tests and receive treatment. Advocates for medical tourism in Canada argue that the practice promotes improved access to care for patients able to pay for treatment and helps citizens who cannot afford to travel abroad by shortening waiting lists at home. Reference Brent, P. (2017, December 20). How medical tourism – a hot-button issue – could help Canada’s economy. Retrieved on August 8, 2018, from Turner, L. (2011). Canadian medical tourism companies that have exited the marketplace: Content analysis of websites used to market transnational medical travel. Globalization and Health, 7, 40. Turner, L. (2007). Medical tourism: Family medicine and international health-related travel. Canadian Family Physician, 53(10), 1639–1641. RESPONSE TO PEER POST: Amanda, Thank you for your response. A signed informed consent prior to an elective procedure is considered best practice and a standard requirement ensuring that patients are fully informed as to the benefits and adverse effects of a procedure or treatment they are being advised to undergo, and they also have the opportunity to ask questions and seek answers. This may not be available every time in the medical tourism setting, and it is possible that medical tourists may come to regret this if there are failings in professional or clinical practice. As healthcare professionals, we need to know more about how individuals' access, process, and judge medical tourist information they retrieve given such information may be confusing, overwhelming, and even contradictory. The amount of information provided to international medical travelers at destination healthcare facilities is unclear. Because there are no international guidelines or standards, the elements of informed consent and information disclosure vary across countries. Two questions come to my mind when thinking about informed consent in another country. Does the informed consent need to be provided and documented in the language that is the patient’s primary language? Are providers required to have interpreters available to explain the procedures and throughout the medical care experience, as needed?