Jeremy Snyder, Valorie Crooks, Krystyna Adams and Rory Johnston discuss their work on informing Canadians that participate in medical tourism

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Have you ever thought about going to another country for surgery? Or perhaps you or someone you know has already opted to do so.

More and more Canadians are hearing about, talking about, thinking about, and ultimately opting for what has come to be known as ‘medical tourism’. Medical tourism occurs when people choose to travel internationally to access medical care that is typically paid for out of pocket. Given the private and global nature of this practice, reliable numbers of medical tourist flows are hard to come by. We do have anecdotal evidence, however, that Canadian patients are traveling overseas to a large array of countries. These countries include high income destinations like the US, UK, and Barbados, but also low and middle income countries like India, Mexico, and Thailand. Our research over the past several years has shown that Canadians opt for medical tourism for a number of reasons.

Recently, researchers and policymakers have flagged a range of ethical concerns stemming from medical tourism. For medical tourists, there is a concern that they may be subjected to health and safety risks by traveling abroad for care and that informed consent to these risks may be undermined by a lack of transparency in the industry. Within the patient’s home country, there are concerns that medical tourists can spread infectious diseases once home and, if they face complications from their care, may shift costs onto public health systems or private insurers. For local residents in places where medical tourists are traveling to, critics have voiced concerns that medical tourism can enhance differences in access to medical care by shifting resources from the public to private health system and prioritizing care for (sometimes) wealthy visitors. Each of these concerns about the negative impacts of medical tourism can be balanced by claims of this practice’s benefits, including fast and affordable care for patients, outsourcing patients from domestic health systems, and the influx of investment and income for host countries.

Our earlier research established that there has been little indication that Canadians who are thinking about becoming medical tourists are aware of these ethical concerns. These patients are commonly worried about their personal health and safety, but problems such as maintaining continuity of their medical records across countries are less visible to them. Concerns about the impacts of medical tourism on people other than patients and those working in hospitals abroad, such as citizens of the medical tourist’s home and destination countries, are particularly opaque to Canadians thinking about becoming medical tourists; if anything, they typically think that medical tourism is a net benefit to everyone involved. When pressed, we have found that former Canadian medical tourists take a defensive stance toward the ethical dimensions of medical tourism, seeing themselves as the ‘victims’ of a domestic system that is unable to serve their needs.

Because of the lack of visibility of the ethical concerns associated with medical tourism for Canadians thinking about going abroad for care, we decided to develop an information sheet that could better inform them prior to making a decision. Our work on the information sheet was supported by a grant from the Canadian Institutes of Health Research. The inspiration of this project was ethical purchasing campaigns, such as those associated with ‘free trade’ coffee, ethically sourced chocolate, ‘sweat-free’ clothing, and sustainable fisheries. Insofar as consumers are willing to let values like sustainability, a living wage, and decent working conditions influence their purchasing decisions (including when living up to these values requires paying higher prices), we were hopeful that Canadians considering engaging in medical tourism might similarly be influenced.

There are few existing information sources for potential Canadian medical tourists, and these tend to exclusively consider health and safety concerns. Therefore, we examined guidelines in areas that overlap with medical tourism: sustainable tourism, patient use of public health resources, and medical volunteering abroad. Based on common themes within these guidelines, we created a draft information sheet for would-be medical tourists that stressed ethical values such as efficiency, stewardship, equity, reciprocity, non-maleficence, autonomy, and empathy. These values were matched with a set of goals and a linked set of actions to achieve these goals. This draft was presented to focus groups of medical tourism stakeholders in Montreal, Toronto, and Vancouver. Based on participants’ feedback we simplified the information sheet. While the focus group participants sought an information sheet that was prescriptive and action guiding, we quickly hit a road block in terms of the dearth of context-specific information on the impacts of medical tourism.

This revised information sheet was then presented to 24 former Canadian medical tourists in one-on-one interviews. In some cases, these individuals felt that the information provided was condescending or overly simplistic, but others felt it was clear and helpful. While some participants expressed that they felt that the information sheet was trying to dissuade Canadians from engaging in medical tourism, in general they responded that the sheet was balanced, as was our intention. (You can see the final product, which resulted from a few minor changes in light of these patient interviews, below. And, we’d love your comments on the information sheet as well!).

Our aim now is to distribute this information sheet throughout Canada to help Canadians ask critical questions that will better inform their decision of whether and how to engage in medical tourism.

As is, the information sheet suffers from our lack of clear information on the impact of medical tourism, which we are looking into at the moment in a different study, and the fact that we cannot yet guide people in the direction of additional resources to consult when making their decisions as they simply do not exist. Our next goal is to develop a website that will contain more information for potential medical tourists that will be updated as our ongoing research on the impacts of medical tourism progresses. This information will likely be a long time in coming, but medical tourism is a phenomenon that does not seem likely to disappear soon.

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Jeremy Snyder is Assistant Professor in the Faculty of Health Sciences, Simon Fraser University; Valorie Crooks is Associate Professor in the Department of Geography, Simon Fraser University; Krystyna Adams is a Master’s student in Public Health at Simon Fraser University; and Rory Johnston is a PhD candidate in the Department of Geography at Simon Fraser University.