Why People Are Traveling Around The World To See A Doctor

You've likely heard of medical tourism -- when individuals travel abroad to obtain health care they find too costly or delayed at home. What you might not realize is that this industry, fueled by inefficiencies in national health care systems and an increasingly interconnected world, is estimated to be worth tens of billions of dollars annually. 

In his new book, Outpatients: The Astonishing New World of Medical Tourism , journalist Sasha Issenberg takes a look at the practice and its ramifications for the way people around the world receive health care. He examines examples ranging from a Hungarian dentist who has built an empire out of treating travelers, to heart surgery on the cheap in Thailand, to a backlash against foreign patients in Israel.  

Read an excerpt from Outpatients: The Astonishing New World of Medical Tourism

Though one might assume medical tourism is dominated by wealthy elites flying for elective surgeries, Issenberg explains that it's largely driven by middle class individuals seeking cheaper health care. Through interviews and case studies, the book lays out the sometimes surprising implications of the decision to travel for medical care.

The WorldPost sat down with Issenberg to discuss how medical tourism works and whom it helps and hurts.

What are some of the key factors that have spurred the growth of medical tourism over the past couple of decades?

The first is air travel -- in Europe, specifically discounted air travel. The moment that low-cost carriers make it possible to get to Budapest for 79 quid, the economics for somebody in Liverpool just radically changes.

European integration, too. Serbia would love to compete with Poland [for medical tourists], but until they're a member of the European Union, it'll be just that much harder to get people to travel there from Western and Northern Europe.

Medical tourism would also be functionally impossible without the ability of people to research things over the Internet. It remains a surprisingly do-it-yourself area where almost all the initiative is taken by individuals.

To what extent is medical tourism a naturally occurring thing and to what extent is it driven by a desire to lure foreign patients? You talk in the book about how the Hungarians have been able to brand themselves as the dental capital of the world.

I think it's fairly organic, and governments are currently trying to corral it or steal market share from it.

There's not a lot of marketing that I see anywhere that is convincing people who would stay at home to travel for care. There's no marketing that is trying to turn people into medical tourists. But the Turkish government is trying to get people who would think about going to Greece to go to Turkey.

It seems like in Hungary there's a degree of national pride about medical tourism, but in other countries like Israel there are people condemning it for taking up part of their medical system. How do you account for the differing reactions?

Part of it is what the national expectations about health care are. Have you been as a people conditioned to think of health care as a national guarantee? Have you been conditioned to think there's a natural scarcity, where only X amount of procedures can be done in a year, and if a foreigner gets one, then your countryman does not? Have you been told that there's a shortage of skilled doctors or professionals in your country?

In some places, specifically in single-payer systems, there's a fear of scarcity. Almost invariably foreigners are coming in and paying cash and full retail price. So if you have any sort of medical system where local patients are paying anything less than that, it's going to be really appealing for hospital administrators or doctors to prioritize foreign patients ahead of them.

You see certain amounts of skipping ahead of the line.

Exactly. If people are in a system where they feel as taxpayers they are guaranteed health care and they're not getting it at the speed that they are entitled, and then they see foreigners buying their way into a system they helped build -- which is what is going on in Israel -- that's the resentment.

In Hungary, dentistry has been private for 20 years. There's not a perception of scarcity and not a government guarantee. Dental coverage is treated far more as a private good.

When it's seen as a competition for public resources, that's where you get a dangerous mix.

When it comes to medical tourism involving organ transplants, is there a different calculus than, say, the dental industry? Because transplants seem to have a bigger benefit for the receiver than for the destination populace.

It's a great question. Definitely ethicists think of organ transplants belonging in a different category.

There's also a level of specialty in organ transplants that means there's far fewer facilities on earth that are able to do organ transplants and it is a reflection of some form of comparative advantage that some countries have developed.

It would be functionally impossible for us to live in a world where every country or big city had an organ transplant hospital. So at some point, people will have to travel for organ transplants.

The question for the world is not do we feel OK with people getting organ transplants in countries other than their own, but how do we develop an ethical way of doing it that recognizes the national boundaries around organ transplants are inherently problematic because there's a lot of places where countries are not capable. 

Does medical tourism potentially take pressure off governments to change their own health care policies? An example would be Ireland: Are they less likely to legalize abortion if it becomes easier to travel abroad to do that procedure?

Yeah, I think so. Certainly for the politically, culturally or morally tricky issues like those. I write about a women's health hospital in Sofia, [Bulgaria,] that's relying on Turks and Italian couples to come for in vitro fertilization because for religious reasons, Italian and Turkish law makes it very difficult for couples to get that at home. The political constituency that there would be for reproductive reform in those countries has basically disappeared because they're being satisfied elsewhere.

The deeper problem is not just in the areas that are politically, morally, religiously tricky, but in developing countries where the whole elite reflexively goes abroad for treatment. In the book, I have something about how Nigerians with any money will save up to send family members abroad when they need something, because they're probably rightfully distrustful of the local medical infrastructure in Nigeria.

There is going to be no domestic pressure on Nigerian officials to improve the quality of medical offerings, to remove corruption from the domestic health system, if anybody in Nigeria knows they can get decent health care if they leave the country.

Who are the biggest beneficiaries of medical tourism and who are the biggest losers?

The biggest losers are probably those in developing or underdeveloped countries that could be on the cusp of having governments or civil societies that are able to invest in modern medical facilities, and instead see any political urgency around that dry up because their political, economic elite and their middle class have access to medical care abroad.

I start the book with a great beneficiary of medical tourism, who is [Hungarian] Prime Minister Viktor Orban's dentist. He is probably the greatest beneficiary. So you do have select doctors, dentists and hospital administrators who have done well because of this, but not on a great scale. There's no global corporation that has cornered the market on medical tourism. I've yet to find the hedge fund that's gotten filthy rich off medical tourism.

The beneficiaries are middle and upper-middle class consumers in the developed world, who are no longer trapped by the decisions that their politicians have made about the necessary trade-offs to create a health care system that serves their entire country.

Policymakers have often made a lot of very responsible and reasonable decisions that are in the best long-term interests of a country on how to provide the best possible care for the most people at the least unnecessary cost to society. Different countries have come up with their own solutions, each of them imperfect in their own different ways. But, almost by definition, in the short term those are not going to serve everybody. Some people are going to not get what they want out of that.

This interview has been edited for length and clarity.