Globalization of health care delivery in the United States through medical tourism

Healthcare Facilities and Medical Tourism Across the World: A Bibliometric Analysis

This study aimed to review the literature on healthcare facilities and medical tourism from a range of nations that have established medical tourism sectors and assess the effect of healthcare facilities on medical tourism. A bibliometric study of the Scopus database was carried out by using the search terms '(Facility AND of AND healthcare) AND TITLE-ABS-KEY (health AND tourism) AND medical tourism' for the years 2012-2022. A qualitative evaluation of the literature was then performed to find and locate 92 articles. VOSviewer and NVivo 12 Plus were employed for data analysis. The findings indicated that the following trending subject keywords were used during the period in question: health (rate 1.97), medicine (rate 1.91), tourism (rate 1.70), care (rate 0.83), facilities (rate 0.64) and healthcare (rate 0.61). Furthermore, this research identified four distinct clusters: i) medical tourism, ii) healthcare quality, iii) healthcare system and iv) health services. The study found that healthcare facilities, as actors that have a role in the development of medical tourism, have not been sufficiently explored, even though there is evidence that they play a role in the growth of the sector. This result is in line with Heung's argument, which makes the same point.

Tourism during health disasters: Exploring the role of health system quality, transport infrastructure, and environmental expenditures in the revival of the global tourism industry

Tourism is one of the most important promoters of sustainable development in many nations and regions around the globe. Tourism expansion has been a significant contributor to social and economic growth, particularly in developing economies. It is, however, vulnerable to all kinds of health crises and natural disasters, no matter how small they are. The primary purpose of this study is to acquire an empirical understanding of the effects of health crises and disasters on international tourism. The SYS-GMM was used to examine the impact of health calamities and crises, carbon footprints from transportation, and green finance on the tourism of 51 countries between 2007 and 2020. The results showed that health crises and natural disasters have a big effect on international tourism. Alternatively, the presence of eco-friendly and secure transportation at tourist destinations has a positive effect on the tourism industry. The results also showed that environmental expenditures have positive short- and long-term effects on international tourism. Furthermore, the sensitivity of travelers to health crises and natural disasters varies over the short and long term. The study also showed that compared to normal times, international tourism dropped by more than 67% during COVID-19. Consequently, this research assists us in comprehending, predicting, and preventing the potential adverse effects of COVID-19 and other similar economic, health disasters and crises that could occur in the future and harm the tourism industry.

Epidemiological Characteristics and Trends of Primary Hip Arthroplasty in Five Tertiary Hospitals: A Multicenter Retrospective Study

OBJECTIVE

The number of primary hip arthroplasty (PHA) has increased sharply in recent years. Whether the epidemiological characteristics and trends of PHA have changed are unknown. This study aims to analyze the epidemiological characteristics and trends of those patients are urgent for public health institutions.

METHODS

The data of patients who underwent PHA in five tertiary hospitals from January 2011 to December 2020 were retrospectively reviewed. A total of 21,898 patients were included, most of whom were aged 60-69 years (25.1% males and 31.5% females). According to the hospitalization date, the patients were divided into two groups (Group A and Group B). The patients admitted between January 2011 and December 2015 were designated as Group A (7862), and those admitted between January 2016 and December 2020 were designated as Group B (14036). The patient data of the two groups, including sex, age, disease causes, body mass index (BMI), comorbidities, surgical procedures, hospital stay duration, and hospitalization costs, were analyzed by Pearson chi-Square test, Student t test or Mann-Whitney U test.

RESULTS

More women were included in Group B than in Group A (58.5% vs 52.5%, P < 0.001). The mean age of Group B was less than that of Group A (62.27 ± 14.77 vs 60.69 ± 14.44 years, P < 0.001). Femoral head necrosis was the primary pathogenic factor in both groups, with a higher proportion in Group B than in Group A (55.5% vs 45.5%, P < 0.001). Significant differences were found between the two groups in BMI, comorbidities, surgical procedures, hospital stay duration, and hospitalization costs. Total hip arthroplasty (THA) was the most common surgical procedure in both groups, with a higher proportion in Group B than in Group A (89.8% vs 79.3%, P < 0.001). The proportion of patients with one or more comorbidities was significantly higher in Group B than in Group A (69.2% vs 59.9%, P < 0.001). In addition, Group B had a shorter hospital stay duration and higher hospitalization costs than Group A.

CONCLUSION

Femoral head necrosis was the primary etiology for PHA in this study, followed by femoral neck fracture and hip osteoarthritis. Patients who underwent PHA exhibited a higher percentage of femoral head necrosis; underwent THA more often; and had larger BMIs, more comorbidities, higher medical costs, and younger age in the past decade.

Medical, Health and Wellness Tourism Research-A Review of the Literature (1970-2020) and Research Agenda

Medical, health and wellness tourism and travel represent a dynamic and rapidly growing multi-disciplinary economic activity and field of knowledge. This research responds to earlier calls to integrate research on travel medicine and tourism. It critically reviews the literature published on these topics over a 50-year period (1970 to 2020) using CiteSpace software. Some 802 articles were gathered and analyzed from major databases including the Web of Science and Scopus. Markets (demand and behavior), destinations (development and promotion), and development environments (policies and impacts) emerged as the main three research themes in medical-health-wellness tourism. Medical-health-wellness tourism will integrate with other care sectors and become more embedded in policy-making related to sustainable development, especially with regards to quality of life initiatives. A future research agenda for medical-health-tourism is discussed.

Healthcare service provider type selection of the medical tourists by using neutrosophic sets

Medical tourism service offers a professional healthcare opportunity by travelling abroad with the chance of touristic and cultural activities at the destination country. Medical travelers prefer a foreign country for treatment due to long waiting periods, high costs, excessive number of patients, inadequate number of healthcare professionals and inadequate cutting-edge technological equipment at their country of residence. An assistance company (AC) is a legal requirement to support medical tourists in Turkey during the treatment period, and offers alternative healthcare service providers (HSPs) that are public hospitals, private hospitals and private clinics at the first phase of the medical tourism service. Moreover, there are specific HSPs certificated by the government, and a few number of public hospitals authenticated for medical tourism. By taking the whole above statements into consideration, HSP selection is a key decision-making point differentiating from a traditional hospital selection of a patient. Medical tourists must evaluate various criteria in order to select a proper HSP. Additionally, these decision criteria are often vague, complex, indeterminate and inconsistent information in the HSP type decision. Hence, in this study, a decision making model based on neutrosophic fuzzy sets considering HSP selection in every aspect (truthiness, indeterminacy and falsity) is suggested.

International tourism, social distribution, and environmental Kuznets curve: evidence from a panel of G-7 countries

The study examined the long-run and causal relationship between international tourism receipts (ITR), social distribution, FDI inflows, and carbon (CO2) emissions to verify the different alternative and plausible hypotheses, i.e., environmental Kuznets curve (EKC) hypothesis, "pollution haven" hypothesis (PHH), and "resource efficiency" (REF) hypothesis, in a panel of Group of Seven (G-7) countries for the period of 1995-2015. The study employed panel random effect (RE) regression and panel causality test for robust inferences. The results show that ITR and FDI inflows increase CO2 emissions to verify PHH while government education expenditures (GEE) decrease CO2 emissions to substantiate the REF hypothesis across countries. The results validate the inverted U-shaped EKC relationship between CO2 emissions and economic growth (EG) with the turning point of US$30,900. In addition, GEE increase ITR while healthcare expenditures (HEXP) decrease ITR, which partially supported the REF hypothesis in a panel of countries. The impact of income inequality (INEQ) on ITR is positive at current time period while at later stages INEQ declines ITR that supported an inverted U-shaped relationship between them. The causality estimates confirm the bidirectional relationship between ITR and EG, while there is unidirectional casualty running from (i) ITR, EG, FDI inflows, and GEE to CO2 emissions, (ii) FDI inflows to ITR, (iii) GEE to EG, (iv) EG to social expenditures, (v) income inequality to health expenditures, (vi) social expenditures (SEXP) to ITR, and (vii) INEQ to ITR. There is no causal relationship found between ITR and EG during the study time period. The findings endorse the need for efficient resource spending, sustainable tourism (STR), and rational income distribution to improve environmental sustainability agenda in a panel of G-7 countries.

Dental Websites as New Media Tools for Patients in Dental Health Tourism

Introduction:

Nowadays, potential patients surf the internet to check the websites of health care organizations to select the most suitable health organization for their needs within the perspective of health tourism. To this effect, dental health tourism as a subset of health tourism is considered to be a developing sector.

Aim:

The aim of the study was to assess whether websites are effectively used as media tools by dental health care organizations, which serve as currently active as well as promising components of health tourism in Turkey.

Methods:

In this cross-sectional study, 555 websites of dental health care organizations were examined. Web pages were evaluated by using E-Information Quality Scale of the Health Centre. A low score indicates well-designed websites.

Results:

Scores related to “contact information” and “website layout” were lower in the private ones (n:146) than the public institutions (n:409)(p=0.000, p=0.011). It was observed that 80.8% (n:122) of the websites with foreign language options (n:151), were private institutions); whereas, public institutions only constitute 19.2% (n:29) of the total. All sub-group scores in the scale were lower in the organizations offering foreign language alternatives in contrast to the ones without foreign language options (p<0.05).

Conclusion:

In private dental health care organizations,“ contact information” and “website layout” of websites were observed to be the most prominent features in the conduct of public relations activities. Websites with foreign language alternatives were well-designed due to the fact that language options were considered to be an incentive for the health tourists.

Plastic Surgery Complications from Medical Tourism Treated in a U.S. Academic Medical Center

BACKGROUND

Medical tourism is a growing, multi-billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors' center.

METHODS

A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied. The authors collected demographic information, types of surgery performed, destinations, insurance coverage, and complications.

RESULTS

Seventy-eight patients were identified over 7 years. Most commonly, complications were seen following abdominoplasty (n = 35), breast augmentation (n = 25), and foreign body injections (n = 15). Eighteen patients underwent multiple procedures in one operative setting. The most common destination country was the Dominican Republic (n = 59). Complications included surgical-site infections (n = 14), pain (n = 14), and wound healing complications (n = 12). Eighty-six percent of patients (n = 67) relied on their medical insurance to pay for their follow-up care or manage their complications, with the most common type of health insurance coverage being Massachusetts Medicaid (n = 48).

CONCLUSIONS

Cosmetic surgery performed in developing countries can carry substantial risks of complications that can be challenging to patients, primary care providers, insurers, and plastic surgical teams not associated with the original surgery. These complications pose significant burdens on our public health systems.

Medical tourism and national health care systems: an institutionalist research agenda

Although a growing body of literature has emerged to study medical tourism and address the policy challenges it creates for national health care systems, the comparative scholarship on the topic remains too limited in scope. In this article, we draw on the existing literature to discuss a comparative research agenda on medical tourism that stresses the multifaceted relationship between medical tourism and the institutional characteristics of national health care systems. On the one hand, we claim that such characteristics shape the demand for medical tourism in each country. On the other hand, the institutional characteristics of each national health care system can shape the very nature of the impact of medical tourism on that particular country. Using the examples of Canada and the United States, this article formulates a systematic institutionalist research agenda to explore these two related sides of the medical tourism-health care system nexus with a view to informing future policy work in this field.

Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013-2014(1)

Infections in 6 states were linked to persons traveling to undergo cosmetic surgical procedures.

During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.

Global trends in center accreditation by the Joint Commission International: growing patient implications for international medical and surgical care

Millions of patients travel internationally for medical and surgical care. We found that the annual number of centers accredited by the Joint Commission International increased from one center in 1999 to 132 centers in 2016; there are currently 939 accredited centers across 66 countries. Public health and medicolegal implications related to medical travel deserve attention.

Factors affecting health tourism and international health-care facility choice

Purpose

Health-care tourism has become a major industry in the past decade. Following the increasing activity in health-care tourism, the decision-making process of consumers in choosing an international health-care facility has become increasingly important to the related parties. The present study aims to offer a holistic model of international health-care facility choice that incorporates the important dimensions by assessing the growth drivers and the alternative factors proposed in the literature and by validating them via a survey study.

Design/methodology/approach

The factors deemed important in the existing literature were used as the basis of a study in Turkey. In total, 65 structured interviews were conducted with health-care professionals and international health tourists to understand the perspective of the two important parties that affect policymaking.

Findings

The findings of the study support the significance of the majority of the variables proposed as important factors affecting international health-care facility choice.

Research limitations/implications

The study was carried out in four large hospital chains in Turkey; however, this creates a limitation in scope and may have limited representativeness of the overall market. The model has yet to be tested on a larger scale.

Practical implications

There are significant differences in the opinions of professionals and international health-care tourists in terms of choice criteria. This indicates problems with health professionals’ understanding of the consumer decision process.

Originality/value

The study provides a model that can be used to gain insights on the consumer decision process and also provides the policymakers and stakeholders of the international health-care industry with a sound theoretical foundation to build further studies upon. Only a limited number of studies was carried out in Turkey that focus on international health-care tourism, and the present study will fill a substantial research gap.

Framing Service, Benefit, and Credibility Through Images and Texts: A Content Analysis of Online Promotional Messages of Korean Medical Tourism Industry

This study examines how the Korean medical tourism industry frames its service, benefit, and credibility issues through texts and images of online brochures. The results of content analysis suggest that the Korean medical tourism industry attempts to frame their medical/health services as "excellence in surgeries and cancer care" and "advanced health technology and facilities." However, the use of cost-saving appeals was limited, which can be seen as a strategy to avoid consumers' association of lower cost with lower quality services, and to stress safety and credibility.

Risk of symptomatic venous thromboembolism associated with flying in the early postoperative period following elective total hip and knee arthroplasty

Air travel and total joint arthroplasty (TJA) are both risk factors for venous thromboembolism (VTE). Patients are counseled against flying after surgery, however the basis for this recommendation has not been investigated and may be unfounded. A retrospective cohort of 1465 consecutive TJA patients was divided into a study population of 220 patients (15.0%) who flew home at a mean of 2.9 days after surgery (range, 1-10 days) and a control population of 1245 patients (85.0%) who did not fly. We found no differences in the rate of deep vein thrombosis, pulmonary embolism, or overall VTE between the groups, and incidence of all events was low in both groups and comparable with published data. Allowing air travel after TJA appears to be a safe practice.

Communication needs of medical tourists: an exploratory study in Thailand

Purpose

– The aim of this paper is to contribute a conceptualization of the information and communication needs of medical tourists from Western countries in an Asian health care context.

Design/methodology/approach

– Multi-phase, semi-structured, in-depth interviews and observations were conducted with 27 multi-source informants who have communication experience in the international healthcare setting.

Findings

– Multi-level information provision should be used to address communicative incongruence in Asian healthcare provider – Western patient encounters as was self-reported by the participants and observed by authors. The use of an informative communication model is proposed in order to facilitate interaction and the effective transfer of information with Western patients to overcome negative, underlying emotions and enable autonomous decision making by the patients.

Research limitations/implications

– This exploratory study is focused on Western patients and Asian practitioners in Thailand. Future research in other countries and with patients from other geographical areas could expand to generalize findings.

Practical implications

– Fostering information sharing with Western patients by using an integrative communication model can improve patient satisfaction and health outcomes. The need for developing and implementing these improved practices for communicating with Western patients is reflected by the healthcare industry's current developmental trends helping to lead to a future of health service internationalization.

Originality/value

– This is the first empirical study to provide insights concerning the communication needs and coping strategies of Western patients with Asian doctors in developing countries.

The globalization of healthcare: implications of medical tourism for the infectious disease clinician

Travel abroad for healthcare has increased rapidly; interventions include organ transplant; cardiac surgery; reproductive care; and joint, cosmetic, and dental procedures. Individuals who receive medical care abroad are a vulnerable, sentinel population, who sample the local environment and can carry home unusual and resistant infections, documented in many reports. Medical tourists are at risk for hospital-associated and procedure-related infections as well as for locally endemic infections. Patients may not volunteer details about care abroad, so clinicians must inquire about medical procedures abroad as well as recent travel. Special infection control measures may be warranted. Healthcare abroad is associated with diverse financial, legal, ethical, and health-related issues. We focus on problems the infectious disease clinician may encounter and provide a framework for evaluating returned medical tourists with suspected infections. A better system is needed to ensure broad access to high-quality health services, continuity of care, and surveillance for complications.

Cross-border health care utilization among the Hispanic population in the United States: implications for closing the health care access gap

OBJECTIVES

To examine predictors of health care service utilization in Mexico or any other country in Latin America among the U.S. Hispanic population.

METHODS

This study used data from the 2007 Pew Hispanic Healthcare Survey, a nationally representative survey of 4013 Hispanic adults. Using the Behavioral Model of Health Service Use (BMHSU) model, we examined three levels of predictive factors: (1) predisposing characteristics (e.g., language proficiency), (2) enabling resources (e.g., health insurance status), and (3) need (e.g., self-perceived health status). Multivariate logistic regression analyses were conducted to predict odds of seeking health care services in Mexico or any other country in Latin America.

RESULTS

As hypothesized, lack of continuous health insurance coverage, perceived lack of quality health care, and low English proficiency increased the likelihood of seeking health care in Mexico or any other Latin American country among US Hispanic adults. Self-reported health status and usual source of care, however, were not significant predictors.

CONCLUSIONS

Hispanic immigrants face critical access gaps to health care in the United States. Implications for closing the access gap for this population are discussed within the context of health care system reform and immigration reform in the United States.

Beyond "medical tourism": Canadian companies marketing medical travel

Background

Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel.

Methods

Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures.

Results

Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross-border health services available in the United States and intranational travel to clinics in Canada. In contrast to medical tourism companies, they do not market holiday tours in addition to medical care. Two companies occupy a narrow market niche and promote testing for CCSVI and “Liberation therapy” for multiple sclerosis. Three additional companies offer bariatric surgery and cosmetic surgery at facilities in Mexico. Four businesses offer health insurance products intended to cover the cost of obtaining privately financed health care in the U.S. These businesses also help their clients arrange treatment beyond Canada’s borders. Finally, one medical travel company based in Canada markets health services primarily to U.S. citizens.

Conclusions

This article uses content analysis of websites of Canadian companies marketing medical travel to provide insight into Canada’s medical travel industry. The article reveals a complex marketplace with different types of companies taking distinct approaches to marketing medical travel.