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In this chapter, the focus shifts to consider medical tourism from the destination country perspective. A number of authors, scholarly and popular, have critiqued medical tourism’s inequities: vast medico-industrial complexes, replete with the newest expensive technologies to provide comparatively wealthy medical tourists with hip replacements and facelifts, coexist with large swaths of the population dying from malaria, AIDS, and lack of basic sanitation and clean water. These disparities raise several interesting fundamental questions that are the subject of this chapter: first, under what conditions is medical tourism likely to produce negative consequences on health care access in less developed destination countries, and is there good evidence it is having that effect? Second, as a moral matter of global justice, what responsibility do home countries and others bear for health care access disparities related to medical tourism? And finally, what kinds of regulations might best ameliorate such potential negative consequences?

This chapter describes twenty-seven reported cases of medical tourists who died during or shortly after undergoing cosmetic surgery or bariatric surgery abroad since 1993. It limits the analysis to news media reports that were in the public domain and were intended for public consumption. It also offers brief descriptions of these cases of mortality in individuals who traveled abroad and underwent cosmetic or bariatric surgery at international medical facilities. Of the twenty-seven reported deaths, twenty-five of the individuals were women. Eleven individuals had died after receiving health care in Mexico. Four fatalities had taken place in the Dominican Republic. In general, the in-depth case studies indicate strategies that might enhance patient safety, quality of care, disclosure of information, quality of advertising, and protection of patients in the global marketplace for health services. The significance of establishing effective measures for tracking clinical outcomes in medical tourism is also observed.

This chapter provides a media content analysis of Canadian print media depictions of medical tourism. It describes how the lack of reliable information in these sources about the numbers and motivations of Canadians traveling abroad for care, and about how the public-health and resource-allocation effects of this practice domestically and abroad, have hindered a balanced and informed public discussion of the ethical issues raised by medical tourism. Fifty-nine articles are included in this media analysis. The analysis shows that Canadian print news media articles identify various factors employed to explain why Canadian patients go abroad for private medical care. The Canadian news media accounts of medical tourism address ethical issues linked to the quality of care and patient safety at international health care facilities. Finally, the significances for future Canadian media coverage of medical tourism are reviewed.

This chapter addresses the effect medical tourism has on access to health care in the destination country. It also investigates both the existing empirical evidence and developmental economic theorizing as to when medical tourism is likely to have negative effects. Then, it describes under what circumstances home countries bear obligations to prevent or remedy those negative effects. The four types of theories that propose to find fault with medical tourism are specifically explained, namely self-interest, cosmopolitan theories, statist theories, and intermediate theories. It is shown that the application of cosmopolitan, statist, and intermediate theories to medical tourism details the gaps and indeterminacies as well as reasons some of these theories may not be good fits for applied ethics inquiry, and built on existing discussions of pharmaceutical pricing and medical migration.

Before we can wrestle with the many legal and ethical issues raised by medical tourism, we need a better understanding of the industry, its scope, and its components. This chapter aims to put flesh on the bone. It begins by offering a taxonomy of kinds of medical tourism, then discusses the major components of the industry: traveling patients, destination country hospitals and health care workers, destination country governments with a hand in medical tourism, facilitators (sometimes called “intermediaries”), insurers covering the practice, accreditors, and home country hospitals that partner with destination country hospitals. As this is a lot of ground to cover, the discussion is focused on the pieces that are most relevant to the legal and ethical discussions that follow, in many cases taking a 10,000-foot view. Still this chapter seeks to offer the most comprehensive set of data on the industry yet collected.

This chapter analyses ‘health tourism’ as a specific form of alleged benefit fraud. Medical tourism takes place when individuals opt to travel overseas with the primary intention of receiving medical treatment. As such, it can be thought of as a type of patient or ‘consumer’ mobility in which individuals travel outside their country of residence for the consumption of health care services. More recently, media coverage of medical tourism has adopted the narrative of benefit fraud or exploitation, with tourists either purposely or unwittingly accessing care they are not entitled to or not paying for that which they are required to pay. This issue has proven particularly incendiary, prompting formal responses from the government. In the lead up to and aftermath of the UK's EU referendum, the issue played a central role in wider discussions around migration and the free movement of individuals across Europe.

Health systems rely upon two groups of people: health workers and patients. In recent decades both groups have been on the move globally, with the creation of internationalized labour market opportunities (the hunt for skilled labour in the case of health workers) and private investments in high-end health care on lower-cost developing countries (one of the key incentives for patients seeking care outside of their own country, for uninsured or under-insured services). Both flows raise a number of health equity concerns. Health worker migration can pose undue hardships on low-resource, high-disease burden countries who lose their workers to richer nations, creating a ‘perverse subsidy’ of poor to rich. With medical tourism, private, fee-paying foreign patients in poorer countries could ‘crowd out’ access to care for domestic patients in those countries, while potentially returning with drug resistant infections or complications burdening their home country’s health systems.

This chapter explores the legal remedies available to medical tourists in Europe when they experience an adverse event. It investigates Europeans' right to medical tourism services under the Maastricht Treaty. It then describes the ability of a plaintiff to have a judgment or award enforced when diversity jurisdiction is present. Under the Brussels Convention, parties to a contract may use a jurisdiction clause to override the default rules for jurisdiction determination. Consumer transactions are also consorted their own jurisdictional loophole. Both European Union (EU) medical tourism vendors (MTVs) and patients should be aware of the general default rule for identifying diversity jurisdiction. After an adverse medical outcome, unwary medical tourists and MTVs may find that they have accepted more liability than they have realized. It can be concluded that EU medical tourists should carefully read any contract they sign and ask appropriate questions.

In this dialogue, Dr. Rebecca Franklin moderates a heated exchange that took place at a meeting of the International Stem Cell Organization between two individuals who hold polarized views on stem cell tourism: Robert Flossel, a stem cell scientist, and Dr. Barbara Grant, who has argued in a book that there are insufficient ethical standards for clinical trials in Third World nations and wants Western nations to refuse data from trials that do not meet minimum standards. Flossel advocates getting government off the backs of scientists and out of the business of regulating clinical trials. The term “medical tourism” refers to patient travel from industrialized nations to foreign clinics for medical treatment. Here Flossel and Grant express their views on whether stem cell tourism should be supported as the quintessential free market of frontier medical therapies or should be abolished as a cruel commercial abuse of medicine that gives patients false hope. They also discuss the role of the state in protecting its citizens by prohibiting or warning against traveling abroad to receive uncertified experimental treatments with stem cells.

This chapter introduces the Global-Health Impact Labels (GHILs), which are a form of accreditation awarded to corporations that have made significant impact on global health. Though the idea is not without its criticisms, it can at least be implemented in the medical tourism industry in order to alleviate brain drain concerns in developing countries.

Global health affords an opportunity for people from diverse countries to interact and to develop trusting ties with one another. People from affluent nations initiate many of these health interactions, and although unintentionally, often do so at the detriment of people in poor countries. This chapter develops this argument with reference to medical brain drain, medical tourism and international transplantation. Basic principles of fairness, reciprocity, and justice suggest that a global scenario in which the health of the global poor is sacrificed for people in affluent countries is morally unsettling. A more inclusive approach to the health of newcomers would be an important step toward health justice.

This chapter highlights the role of the private sector in health and medicine with reference to India. The private sector plays a critical role in the field of medicine because the nature and extent of privatization determines not just the kind of medical care delivered, but also reflects the division of labour, specialization and the professional authority of medicine in any given society. The term private sector in this chapter is employed to refer to the institutions that have emerged because of the investment of private capital and the advent of mass industrial production of drugs since the nineteenth century. If we take capital investment and mass production as the markers of a distinct phase in medicine, then the process of privatization has not been uniform for different fields of medicine such as, medical care, manufacture of medicines and medical education. The chapter briefly maps the process in these three sectors.

This chapter examines health economics, financing, and management from the contrasting perspectives of mainstream and social justice-oriented approaches. It evaluates how health care is different from other goods and services and why a free-market approach cannot guarantee equitable or efficient distribution of health care. It scrutinizes different approaches to health care financing, comparing revenue-raising and remuneration arrangements, and the US and Canadian health care systems. It analyzes the aims, assumptions, and uses of cost-analyses and implications for equity, efficiency, and priority-setting. It also assesses the role of World Bank and other dominant global health actors in shaping market approaches to health care in low- and middle-income countries since the 1980s as well as current donor financing strategies. The chapter also covers issues of corruption and medical tourism that jeopardize health care equity. It concludes by presenting alternative social justice approaches to investing for, rather than in, health and health equity.

Surprisingly, despite more than twenty years of state investment, stem cell science in India remains at a very preliminary stage. In contrast, venture capital investments in stem cell science has surged ahead, matched in India by an unregulated nature of medical care in India. The author examines how patients with certain diseases are being offered speculative stem cell treatments in a number of cities in India. Additionally, she explores how a public policy–led growth of medical tourism has also facilitated the stem cell industry. Patients from abroad—the so-called therapeutic refugees—now come to India because such therapies are not permitted in their own countries. In closing, the author asks: how ethical is it for India to be investing in such technologies when it is unwilling to make investments in the health care needs of the majority of the population?

As a technique of reproduction, the IVF procedure enables doctors to play god to help couples in procreation of children — not merely infertile heterosexual couples, but same sex couples as well. Surrogacy is an off shoot of this medical procedure. India has been a favoured destination even for foreign couples desiring children, not merely because of the relatively lower costs of procuring children through surrogate motherhood but also on account of the absence of legal regulation for adopting IVF procedures. The IMC has issued regulations for IVF procedures but with growing complaints of exploitation of women in India and with court responses to commercial exploitation of surrogacy being ad hoc and unsatisfactory, we are moving towards the prospect of parliamentary legislation to stem the rot.