A European perspective on medical tourism: the need for a knowledge base.

Since the early 1990s, medical tourism, whereby individuals choose to travel across national borders or overseas to receive treatments, has been increasingly recognized in the United States and Asia. This article highlights the emergence of medical tourism in the European context. It examines the drivers for such developments and situates medical tourism within the broader context of health globalization and forms of patient mobility in the European Union. In outlining the developments of medical tourism in Europe, the authors distinguish between two types of medical tourist: the citizen and the consumer. The discussion explores the need for greater empirical research on medical tourism in Europe and argues that such research will contribute toward knowledge of patient mobility and the broader theorization of medical tourism. The authors make suggestions about the content of this research agenda, including understanding the development of medical tourist markets, the nature of choice, equity implications, the role of brokers and intermediaries, and general issues for health management.

Medical tourism: assessing the evidence on treatment abroad.

The review focuses on one growing dimension of health care globalisation - medical tourism, whereby consumers elect to travel across borders or to overseas destinations to receive their treatment. Such treatments include cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The review sought to identify the medical tourist literature for out-of-pocket payments, focusing wherever possible on evidence and experience pertaining to patients in mid-life and beyond. Despite increasing media interest and coverage hard empirical findings pertaining to out-of-pocket medical tourism are rare. Despite a number of countries offering relatively low cost treatments we know very little about many of the numbers and key indicators on medical tourism. The narrative review traverses discussion on medical tourist markets, consumer choice, clinical outcomes, quality and safety, and ethical and legal dimensions. The narrative review draws attention to gaps in research evidence and strengthens the call for more empirical research on the role, process and outcomes of medical tourism. In concluding it makes suggestion for the content of such a strategy.

Health care financing reforms in Germany: the case for rethinking the evolutionary approach to reforms.

Health care reform has been a perpetual issue in German politics since reunification. Reform initially focused on restructuring the health care system of the former East Germany. It has subsequently focused on questioning whether the financing of the German social health insurance (SHI) system is sustainable, in light of economic malaise that characterized the 1990s and heightened global competition. In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.

Globalization and healthcare: understanding health and medical tourism.

Faced with long waiting lists, the high cost of elective treatment and fewer barriers to travel, the idea of availing healthcare in another country is gaining greater appeal to many. The objective of this review is to perform a literature review of health and medical tourism, to define health and medical tourism based on the medical literature and to estimate the size of trade in healthcare. The Medline database was used for our literature review. In our initial search for 'health tourism' and 'medical tourism' we found a paucity of formal literature as well as conceptual ambiguity in the literature. Subsequently, we reviewed the literature on 'tourism' in general and in the context of healthcare. On the basis of 149 papers, we then sought to conceptualize health tourism and medical tourism. Based on our definitions, we likewise sought to estimate market capacity internationally. We defined health tourism as "the organized travel outside one's local environment for the maintenance, enhancement or restoration of an individual's wellbeing in mind and body". A subset of this is medical tourism, which is "the organized travel outside one's natural healthcare jurisdiction for the enhancement or restoration of the individual's health through medical intervention". At the international level, health tourism is an industry sustained by 617 million individuals with an annual growth of 3.9% annually and worth US$513 billion. In conclusion, this paper underscored the issue of a severely limited formal literature that is compounded by conceptual ambiguity facing health and medical tourism scholarship. In clarifying the concepts and standardizing definitions, and providing evidence with regard to the scale of trade in healthcare, we hope to assist in furthering fundamental research tasks, including the further development of reliable and comparable data, the push and pull factors for engaging in health and medical tourism, and the impact of health tourism but, more so, medical tourism on local healthcare systems.