Daniel Horsfall

Medical tourism: a cost or benefit to the NHS?

‘Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

Medical tourism: A snapshot of evidence on treatment abroad

The scoping review focuses on 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; and organ and tissue transplantation. The review assesses the emerging focus of research evidence post-2010. The narrative review traverses discussion on medical tourism definitions and flows, consumer choice, clinical quality and outcomes, and health systems implications. Attention is drawn to gaps in the research evidence.

Handbook on medical tourism and patient mobility

The growth of international travel for purposes of medical treatment has been accompanied by increased academic research and analysis. This Handbook explores the emergence of medical travel and patient mobility and the implications for patients and health systems. Bringing together leading scholars and analysts from across the globe, this unprecedented Handbook examines the regional and national experiences of medical tourism, including coverage of the Americas, Europe, Africa, the Middle East, and Asia. The chapters explore topics on issues of risk, law and ethics; and include treatment-focused discussions which highlight patient decision-making, patient experience and treatment outcomes for cosmetic, transplantation, dental, fertility and bariatric treatment.

From competition state to competition states

The perceived global and demographic upheavals of the last 30 years have fuelled fierce debate as to whether many developed countries still have a welfare state, and if not, what they now have in its place. Such a controversial debate is marked by the most fragile consensus; advanced nations have begun to depart from the trajectories they followed during what has been termed the ‘golden age’ of welfare states. The competition state thesis has featured prominently amongst the more pessimistic accounts of the modern welfare state. This extreme view of the relationship amongst globalisation, the welfare state and the nation state, suggests that the welfare state no longer exists, having been succeeded by the competition state. Such an assertion sat well with the ‘crisis literature’ that surrounded the welfare state during the late twentieth and early twenty-first centuries. The privileged position held by the competition state thesis within this literature may owe much to a primarily theoretical body of work to date. This has left many questions unanswered, such as: can the competition state be measured? What does such measurement tell us about the competition state? And, is there more than one type of competition state? This article attempts to furnish the theoretical claims of the competition state thesis with data from a variety of sources, most notably the Organisation for Economic Co-operation and Development (OECD). This data have been used to index 25 countries in terms of their ‘competition stateness’ providing a fresh perspective with which to view the claims of the competition state thesis. This article represents the first, tentative steps towards fully operationalising and measuring the competition state and interestingly, uncovers two seemingly distinct forms of the competition state.

A global research agenda on migration, mobility, and health

2358 www.thelancet.com Vol 389 June 17, 2017 An to ni o Pa rri ne llo /R eu te rs 13 Mtatiro SN, Singh T, Rooks H, et al. Genome wide association study of fetal hemoglobin in sickle cell anemia in Tanzania. PLoS One 2014; 9: e111464. 14 American Society of Hematology. State of sickle cell disease: 2016 report. Washington, DC: American Society of Hematology, 2016. http://www. scdcoalition.org/report.html (accessed June 8, 2017). 15 Makani J, Lyimo M, Magesa P, Roberts DJ. Strengthening medical education in haematology and blood transfusion: postgraduate programmes in Tanzania. Br J Haematol 2017; published online April 3. DOI:10.1111/ bjh.14644.

The Impact of the Internet on Medical Tourism

The key arguments of this chapter are as follows: Medical tourism has become increasingly prominent during the last decade and this is in large part a consequence of the way it is marketed through the Internet. Concerns regarding the quality of health information that exists on the Internet have been held for some time. Given that most medical tourism websites have a commercial purpose, assessing the quality of information available to consumers is extremely important. The findings of our study were as follows: Commercial sites aimed at people seeking dental treatment abroad generally appear extremely professional. The apparent professionalism of dental tourism sites masks the fact that important information is often missing from sites. Consequently dental tourism consumers are unlikely to be fully informed of all aspects of the dental tourism process. The range of features adopted by dental tourism sites to engender trust are broad, though often meaningless. Addressing the poor quality of information on dental tourism sites is extremely important; however, for many reasons a regulatory approach is neither viable nor even desirable. It is likely that a combination of better education for patients as part of an ongoing relationship with ‘offline’ health care professionals, alongside self-regulation within the medical tourism industry represents the most realistic route forward.

Medical tourism by numbers

For many reasons numbers are at the heart of medical tourism. From an industry perspective it is essential to establish the scale of medical tourism so as to normalise it and the potential cost-savings so as to promote it. From the perspective of many national governments it is necessary to quantify the process so as to justify investment, chart growth, and demonstrate the impact on the national economy. And for academics there are a multitude of reasons to track the various numbers associated with medical tourism. This chapter opens by exploring the issue of costs, often portrayed as the key motivator for people to seek treatment abroad. Here we see that there sometimes exists a gap between the prices advertised online, the price quoted to prospective medical tourists and the final price that is paid. We reflect on the fact that whilst cost is an important factor for those who choose to travel, it is not always the key motivator and consider what this means for those providers that put costs at the heart of their marketing strategy. The chapter builds on the issue of costs and cost-savings by exploring whether the ‘fantastic offers’ provided by medical tourism providers are genuinely translating into large numbers of people travelling for treatment. Here some of the key figures quoted by both the industry and the academy are interrogated and in some cases exposed, before a tentative ‘total’ is put forward. The chapter then closes by considering how such figures translate into revenue.

The shaping of contemporary medical tourism and patient mobility

Travel for health benefits pre-dates the rise of modern medicine and existence of passports, harking back to porous borders and less institutionalized medicine. Alongside change in travel technology, scientific and surgical developments encouraged growing patient mobility during the twentieth century. In recent decades wealthy people from less developed areas of the world travelled to developed nations to access better facilities and highly trained clinicians, drawn by innovation and reputation. In what is predominantly a private sector there has been dramatic commodification of health and medical treatments. This chapter traces the shaping of contemporary medical tourism, including the strategic role of governments in supporting and promoting national interests, and demands for regulation.

New Zealand’s Reform of Sickness Benefit and Invalid’s Benefit

In common with many other OECD states, policy makers in New Zealand have struggled to reduce the numbers of people in receipt of long-term disability benefits. Disability benefits reform is a wide and challenging agenda and remains at the forefront of social security reform within New Zealand. Successive governments have sought to address the rise in numbers with only limited success. This chapter overviews the New Zealand situation and seeks to: outline the development of measures aimed at reforming New Zealand’s main disability benefits, namely Sickness Benefit (SB) and Invalid’s Benefit (IB), including the underpinning rationales situate these changes within the broader context of both active labour market policy and disability initiatives assess the continuing challenges that exist within the New Zealand context.

A fuzzy set ideal-type approach to measuring the competition state

Abstract Contemporary empirical explorations of the welfare state have paid much attention to its multidimensional nature, noting that nations blend differing approaches to the various dimensions of the welfare state. Sometimes such behaviours can even be contradictory with behaviour in one policy arena perhaps being typically liberal in contrast to the corporatist roots of other behaviours. In much the same way those who argue that the welfare state has changed so substantially as to warrant redefining offer nuanced and multidimensional accounts of what has replaced the welfare state. In this paper we see how nations engage with the competition state as the successor to the welfare state and are presented with data that suggests countries, while engaging with the competition state model, are doing so in their own ways.