Rory Johnston
Simon Fraser University
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International Journal for Equity in Health | 2010
Rory Johnston; Valorie A. Crooks; Jeremy Snyder; Paul Kingsbury
BackgroundMedical tourism involves patients intentionally leaving their home country to access non-emergency health care services abroad. Growth in the popularity of this practice has resulted in a significant amount of attention being given to it from researchers, policy-makers, and the media. Yet, there has been little effort to systematically synthesize what is known about the effects of this phenomenon. This article presents the findings of a scoping review examining what is known about the effects of medical tourism in destination and departure countries.MethodsDrawing on academic articles, grey literature, and media sources extracted from18 databases, we follow a widely used scoping review protocol to synthesize what is known about the effects of medical tourism in destination and departure countries. The review design has three main stages: (1) identifying the question and relevant literature; (2) selecting the literature; and (3) charting, collating, and summarizing the data.ResultsThe large majority of the 203 sources accepted into the review offer a perspective of medical tourism from the Global North, focusing on the flow of patients from high income nations to lower and middle income countries. This greatly shapes any discussion of the effects of medical tourism on destination and departure countries. Five interrelated themes that characterize existing discussion of the effects of this practice were extracted from the reviewed sources. These themes frame medical tourism as a: (1) user of public resources; (2) solution to health system problems; (3) revenue generating industry; (4) standard of care; and (5) source of inequity. It is observed that what is currently known about the effects of medical tourism is minimal, unreliable, geographically restricted and mostly based on speculation.ConclusionsGiven its positive and negative effects on the health care systems of departure and destination countries, medical tourism is a highly significant and contested phenomenon. This is especially true given its potential to serve as a powerful force for the inequitable delivery of health care services globally. It is recommended that empirical evidence and other data associated with medical tourism be subjected to clear and coherent definitions, including reports focused on the flows of medical tourists and surgery success rates. Additional primary research on the effects of medical tourism is needed if the industry is to develop in a manner that is beneficial to citizens of both departure and destination countries.
Globalization and Health | 2012
Rory Johnston; Valorie A. Crooks; Jeremy Snyder
BackgroundMedical tourism describes the private purchase and arrangement of medical care by patients across international borders. Increasing numbers of medical facilities in countries around the world are marketing their services to a receptive audience of international patients, a phenomenon that has largely been made possible by the growth of the Internet. The growth of the medical tourism industry has raised numerous concerns around patient safety and global health equity. In spite of these concerns, there is a lack of empirical research amongst medical tourism stakeholders. One such gap is a lack of engagement with medical tourists themselves, where there is currently little known about how medical tourists decide to access care abroad. We address this gap through examining aspects of Canadian medical tourists’ decision-making processes.MethodsSemi-structured phone interviews were administered to 32 Canadians who had gone abroad as medical tourists. Interviews touched on motivations, assessment of risks, information seeking processes, and experiences at home and abroad. A thematic analysis of the interview transcripts followed.ResultsThree overarching themes emerged from the interviews: (1) information sources consulted; (2) motivations, considerations, and timing; and (3) personal and professional supports drawn upon. Patient testimonials and word of mouth connections amongst former medical tourists were accessed and relied upon more readily than the advice of family physicians. Neutral, third-party information sources were limited, which resulted in participants also relying on medical tourism facilitators and industry websites.ConclusionsWhile Canadian medical tourists are often thought to be motivated by wait times for surgery, cost and availability of procedures were common primary and secondary motivations for participants, demonstrating that motivations are layered and dynamic. The findings of this analysis offer a number of important factors that should be considered in the development of informational interventions targeting medical tourists. It is likely that trends observed amongst Canadian medical tourists apply to those from other nations due to the key role the transnational medium of the Internet plays in facilitating patients’ private international medical travel.
International Journal for Equity in Health | 2013
Jeremy Snyder; Valorie A. Crooks; Leigh Turner; Rory Johnston
BackgroundMedical tourism is a global health practice where patients travel internationally with the intention of receiving medical services. A range of low, middle, and high income countries are encouraging investment in the medical tourism sector, including countries in the Caribbean targeting patients in North America and Europe. While medical tourism has the potential to provide economic and employment opportunities in destination countries, there are concerns that it could encourage the movement of health workers from the public to private health sector.MethodsWe present findings from 19 semi-structured interviews with stakeholders across the public health care, private health care, government, allied business, and civil society sectors. These interviews were conducted in-person in Barbados and via phone. The interview transcripts were coded and a thematic analysis developed.ResultsThree themes were identified: 1) Stakeholder perceptions of the patterns and plans for health human resource usage by current and planned medical tourism facilities in Barbados. We found that while health human resource usage in the medical tourism sector has been limited, it is likely to grow in the future; 2) Anticipated positive impacts of medical tourism on health human resources and access to care in the public system. These benefits included improved quality control, training opportunities, and health worker retention; and 3) Anticipated negative impacts of medical tourism on health human resources and access to care in the public system. These impacts included longer wait times for care and a shift in planning priorities driven by the medical tourism sector.ConclusionsStakeholders interviewed who were connected to medical tourism expansion or the tourism sector took a generally positive view of the likely impacts of medical tourism on health human resources in Barbados. However, stakeholders associated with the public health system and health equity expressed concern that medical tourism may spread inequities in this country. The mechanisms by which observed negative health equity impacts in other countries will be avoided in Barbados are unclear. Continued study in Barbados and comparison with the regulatory frameworks in other countries is needed to help enhance positive and mitigate negative impacts of medical tourism on health human resources in Barbados. These findings will likely have import for other Caribbean nations investing in medical tourism and beyond.
Philosophy, Ethics, and Humanities in Medicine | 2013
Krystyna Adams; Jeremy Snyder; Valorie A. Crooks; Rory Johnston
BackgroundMedical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism.ResultsAccording to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision.ConclusionsThe overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.
Journal of Mixed Methods Research | 2011
Valorie A. Crooks; Nadine Schuurman; Jonathan Cinnamon; Heather Castleden; Rory Johnston
Drawing on recent debates pointing to the value of mixed methods research in human geography, the authors revisit a quantitative location analysis model previously created to site palliative care services in rural British Columbia, Canada. The original quantitative model posited that population (i.e., number of residents in the community), isolation (i.e., travel time to existing specialized palliative care), and vulnerability (i.e., number of residents older than 65 years in the community) are three factors that must be accounted for when siting palliative care services in rural areas. Using qualitative interview data, the authors refine this model to include a newly identified factor: community readiness. They conclude with a discussion of the benefits of adopting a mixed methods approach to location analysis model development.
BMC Health Services Research | 2012
Valorie A. Crooks; Keri Cameron; Vera Chouinard; Rory Johnston; Jeremy Snyder; Victoria Casey
BackgroundMedical tourism is the term that describes patients’ international travel with the intention of seeking medical treatment. Some medical tourists go abroad for orthopaedic surgeries, including hip and knee resurfacing and replacement. In this article we examine the findings of interviews with Canadian medical tourists who went abroad for such surgeries to determine what is distinctive about their attitudes when compared to existing qualitative research findings about patients’ decision-making in and experiences of these same procedures in their home countries.MethodsFourteen Canadian medical tourists participated in semi-structured phone interviews, all of whom had gone abroad for hip or knee surgery to treat osteoarthritis. Transcripts were coded and thematically analysed, which involved comparing emerging findings to those in the existing qualitative literature on hip and knee surgery.ResultsThree distinctive attitudinal characteristics among participants were identified when interview themes were compared to findings in the existing qualitative research on hip and knee surgery in osteoarthritis. These attitudinal characteristics were that the medical tourists we spoke with were: (1) comfortable health-related decision-makers; (2) unwavering in their views about procedure necessity and urgency; and (3) firm in their desires to maintain active lives.ConclusionsCompared to other patients reported on in the existing qualitative hip and knee surgery literature, medical tourists are less likely to question their need for surgery and are particularly active in their pursuit of surgical intervention. They are also comfortable with taking control of health-related decisions. Future research is needed to identify motivators behind patients’ pursuit of care abroad, determine if the attitudinal characteristics identified here hold true for other patient groups, and ascertain the impact of these attitudinal characteristics on surgical outcomes. Arthritis care providers can use the attitudinal characteristics identified here to better advise osteoarthritis patients who are considering seeking care abroad.
International Journal of Health Services | 2015
Rory Johnston; Valorie A. Crooks; Jeremy Snyder; Rebecca Whitmore
Governments around the world have expressed interest in developing local medical tourism sectors, framing the industry as an opportunity for economic growth and health system improvement. This article addresses questions about how the desire to develop a medical tourism sector in a country emerges and which stakeholders are involved in both creating momentum and informing its progress. Presenting a thematic analysis of 19 key informant interviews conducted with domestic and international stakeholders in Barbados’s medical tourism sector in 2011, we examine the roles that “actors” and “champions” at home and abroad have played in the sector’s development. Physicians and the Barbadian government, along with international investors, the Medical Tourism Association, and development agencies, have promoted the industry, while actors such as medical tourists and international hospital accreditation companies are passively framing the terms of how medical tourism is unfolding in Barbados. Within this context, we seek to better understand the roles and relationships of various actors and champions implicated in the development of medical tourism in order to provide a more nuanced understanding of how the sector is emerging in Barbados and elsewhere and how its development might impact equitable health system development.
BMC Medical Ethics | 2013
Jeremy Snyder; Valorie A. Crooks; Rory Johnston; Shafik Dharamsi
BackgroundMedical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism.MethodsFocus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants’ perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians’ abilities to support medical tourists’ informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance.ResultsFour key challenges were identified: 1) confusion and tensions related to the regular domestic physician’s role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician’s reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians’ concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy.ConclusionsMedical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad.
Health Care Analysis | 2017
Jeremy Snyder; Rory Johnston; Valorie A. Crooks; Jeffrey Morgan; Krystyna Adams
Medical tourism is the practice of traveling across international borders with the intention of accessing medical care, paid for out-of-pocket. This practice has implications for preferential access to medical care for Canadians both through inbound and outbound medical tourism. In this paper, we identify four patterns of medical tourism with implications for preferential access to care by Canadians: (1) Inbound medical tourism to Canada’s public hospitals; (2) Inbound medical tourism to a First Nations reserve; (3) Canadian patients opting to go abroad for medical tourism; and (4) Canadian patients traveling abroad with a Canadian surgeon. These patterns of medical tourism affect preferential access to health care by Canadians by circumventing domestic regulation of care, creating jurisdictional tensions over the provision of health care, and undermining solidarity with the Canadian health system.
Globalization and Health | 2015
Rory Johnston; Valorie A. Crooks; Meghann Ormond
BackgroundMedical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in locations where it is not yet established. Numerous governments and private hospitals in the Caribbean have recently identified medical tourism as a priority for economic development. We explore here the projects, activities, and outlooks surrounding medical tourism and their anticipated economic and health sector policy implications in the Caribbean country of Jamaica. Specifically, we apply Pocock and Phua’s previously-published conceptual framework of policy implications raised by medical tourism to explore its relevance in this new context and to identify additional considerations raised by the Jamaican context.MethodsEmploying case study methodology, we conducted six weeks of qualitative fieldwork in Jamaica between October 2012 and July 2013. Semi-structured interviews with health, tourism, and trade sector stakeholders, on-site visits to health and tourism infrastructure, and reflexive journaling were all used to collect a comprehensive dataset of how medical tourism in Jamaica is being developed. Our analytic strategy involved organizing our data within Pocock and Phua’s framework to identify overlapping and divergent issues.ResultsMany of the issues identified in Pocock and Phua’s policy implications framework are echoed in the planning and development of medical tourism in Jamaica. However, a number of additional implications, such as the involvement of international development agencies in facilitating interest in the sector, cyclical mobility of international health human resources, and the significance of health insurance portability in driving the growth of international hospital accreditation, arise from this new context and further enrich the original framework.ConclusionsThe framework developed by Pocock and Phua is a flexible common reference point with which to document issues raised by medical tourism in established and emerging destinations. However, the framework’s design does not lend itself to explaining how the underlying health system factors it identifies work to facilitate medical tourism’s development or how the specific impacts of the practice are likely to unfold.