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Medicine beyond borders: the legal and ethical challenges

Kassim PN

Med Law, 2009 Sep;28(3):439-50.
PMID: 20157960

The ease and affordability of international travel has contributed to the rapid growth of the healthcare industry where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care while at the same time touring, vacationing and fully experiencing the attractions of the countries that they are visiting. A combination of many factors has led to the recent increase in popularity of medical tourism such as exorbitant costs of healthcare in industrialized nations, favorable currency exchange rates in the global economy, rapidly improving technology in many countries of the world and most importantly proven safety of healthcare in selected foreign nations. Nevertheless, the development of medical tourism has certainly awakened many ethical and legal issues, which must be addressed. Issues pertaining to malpractice, consumer protection, organ trafficking, alternative medicine and telemedicine need comprehensive legal regulatory framework to govern them. Ethical issues are also been raised by the promotion of medical tourism in particular those pertaining to doctor and patient relationship. A future, where medical law is subsumed into various legal and ethical dimensions, poses serious challenges for the practice and ethics of medicine.

Matched MeSH terms: Medical Tourism/legislation & jurisprudence*; Medical Tourism/ethics*
Medical Tourism in Malaysia: Prospect and Challenges

Sarwar A

Iran J Public Health, 2013 Aug;42(8):795-805.
PMID: 26056632

Tourism, combined with the phrase medical, seems to be a new form of tourism which has gained huge popularity in recent decades. Though, a number of literatures available with regard to the tourism industry and the competitiveness of the destination, however, the major aspects which determine the satisfaction of medical tourists are hardly focused specifically on Malaysia. There is a lack of empirical evidence in this area of study which needs to be bridged. Hence, this study aimed at investigating the various factors contributing towards the development of medical tourism in Malaysia.

Matched MeSH terms: Medical Tourism
Fulltext Investigating revisit intention of medical tourists in China through nutritional knowledge, perceived medical quality, and trust in the physiologist: A recommendation on health tourism policy measures

Fengmin Z, Baijun W, Jiangtao B, Li L, Patwary AK

Front Public Health, 2022;10:893497.
PMID: 36091519 DOI: 10.3389/fpubh.2022.893497

Good medical care has long been a top priority in health tourism to keep the flow of visitors coming for medical treatment. Medical tourism encompasses a range of treatments, from basic check-ups to surgical operations. For its friendly character and high quality of service, China has earned a reputation as one of Asia's top destinations for health tourism. Along with India and Taiwan, Japan, Thailand, and South Korea are China's top tourism destinations. Considering the above fact, this study aims to examine the influence of nutritional knowledge, perceived medical quality, and trust in physiologists on revisiting the intention of medical tourists in China. This study is cross-sectional and follows a quantitative approach. The researchers used questionnaires as a survey tool to obtain information from the respondents. The respondents of this chosen international tourists in China who come for medical treatment purposes. A systematic random sampling technique was used to select the respondents, and 315 usable responses were collected from the respondents and proceeded with further analysis. The study conducted structural equation modeling using Smart PLS version 3. The results found that nutritional knowledge, perceived medical quality, and trust in physiologists significantly influence the revisit intention of medical tourists in China.

Matched MeSH terms: Medical Tourism*
Fulltext Measuring patients' satisfaction toward health tourism in Malaysia through hospital environment, nutritional advice, and perceived value: A study on Chinese exchange students

Li L, Ragavan NA, Patwary AK, Baijun W

Front Public Health, 2022;10:893439.
PMID: 36016897 DOI: 10.3389/fpubh.2022.893439

Malaysia is a reputed destination for health tourism in the Asia Pacific region for its hospitable nature and good quality of service. Patients' satisfaction has been a key concern in health tourism to maintain the flow of tourists' arrival for medical purposes. By considering the importance of health tourism and patients' satisfaction in Malaysia, this study aimed to examine the influence of hospital environment, nutritional advice, perceived value on patients' satisfaction. This study is cross-sectional in nature and follows a quantitative approach. The researchers used questionnaires as a survey tool to obtain information from the respondents. The sample of this is chosen from Chinese exchange students in Malaysia. Using a systematic random sampling technique, 205 usable responses were selected from the respondents and proceeded with further analysis. The study conducted structural equation modeling using Smart PLS version 3. The results found that hospital environment, nutritional advice, and perceived value significantly influence patients' satisfaction in Malaysia.

Matched MeSH terms: Medical Tourism*
Perceptions of an 'international hospital' in Thailand by medical travel patients: cross-cultural tensions in a transnational space

Whittaker A, Chee HL

Soc Sci Med, 2015 Jan;124:290-7.
PMID: 25308233 DOI: 10.1016/j.socscimed.2014.10.002

The growing trade in patients seeking health care in other countries, or medical travel, is changing the forms and experiences of health care seeking and producing changes to hospitals in terms of their design, organization and spaces. What is termed in marketing parlance in Thailand as an 'international hospital' oriented to attracting foreign patients, is a hotel-hospital hybrid that is locally produced through the inflexion of local practices to make a therapeutic space for international patients. The paper reports on work undertaken within a Thai hospital in 2012 which included observations and interviews with thirty foreign in-patients and nine informal interviews with hospital staff. Although theorized as a culturally neutral transnational 'space of connectivity', we show how cross-cultural tensions affect the experience of the hospital with implications for the organization of the hospital and notions of 'cultural competence' in care. There is no single universal experience of this space, instead, there are multiple experiences of the 'international hospital', depending on who patients are, where they are from, their expectations and relationships. Such hospitals straddle the expectations of both local patients and international clientele and present highly complex cross-cultural interactions between staff and patients but also between patients and other patients. Spatial organisation within such settings may either highlight cultural difference or help create culturally safe spaces.

Matched MeSH terms: Medical Tourism/trends*
Exploring Internal Benefits of Medical Tourism Facilitators' Satisfaction: Customer Orientation, Job Satisfaction, and Work Performance

Park JK, Ahn J, Han SL, Back KJ, An M

J Healthc Manag, 2020 3 14;65(2):90-105.
PMID: 32168184 DOI: 10.1097/JHM-D-18-00168

EXECUTIVE SUMMARY: This study examined the impact of employee satisfaction with management and coworkers on their performance as medical tourism facilitators. The proposed hypotheses were tested with structural equation modeling based on data collected from major hospitals in South Korea. Results supported assumptions that satisfaction with management is positively correlated with customer orientation and job satisfaction of medical tourism facilitators, as well as with the assumption that satisfaction with coworkers has a direct impact on customer orientation. This study has practical implications as organizations develop effective internal marketing (i.e., communication) strategies to improve the performance of medical tourism facilitators.

Matched MeSH terms: Medical Tourism/psychology*
Final journeys: exploring the realities of suicide tourism

Zhi GYJ, Flaherty GT, Hallahan B

J Travel Med, 2019 May 10;26(3).
PMID: 30860264 DOI: 10.1093/jtm/taz016
Matched MeSH terms: Medical Tourism/ethics
Fulltext Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia

Pocock NS, Phua KH

Global Health, 2011;7:12.
PMID: 21539751 DOI: 10.1186/1744-8603-7-12

Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Private actors and governments in Southeast Asia are promoting the medical tourist industry, but the potential impact on health systems, particularly in terms of equity in access and availability for local consumers, is unclear. This article presents a conceptual framework that outlines the policy implications of medical tourism's growth for health systems, drawing on the cases of Thailand, Singapore and Malaysia, three regional hubs for medical tourism, via an extensive review of academic and grey literature. Variables for further analysis of the potential impact of medical tourism on health systems are also identified. The framework can provide a basis for empirical, in country studies weighing the benefits and disadvantages of medical tourism for health systems. The policy implications described are of particular relevance for policymakers and industry practitioners in other Southeast Asian countries with similar health systems where governments have expressed interest in facilitating the growth of the medical tourist industry. This article calls for a universal definition of medical tourism and medical tourists to be enunciated, as well as concerted data collection efforts, to be undertaken prior to any meaningful empirical analysis of medical tourism's impact on health systems.

Matched MeSH terms: Medical Tourism
Factors affecting the attractiveness of medical tourism destination: an empirical study on India- review article

Sultana S, Haque A, Momen A, Yasmin F

Iran J Public Health, 2014 Jul;43(7):867-76.
PMID: 25909055

In this edge, medical tourism is not a new idea. Medical treatment is one of the essential demands of human beings and it requires high quality and intensive care. Beside western world, few developing countries are playing key roles as medical tourism destinations. India is one of the leading names among these countries. The purpose of the paper is to find the factors influencing the attractiveness of India as a health tourism destination.

Matched MeSH terms: Medical Tourism
International Patients' Travel Decision Making Process- A Conceptual Framework

Khan MJ, Chelliah S, Haron MS

Iran J Public Health, 2016 Feb;45(2):134-45.
PMID: 27114978

BACKGROUND: Role of information source, perceived benefits and risks, and destination image has significantly been examined in travel and tourism literature; however, in medical tourism it is yet to be examined thoroughly. The concept discussed in this article is drawn form well established models in tourism literature.
METHODS: The purpose of this research was to identify the source of information, travel benefits and perceived risks related to movement of international patients and develop a conceptual model based on well-established theory. Thorough database search (Science Direct, utmj.org, nih.gov, nchu.edu.tw, palgrave-journals, medretreat, Biomedcentral) was performed to fulfill the objectives of the study.
RESULTS: International patients always concern about benefits and risks related to travel. These benefits and risks form images of destination in the minds of international patients. Different sources of information make international patients acquaint about the associated benefits and risks, which later leads to development of intention to visit. This conceptual paper helps in establishing model for decision-making process of international patients in developing visit intention.
CONCLUSION: Ample amount of literature is available detailing different factors involved in travel decision making of international patients; however literature explaining relationship between these factors is scarce.

Matched MeSH terms: Medical Tourism
Will medical tourism survive covid-19?

Tatum M

BMJ, 2020 07 10;370:m2677.
PMID: 32651180 DOI: 10.1136/bmj.m2677
Matched MeSH terms: Medical Tourism/economics; Medical Tourism/trends*
Fulltext The north-south policy divide in transnational healthcare: a comparative review of policy research on medical tourism in source and destination countries

Virani A, Wellstead AM, Howlett M

Global Health, 2020 04 22;16(1):37.
PMID: 32321561 DOI: 10.1186/s12992-020-00566-3

Medical tourism occupies different spaces within national policy frameworks depending on which side of the transnational paradigm countries belong to, and how they seek to leverage it towards their developmental goals. This article draws attention to this policy divide in transnational healthcare through a comparative bibliometric review of policy research on medical tourism in select source (Canada, United States and United Kingdom) and destination countries (Mexico, India, Thailand, Malaysia and Singapore), using a systematic search of the Web of Science (WoS) database and review of grey literature. We assess cross-national differences in policy and policy research on medical tourism against contextual policy landscapes and challenges, and examine the convergence between research and policy. Our findings indicate major disparities in development agendas and national policy concerns, both between and among source and destination countries. Further, we find that research on medical tourism does not always address prevailing policy challenges, just as the policy discourse oftentimes neglects relevant policy research on the subject. Based on our review, we highlight the limited application of theoretical policy paradigms in current medical tourism research and make the case for a comparative policy research agenda for the field.

Matched MeSH terms: Medical Tourism/trends; Medical Tourism/statistics & numerical data*
Fulltext Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism: Theoretical model

Khan MJ, Chelliah S, Haron MS, Ahmed S

Sultan Qaboos Univ Med J, 2017 Feb;17(1):e11-e17.
PMID: 28417022 DOI: 10.18295/squmj.2016.17.01.003

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation.

Matched MeSH terms: Medical Tourism/economics; Medical Tourism/psychology*
Aesthetic journeys: a review of cosmetic surgery tourism

Pereira RT, Malone CM, Flaherty GT

J Travel Med, 2018 06 01;25(1).
PMID: 29924349 DOI: 10.1093/jtm/tay042

Background: Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism.
Methods: Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'.
Results: This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed.
Conclusion: This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.

Matched MeSH terms: Medical Tourism/economics; Medical Tourism/statistics & numerical data*
Fulltext Grey System Theory in the Study of Medical Tourism Industry and Its Economic Impact

Dang HS, Nguyen TM, Wang CN, Day JD, Dang TMH

Int J Environ Res Public Health, 2020 02 04;17(3).
PMID: 32033177 DOI: 10.3390/ijerph17030961

The Asia-Pacific region is known as a favorite destination for global medical travelers due to its medical expertise, innovative technology, safety, attractive tourism destination and cost advantage in the recent decade. This study contributes to propose an approach which effectively assesses performance of medical tourism industry based on considering the economic impact factors as well as provides a conceptual framework for the industry analysis. Grey system theory is utilized as a major analyzing approach. According to that, factors impact on the sustainable development of medical tourism in Asia-Pacific region could be identified. The performance of each destination in this region was simultaneously revealed. The results presented an overall perspective of the medical tourism industry in the scope of the Asia-Pacific region, and in Taiwan particularly. Data was collected on six major destinations including Singapore, Thailand, India, South Korea, Malaysia and Taiwan. The results proved that tourism sources and healthcare medical infrastructures play a crucial role in promoting the healthcare travel industry, while cost advantage and marketing effectiveness were less considered. In addition, performance analyse indicated that Thailand has a good performance and stands in the top ranking, followed by Malaysia, India, Singapore, South Korea and Taiwan, respectively. The revenue of Taiwan has increased slowly in the last six years, with a market worth approximately NT$20.5 billion, and the number of medical travelers is expected to increase to 777,523 by 2025. The findings of this study are expected to provide useful information for the medical tourism industry and related key players in strategic planning.

Matched MeSH terms: Medical Tourism
Solidarity by demand? Exit and voice in international medical travel - the case of Indonesia

Ormond M

Soc Sci Med, 2015 Jan;124:305-12.
PMID: 24947552 DOI: 10.1016/j.socscimed.2014.06.007

Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and management of these in the home context.

Matched MeSH terms: Medical Tourism/trends*
An international view of surgically assisted conception and surrogacy tourism

Ahmad N

Med Leg J, 2011;79(Pt 4):135-45.
PMID: 22156300 DOI: 10.1258/mlj.2011.011029

Modern medicine, specifically assisted reproductive technology (ART), has overtaken the law in many jurisdictions around the world. New technologies and practices open a Pandora's Box of ethical, religious, social and legal questions, and may present a variety of significant legal problems to the courts and legislators. Surrogate motherhood and pregnancy through ART have both attracted controversy. Some groups condemn ART and want it banned while its supporters acknowledge there is a need for legislative guidelines and regulations. A proposed statute, the Assisted Reproductive Technique Services Act, aimed at regulating reproductive technologies, including surrogacy arrangements, will be introduced in the Malaysian parliament, probably in 2012, and the Assisted Reproductive Technology (Regulation) Bill 2010 is already before the Indian parliament. This paper will discuss several of the potential socio-legal issues surrounding ART in the light of the complex situation, with a comparative analysis of the Malaysian, USA, UK and Indian positions.

Matched MeSH terms: Medical Tourism*
Fulltext Health tourism in Malaysia: the strength and weaknesses

Aniza, I., Aidalina, M., Nirmalini, R., Inggit, M.C.H., Ajeng, T.E.

Malaysian Journal of Community Health, 2009;15(1):7-15.
MyJurnal

Introduction : Globalization has made health tourism possible and continues to flourish. For participating countries, this new industry rakes in billions of dollars a year, and is worth focusing on and being developed.
Objective : This write up aims to find out the history and success of health tourism in countries around the world, study the scenario in Malaysia and propose strategies which could make Malaysia prosper with this multibillion dollar industry.
Methodology: The methodology applied was compilation, data review and comparison from annual report, action plan report and articles.
Result : In the ASEAN region, Malaysia is making a mark in the health tourism industry, thanks to the availability of medical and technical expertise, political and economical stability, high quality infrastructure, and scenic beauty of the land. Nonetheless, despite all these, Malaysia has yet to be at par with her neighbours- Thailand, Singapore and India, in terms of the number of foreign patients and the revenue gained from this industry. Thus there is a serious and urgent need to conduct research to analyze the current situation and future prospects of health tourism in Malaysia. This industry is open to all countries around the world. It is those countries that can continually analyze and adapt that will prosper in the emerging medical tourism industry. Some of the key issues which need to be addressed are those of promotion, finding the niche market, branding, legislations, immigration and quality of healthcare. In addition to these, matters regarding human resource, particularly that of internal brain-drain, need to be looked into.
Conclusion : Malaysia has great potential of becoming the giant of the health tourism industry provided appropriate and timely actions are taken towards achieving it. The negative impact must not be ignored or overlooked; instead it must be thoroughly studied and rectified.

Matched MeSH terms: Medical Tourism

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