Is Medical Tourism Ethical?


In March of 2017, The New York Times published “Five Ways to be a Savvy Medical Tourist and Enjoy a Vacation.” As the light-hearted title suggests, this piece offers practical tips for readers considering going abroad for a medical procedure. This modern option allows patients to save costs and/or apply medical spending toward an exotic trip. And it’s relatively easy to plan these days, thanks to the availability of all-inclusive packages, as well as the plethora of online resources for comparing providers and destinations.

The author of the piece, Freda Moon, describes her own experience of going to Bangkok for a root canal. Her family of three managed to save $1600 and spend two and half weeks in two countries. “Not bad,” Moon reflects.

This story is just one of a handful of NYT pieces touting the medical tourist industry and the “family adventures” that it makes possible. The public appears to share this enthusiasm, as more and more Americans plan “sun and surgery” and wellness retreats in destinations ranging from India to South Africa.

Medical tourism and the globalization of healthcare, more broadly, are driven by various social and economic pressures, such as the high demand and cost of treatment in the Western world and the low cost and improved quality of care in developing nations.[1] This dynamic has given rise to industry slogans such as “First World Treatment at Third World Prices.”

Generally, high-level policymakers have supported healthcare’s globalization by implementing neoliberal economic policies around the world. Institutions like the World Bank and the International Monetary Fund (IMF) have incentivized nations to privatize and deregulate capital. This, in turn, has created commodity-driven markets, such as privatized healthcare. Boundary-crossing medicine is, thus, thought to be both a natural and inevitable effect of modern economic systems.

The problem, according to critics, is that neoliberal policies are to blame for the exorbitant costs of healthcare in the West, without which patients would have no need to travel. In the name of “free markets,” Western governments have neglected to regulate and contain the health industries. And now that healthcare costs are so out of control, those governments’ citizens are trying to appropriate the public health resources of other nations at the expense of local populations.

“Affluent residents and internationals can receive high-quality care in a state-of-the-art, spa-like facility in the city, while locals (especially in rural areas) wait for beds in increasingly unsanitary, ill-equipped, and understaffed facilities.”

For the most part, they’re getting away with it. In Israel, for instance, a two-pronged health system has developed to accommodate international demand. Private hospitals that attract wealthy and Western patients flourish, while public hospitals serving more vulnerable, local communities deteriorate. Affluent residents and internationals can receive high-quality care in a state-of-the-art, spa-like facility in the city, while locals (especially in rural areas) wait for beds in increasingly unsanitary, ill-equipped, and understaffed facilities. Similar scenarios exist in other popular destinations, such as Cuba, Mexico, Kenya, and many South African countries.

In many top-destination countries, governments are doing little by way of policy to support their own citizens. This is because leaders are too allured by the promises of modernization. Wanting to improve national and economic standing, national leaders have followed the directives of the World Bank and the IMF to push free markets and cut public programs. Drawing on the same neoliberal rhetoric that has prevailed in the West, these leaders argue that such free-market initiatives will ultimately improve national welfare.

But so far, medical tourism has only widened health inequalities between the “haves” and the “have-nots.” In India, which is now considered to have the most privatized medical sector, health costs have increased five fold. As a result, more citizens—especially women and children—are going without needed care.

Given realities such as this, some critics wonder whether Americans and other Westerners are acting unethically when they pursue cross-border care. These critics ask: Isn’t medical tourism a contemporary iteration of colonialism? What right do Westerners have to appropriate the resources of defenseless communities?

The counter-argument is that Westerners, too, are victims of neoliberal policies. Many individuals are uninsured or underinsured because of policies that they may have never supported.

But some critics of medical tourism, such as Zahra Meghani, say that this does not matter. Meghani argues that Western populations have benefitted from the flow of capital from poorer (debtor) nations for years, and this privilege renders Westerners responsible for the structural injustices inflicted around the world. This does not mean that such individuals are not deserving of compassion. “They are,” according to Meghani. But when these “individuals turn to medical tourism rather than use their political agency to bring about change in US policies . . . they allow their elected officials to remain committed to free-market ideology and to continue catering to corporate interests that finance their campaigns.”

Here, Meghani takes for granted that medical tourists are politically quiet when, in fact, many individuals with chronic conditions and/or poor access to healthcare are tirelessly advocating at the local, state, and federal levels. In many cases, their “political agency” is very restricted, as they have limited financial, emotional, psychological, and/or physical resources. Should these individuals be expected to forgo a potentially life-saving treatment while they wait for their governments to respond?

Nonetheless, Meghani’s broader point stands. Medical tourism is morally fraught, and all members of society—even vulnerable patients—have a duty to think more critically about its workings.

This means broadening public conversations about the industry. Experts, analysts, and media representatives have tended to focus on the practical, economic, and legal uncertainties surrounding medical tourism. For instance, they ask: Who is responsible for follow-up care? Do patients have recourse in case of malpractice? How can employers and insurers incentivize medical tourism? (And, of course, how can individuals “enjoy a vacation” while simultaneously obtaining a procedure?)

In addition, individuals ought to ask questions such as the following: Who actually benefits from medical tourism and who is harmed by it? To what extent? What social and economic risks does this industry create? What conditions, if any, justify medical tourist travel? For instance, is a heart transplant more justifiable than a cosmetic procedure?

A simple step toward this end may be to continue to employ the term “medical tourism.” The vernacular is somewhat controversial, especially among patients, since “tourism” implies recreation and frivolity. Having to go to a foreign country to receive care that one cannot access or afford at home is not exactly a luxury, these stakeholders say.

But comparatively, it is. To realize this, patients need only to step outside their luxury suites and walk a few blocks to see the “crumbling, overcrowded, open wards of public hospitals” in the cities to which they have traveled. There, they will see individuals who are far more severely impacted by the collapsing public health systems in Western countries. Perhaps, at the very least, medical tourists ought to accept the uncomfortable feelings that the term “medical tourist” invokes.

[1] This essay focuses on medical tourism motivated by high costs. In some cases, medical tourism is motivated by domestic lack of available treatments and/or long wait lists, as is more common in cases of patients traveling to the United States.


About Author

Audrey Farley is the Editor in Chief of Pens and Needles. She recently earned a PhD in English from University of Maryland, College Park, where she studied contemporary American fiction, popular culture, and the medical humanities. She has written for various peer-reviewed journals in the literary fields, as well as outlets such as Public Books, ASAP/J, and Insulin Nation. She lives with chronic migraine and is the parent of a child with Type 1 diabetes. Follow her on Twitter @AudreyCFarley.

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