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      On the Ethics of Medical Tourism: An Examination of Patients’ Perspectives

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          Abstract

          Dear Editor-in-Chief Medical tourism is often referred to as the act of leaving one’s country to go to a country other than the home country for specific and enhanced medical care and recuperation (1). It represents the less costly private medical care for patients, mostly from developed countries that need serious surgical operations (2). Besides, many patients from less developed countries also visiting various European countries and the United States for better healthcare for some specific diagnostics and treatments which are not available in their own countries (3). Today, medical tourism is truly a global phenomenon. It is being promoted by many countries around the world; owing to the fact that the idea provides these individuals with many benefits. As for the health travelers, there are numerous options for medical vacation spots which add to their advantages and reduced healthcare costs (4). Consequently, medical tourism is not only practical but also economical for those who look to having a satisfying vacation whilst attending to their healthcare needs at the same time. For organizations and administration, medical vacation can be considered as a profitable industry to raise profit and contribute to the gross domestic product. How Patient Experience Can Inform Policy Making and Legislation? Medical tourism is different from other services as it is about confidence and assurance in the treatment and standard of care received. The major problem in medical tourism is that there is no legal constitution for medical tourists in the providing country that might help them when things go wrong (5). Due to lack of proper government regulations as well as the insurance policies, the medical tourists’ life is at risk while they visit to a foreign country for obtaining healthcare. In most cases, patients do not have precise ideas about the technical matter for the treatment. Many patients also cannot differentiate the performance in caring and curing provided by the medical service providers (6). For this reason, sometimes it becomes a potential problem for data collection as they are the main source of judging the service quality of the industry. Carman et al. has proposed a framework for patient’s engagement in the decision making process (7). According to them, patients need the relevant information regarding the clinical procedure to exercise their right to decide whether to undergo the treatment in abroad. This ultimately increases the risks for the medical tourists those are planning for a surgery abroad as they are not aware of the legal consequences in case something goes wrong. Therefore, patients must understand the legal redress available to them before their travel for medical care abroad (8). The popularity of medical tourism is increasing worldwide as the benefits are numerous. Competition in the global medical tourism market is greater than ever as many countries are promoting medical tourism. As nations around the world positively promote medical travel and leisure, heavy investment goes into upgrading the healthcare system of these countries. For this, the quality of healthcare in that country can be enhanced and the residents will benefit. Nevertheless, this investment and the particular demand inspired by the foreign patients poses particular risk of increased healthcare price and overlooked need of the neighborhood residents that indicates negative impact to the healthcare system of the actual vacation spot countries (9). In conclusion, medical tourism is among the most rapidly developing industries that has undergone a rapid expansion. This has led the hospitality industries to great improvements in competition and with a large number of clients. There is certainly a wide base of international and home customers and the medical tourism industry need to ensure quality services. Besides, due to the ever-increasing media coverage on the satisfaction of the patients treated outside U.S. in the last few years have attracted a large number of the U.S. patients to seek treatments abroad. This trend indicates that the quality and services provided by the hospitals across the globe has been equalized that creates further demand to investigate on how to engage patients in the decision making process to come up with the most appropriate policy that will benefit both the patients and the providers. As healthcare is an industry that is patient centered, thus, engaging patients in the decision making process will help the policy makers to understand the patients’ wants and requirements more clearly. Likewise, patients should have the rights to accept or to decline any healthcare services. Hence, it is of vital importance for patients to have adequate knowledge on the various aspects while going for medical tourism abroad.

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          Patients, providers, and systems need to acquire a specific set of competencies to achieve truly patient-centered care.

          Studies show that patients want to be more involved in their own health care. Yet insufficient attention has been paid to the specific competencies of both patients and providers that are needed to optimize such patient engagement and shared decision making. In this article we address the knowledge, skills, and attitudes that patients, physicians, and health care systems require to effectively engage patients in their health care. For example, many patient-physician interactions still follow the traditional office visit format, in which the patient is passive, trusting, and compliant. We recommend imaginative models for redesigned office care, restructured reimbursement schemes, and increased support services for patients and professionals. We present three clinical scenarios to illustrate how these competencies must work together. We conclude that effective shared decision making takes time to deliver proficiently and that among other measures, policy makers must change payment models to focus on value and support education and discussion of competencies for a modern health care system.
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            The effects of medical tourism: Thailand's experience

            OBJECTIVE: To explore the positive and negative effects of medical tourism on the economy, health staff and medical costs in Thailand. METHODS: The financial repercussions of medical tourism were estimated from commerce ministry data, with modifications and extrapolations. Survey data on 4755 foreign and Thai outpatients in two private hospitals were used to explore how medical tourism affects human resources. Trends in the relative prices of caesarean section, appendectomy, hernia repair, cholecystectomy and knee replacement in five private hospitals were examined. Focus groups and in-depth interviews with hospital managers and key informants from the public and private sectors were conducted to better understand stakeholders' motivations and practices in connection with these procedures and learn more about medical tourism. FINDINGS: Medical tourism generates the equivalent of 0.4% of Thailand's gross domestic product but has exacerbated the shortage of medical staff by luring more workers away from the private and public sectors towards hospitals catering to foreigners. This has raised costs in private hospitals substantially and is likely to raise them in public hospitals and in the universal health-care insurance covering most Thais as well. The "brain drain" may also undermine medical training in future. CONCLUSION: Medical tourism in Thailand, despite some benefits, has negative effects that could be mitigated by lifting the restrictions on the importation of qualified foreign physicians and by taxing tourists who visit the country solely for the purpose of seeking medical treatment. The revenue thus generated could then be used to train physicians and retain medical school professors.
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              Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives

              Objectives Medical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue is dominated by speculation and lacks meaningful input from people with specific expertise in patient health and safety. We consulted with patient health and safety experts in the Canadian province of British Columbia to explore their views concerning risks that medical tourists may be exposed to. Herein, we report on the findings, linking them to existing ethical and legal issues associated with medical tourism. Design We held a focus group in September 2011 in Vancouver, British Columbia with professionals representing different domains of patient health and safety expertise. The focus group was transcribed verbatim and analysed thematically. Participants Seven professionals representing the domains of tissue banking, blood safety, health records, organ transplantation, dental care, clinical ethics and infection control participated. Results Five dominant health and safety risks for outbound medical tourists were identified by participants: (1) complications; (2) specific concerns regarding organ transplantation; (3) transmission of antibiotic-resistant organisms; (4) (dis)continuity of medical documentation and (5) (un)informed decision-making. Conclusions Concern was expressed that medical tourism might have unintended and undesired effects upon patients’ home healthcare systems. The individual choices of medical tourists could have significant public consequences if healthcare facilities in their home countries must expend resources treating postoperative complications. Participants also expressed concern that medical tourists returning home with infections, particularly antibiotic-resistant infections, could place others at risk of exposure to infections that are refractory to standard treatment regimens and thereby pose significant public health risks.
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                Author and article information

                Journal
                Iran J Public Health
                Iran. J. Public Health
                IJPH
                IJPH
                Iranian Journal of Public Health
                Tehran University of Medical Sciences
                2251-6085
                2251-6093
                May 2016
                : 45
                : 5
                : 688-689
                Affiliations
                [1. ]Faculty of Management, Multimedia University, Cyberjaya, Selangor 63100, Malaysia
                [2. ]Faculty of Economics & Management Sciences, International Islamic University Malaysia, Selangor, Malaysia
                [3. ]Dept. of Marketing, Sunway Business School, Selangor, Malaysia
                Author notes
                [* ] Corresponding Author: Email: sunabdullah@ 123456gmail.com
                Article
                ijph-45-688
                4935713
                27398342
                72666f3e-4a0f-4e95-ac40-3cd233856b0c
                Copyright© Iranian Public Health Association & Tehran University of Medical Sciences

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 10 December 2015
                : 25 December 2015
                Categories
                Letter to the Editor

                Public health
                Public health

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