Research articleMedical tourism: Sea, sun, sand and … surgery
Introduction
It is a truism that tourism is supposed to be about relaxation, pleasure and an increase in well being and even health. Even with the rise in cultural tourism and notions of tourism also being a learning experience, such learning too is expected to be relaxing and quite different from classroom memories. Tourists need not necessarily be hedonists, but they anticipate a beneficial outcome. In the past decade the attempt to achieve better health while on holiday, through relaxation, exercise or visits to spas, has been taken to a new level with the emergence of a new and distinct niche in the tourist industry: medical tourism. This paper seeks to provide a first assessment of this emerging phenomenon.
Some of the earliest forms of tourism were directly aimed at increased health and well being: for example, the numerous spas that remain in many parts of Europe and elsewhere, which in some cases represented the effective start of local tourism, when ‘taking the waters’ became common by the 18th century. By the 19th century they were evident even in such remote colonies as the French Pacific territory of New Caledonia, while the emergence of hill stations virtually throughout the tropics further emphasised the apparent curative properties of tourism and recreation in appropriate, often distant, therapeutic places (Smyth, 2005). Somewhat later, recreation and tourism shifted seawards in developed countries, and extended from elites towards the working classes, and sea bathing became a healthy form of recreation (e.g. Gilbert, 1954). Other sports, such as golf, cycling, walking and mountaineering, similarly became part of the tourist experience and were supposedly pleasurable ways of combining tourism and well being. Even more recently tourists have travelled in search of yoga and meditation. The legacy of all this is the continued presence of ‘health tourism’ where people visit health spas, for example in Kyrgyztan (Schofield, 2004), with the primary purpose of beneficial health outcomes.
With the partial exception of some spas, none of this has involved actual medical treatment, but merely assumed incidental benefits in amenable, relaxing contexts. This paper is a preliminary attempt to examine a contemporary elaboration of this—the rise of ‘medical tourism’, where tourism is deliberately linked to direct medical intervention, and outcomes are expected to be substantial and long term. A distinct tourism niche has emerged, satisfying the needs of a growing number of people, mainly in developed countries, benefiting both themselves and a growing number of destinations, principally in developing countries.
Section snippets
A new form of niche tourism
In the last decade, and primarily in the present century the notion of well being has gone further than ever before. No longer is improved health on holiday merely an anticipated consequence of escape from the arduous drudgery of work and the movement to a place with a cleaner (or warmer) climate, or the outcome of ‘taking the waters’, but in some circumstances—the rise of medical tourism—it has become the central theme of tourism in an active rather than a passive sense. A new niche has
The rise of medical tourism in Asia
Medical tourism has grown in a number of countries, such as India, Singapore and Thailand, many of which have deliberately linked medical care to tourism, and thus boost the attractions of nearby beaches etc. But medical tourism has also developed in South Africa and in countries not hitherto associated with significant levels of western tourism such as Belarus, Latvia, Lithuania and Costa Rica. Hungary, for example, declared 2003 to be the Year of Health Tourism. Eastern European countries
Tourists—the economic rationale?
Medical tourists not surprisingly are mainly from rich world countries where the costs of medical care may be very high, but where the ability to pay for alternatives is also high. Most are from North America, Western Europe and the Middle East. In India a majority are part of the Indian Diaspora in the United States, Britain and elsewhere, but include elites from a range of countries, including several African states, but there has been a gradual shift to a more diverse patient population. One
‘It's a fine line between pleasure and pain’. Tourism?
While almost all advertisements for medical tourism stress the links between surgery and tourism, especially during recuperation, the extent to which recuperating patients may be able to benefit from ‘normal’ elements of tourism may be queried. Is this therefore merely long distance migration for surgery, marketed as an attractive tourist experience, or is there actual tourism? Indeed describing a medical procedure as part of a tourist experience might seem to be in itself merely cosmetic
Conclusion: ‘first world service at third world cost’?
Medical tourism is likely to increase even faster in the future as medical care continues to be increasingly privatised, and cost differentials remain in place. As the demand for cosmetic surgery (including dentistry) continues to expand so will demand for overseas services, and this will probably replace heart surgery as the core element in medical tourism. Moreover, as successful outcomes become more evident, demand is likely to increase further. Western insurance companies might encourage
Acknowledgements
I am indebted to Ming Wang and two anonymous referees for their comments on an earlier version of this paper.
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