Traveling abroad for the purpose of improving one’s physical, mental, and spiritual well-being is increasing in popularity. Such “health tourism” includes, but is not limited to, traveling for alternative therapies, such as balneotherapy (treatment by baths) and thalassotherapy (treatment based on the use of sea water), religious pilgrimages, and modern medical treatments, including elective surgery.
Therapies that are considered “natural” are not without hazards. Mineral and “holy” waters may not be potable by U.S. standards and have been sources of infectious diseases. Moreover, pilgrims are subject to the same destination-associated risks as other travelers (e.g., heat and altitude-associated illnesses), but many may be traveling in ill-health. Outbreaks of meningitis due to Neisseria meningitidis have occurred in Hajj pilgrims, leading to the requirement that all pilgrims participating in the Hajj be immunized before their departure. With the shift in the timing of the Hajj to winter months, pilgrims may also be at increased risk for respiratory tract infections, such as influenza and adenovirus.
Medical tourism, traveling to another country for medical, dental, or surgical care, is a rapidly growing industry. Traditionally, people who could afford to do so traveled from lower-income counties to more developed countries in order to seek care not available in their home country. In recent years, however, people from higher-income countries have started traveling to lower income countries in seek of lower medical costs and shorter waiting times, Companies offering vacation packages bundled with medical consultations and financing options provide direct-to-consumer advertising over the internet.
Enter “medical tourism” into any internet search engine and one will find a variety of tourism packages from travel agencies and health-care facilities worldwide.
Recognizing the potential revenue to be gained through medical tourism, countries such as India, Thailand, Costa Rica, Turkey, and others have promotional campaigns to attract tourists seeking traditional and alternative therapies. Such medical packages often claim to provide high-quality care, but as mentioned above, the quality of health care in developing countries is highly variable, and only a handful of international health-care facilities are accredited by the Joint Commission International.
For the most part, medical insurance companies do not pay for medical procedures performed abroad, although some health insurance providers in the U.S, recognizing the cost benefits, allow policy holders to seek care in Mexico. Another problem with medical tourism is that there is little follow-up care. The patient usually is in the hospital for only a few days and then returns home. Complications are then the responsibility of the health-care system in the traveler’s home country. For example, CDC received a number of reports of nontuberculous mycobacterial infections after elective cosmetic surgery abroad.
In addition to these postoperative complications, procedures that result in significant blood loss and require transfusion subject the traveler to greater risk for blood-related complications, including compatibility errors and infection with hepatitis viruses or HIV. Finally, countries that offer medical tourism may have weaker malpractice laws than those in the U.S, giving the patient little recourse to local courts or medical boards if something goes wrong.
“Transplant Tourism,” a special type of medical tourism, has been increasing as the number of available organs, especially kidneys, is decreasing relative to the increasing demand. A number of international transplantation rings have been discovered, in which people from developing countries are paid for donating organs. This practice is considered legal in only a few countries. Recently the World Health Assembly met to discuss the challenges of transplantation and to address international transplantation guidelines. It encouraged countries to protect those most vulnerable to such exploitation, but there is still no international consensus on incentives for organ donation. In June 2006, the Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS) Board of Directors unanimously approved a statement opposing transplant tourism.
Regardless of the reason, people seeking health care abroad should understand that medical systems outside the United States may operate differently from those in the United States and are not subject to the same rules and regulations. Those who are considering seeking health care outside the United States should consult with their local physician before traveling.