Medical tourism refers to people traveling abroad to obtain medical treatment. In the past, this usually referred to those who traveled from less-developed countries to major medical centers in highly developed countries for treatment unavailable at home. However, in recent years it may equally refer to those from developed countries who travel to developing countries for lower-priced medical treatments. The motivation may be also for medical services unavailable or non-licensed in the home country: There are differences between the medical agencies (FDA, EMA etc.) world-wide, whether a drug is approved in their country or not. Even within Europe, although therapy protocols might be approved by the European Medical Agency (EMA), several countries have their own review organizations (i.e. NICE by the NHS) in order to evaluate whether the same therapy protocol would be "cost-effective", so that patients face differences in the therapy protocols, particularly in the access of these drugs, which might be partially explained by the financial strength of the particular Health System.
Medical tourism most often is for surgeries (cosmetic or otherwise) or similar treatments, though people also travel for dental tourism or fertility tourism. People with rare conditions may travel to countries where the treatment is better understood. However, almost all types of health care are available, including psychiatry, alternative medicine, convalescent care, and even burial services.
Health tourism is a wider term for travel that focuses on medical treatments and the use of healthcare services. It covers a wide field of health-oriented, tourism ranging from preventive and health-conductive treatment to rehabilitational and curative forms of travel. Wellness tourism is a related field.
- 1 History
- 2 Description
- 3 International healthcare accreditation
- 4 Risks
- 5 Employer-sponsored health care in the US
- 6 Destinations
- 6.1 Africa and the Middle East
- 6.2 Americas
- 6.3 Asia and the Pacific Islands
- 6.4 Europe
- 7 See also
- 8 Notes
- 9 External links
The first recorded instance of people travelling for medical treatment dates back thousands of years to when Greek pilgrims traveled from the eastern Mediterranean to a small area in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios.
Spa towns and sanitaria were early forms of medical tourism. In 18th-century Europe patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.
Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad. Furthermore, death rates even in the developed countries differ extremely, i.e. UK versus seven other leading countries, including the US.
Many surgical procedures performed in medical tourism destinations cost a fraction of the price they do in other countries. For example, in the United States, a liver transplant that may cost $300,000 USD, would generally cost about $91,000 USD in Taiwan. A large draw to medical travel is convenience and speed. Countries that operate public health-care systems often have long wait times for certain operations, for example, an estimated 782,936 Canadian patients spent an average waiting time of 9.4 weeks on medical waiting lists in 2005. Canada has also set waiting time benchmarks for non-urgent medical procedures, including a 26-week waiting period for a hip replacement and a 16-week wait for cataract surgery.
In First World countries such as the United States, medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.
Additionally, some patients in some First World countries are finding that insurance either does not cover orthopedic surgery (such as knee or hip replacement) or limits the choice of the facility, surgeon, or prosthetics to be used.
Popular destinations for cosmetic surgery include: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Turkey, Thailand and Ukraine. According to the "Sociedad Boliviana de Cirugia Plastica y Reconstructiva", more than 70% of middle and upper class women in the country have had some form of plastic surgery. Other destination countries include Belgium, Poland, Slovakia and South Africa.
However, perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.
Medical tourism providers have developed as intermediaries which unite potential medical tourists with surgeons, provider hospitals and other organizations. In some cases, surgeons from the United States have signed up with medical tourism providers to travel to Mexico to treat American patients. The hope is that using an American surgeon may alleviate concerns about going outside the country, and persuade self-insured American employers to offer this cost-effective option to their workers as a way to save money while still provide high-quality care. Companies that focus on medical value travel typically provide nurse case managers to assist patients with pre- and post-travel medical issues. They may also help provide resources for follow-up care upon the patient's return.
Circumvention tourism is also an area of medical tourism that has grown. Circumvention tourism is travel in order to access medical services that are legal in the destination country but illegal in the home country. This can include travel for fertility treatments that aren’t yet approved in the home country, abortion, and doctor-assisted suicide. Abortion tourism can be found most commonly in Europe, where travel between countries is relatively simple. Ireland and Poland, two European countries with highly restrictive abortion laws, have the highest rates of circumvention tourism. In Poland especially, it is estimated that each year nearly 7,000 women travel to the UK, where abortion services are free through the National Health Service. There are also efforts being made by independent organizations and doctors, such as with Women on Waves, to help women circumvent draconian laws in order to access medical services. With Women on Waves, the organization uses a mobile clinic aboard a ship to provide medical abortions in international waters, where the law of the country whose flag is flown applies.
International healthcare accreditation
International healthcare accreditation is the process of certifying a level of quality for healthcare providers and programs across multiple countries. International healthcare accreditation organizations certify a wide range of healthcare programs such as hospitals, primary care centers, medical transport, and ambulatory care services. There are a number of accreditation schemes available based in a number of different countries around the world.
The oldest international accrediting body is Accreditation Canada, formerly known as the Canadian Council on Health Services Accreditation, which accredited the Bermuda Hospital Board as soon as 1968. Since then, it has accredited hospitals and health service organizations in ten other countries.
In the United States, the accreditation group Joint Commission International (JCI) was formed in 1994 to provide international clients education and consulting services. Many international hospitals today see obtaining international accreditation as a way to attract American patients.
Joint Commission International is a relative of the Joint Commission in the United States. Both are US-style independent private sector not-for-profit organizations that develop nationally and internationally recognized procedures and standards to help improve patient care and safety. They work with hospitals to help them meet Joint Commission standards for patient care and then accredit those hospitals meeting the standards.
A British scheme, QHA Trent Accreditation, is an active independent holistic accreditation scheme, as well as GCR.org which monitors the success metrics and standards of almost 500,000 medical clinics worldwide.
The different international healthcare accreditation schemes vary in quality, size, cost, intent and the skill and intensity of their marketing. They also vary in terms of cost to hospitals and healthcare institutions making use of them.
Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele, and Accreditation Canada or QHA Trent. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.
Medical tourism carries some risks that locally provided medical care either does not carry or carries to a much lesser degree.
Some countries, such as South Africa, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress and expose the patient to mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.
The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility associated with window seats can predispose one towards developing deep vein thrombosis and potentially a pulmonary embolism. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they are sunburned while healing.
Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.
Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.
Patients traveling to countries with less stringent surgical standards may be at higher risk for complications. If there are complications, the patient may need to stay in the foreign country for longer than planned or if they have returned home, will not have easy access to follow up care.
Patients sometimes travel to another country to obtain medical procedures that doctors in their home country refuse to perform because they believed that the risks of the procedure outweigh the benefits. Such patients may have difficulty getting insurance (whether public or private) to cover follow up medical costs should the feared complications indeed arise.
Receiving medical care abroad may subject medical tourists to unfamiliar legal issues. The limited nature of litigation in various countries is a reason for accessibility of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity.
Issues can also arise for patients who seek out services that are illegal in their home country. In this case, some countries have the jurisdiction to prosecute their citizen once they have returned home, or in extreme cases extraterritorially arrest and prosecute. In Ireland, especially, in the 1980s-90s there were cases of young rape victims who were banned from traveling to Europe to get legal abortions. Ultimately, Ireland’s Supreme Court overturned the ban; they and many other countries have since created "right to travel" amendments.
There can be major ethical issues around medical tourism. For example, the illegal purchase of organs and tissues for transplantation had been methodically documented and studied in countries such as India, China, Colombia and the Philippines. The Declaration of Istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".
Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example, in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system. In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care". Medical tourism centered on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation.
Employer-sponsored health care in the US
Some US employers have begun exploring medical travel programs as a way to cut employee health care costs. Such proposals have raised stormy debates between employers and trade unions representing workers, with one union stating that it deplored the "shocking new approach" of offering employees overseas treatment in return for a share of the company's savings. The unions also raise the issues of legal liability should something go wrong, and potential job losses in the US health care industry if treatment is outsourced.
Employers may offer incentives such as paying for air travel and waiving out-of-pocket expenses for care outside of the US. For example, in January 2008, Hannaford Bros., a supermarket chain based in Maine, began paying the entire medical bill for employees to travel to Singapore for hip and knee replacements, including travel for the patient and companion. Medical travel packages can integrate with all types of health insurance, including limited benefit plans, preferred provider organizations and high deductible health plans.
In 2000, Blue Shield of California began the United States' first cross-border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield. In 2007, a subsidiary of BlueCross BlueShield of South Carolina, Companion Global Healthcare, teamed up with hospitals in Thailand, Singapore, Turkey, Ireland, Costa Rica and India. A 2008 article in Fast Company discusses the globalization of healthcare and describes how various players in the US healthcare market have begun to explore it.
Africa and the Middle East
Jordan, through their Private Hospitals Association, attracted 250,000 international patients accompanied by more than 500,000 companions in 2012, with total revenues exceeding 1B US$. Jordan won the Medical Destination of the year award in 2014 in the IMTJ Medical Travel Awards.
Israel is a popular destination for medical tourism. Many medical tourists to Israel come from Europe, particularly the former Soviet Union, as well as the United States, Australia, Cyprus, and South Africa. Medical tourists come to Israel for a variety of surgical procedures and therapies, including bone marrow transplants, heart surgery and catheterization, oncological and neurological treatments, orthopedic procedures, car accident rehabilitation, and in-vitro fertilization. Israel's popularity as a destination for medical tourism stems from its status as a developed country with a high-quality level of medical care, while at the same time having lower medical costs than many other developed countries. Israel is particularly popular as a destination for bone marrow transplants among Cypriots, as the procedure is not available in Cyprus, and for orthopedic procedures among Americans, as the cost of orthopedic procedures in Israel is about half that of in the United States. Israel is a particularly popular destination for people seeking IVF treatments. Medical tourists in Israel use both public and private hospitals, and all major Israeli hospitals offer medical tourism packages which typically cost far less than comparable procedures than in facilities elsewhere with a similarly high standard of care. In 2014, it was estimated that roughly 50,000 medical tourists came to Israel annually. There are reports that these medical tourists obtain preferential treatment, to the detriment of local patients. In addition, some people come to Israel to visit health resorts at the Dead Sea, and on Lake Kinneret.
In 2012, 30,000 people came to Iran to receive medical treatment. In 2015, it is estimated that between 150,000 and 200,000 health tourists came to Iran, and this figure is expected to rise to 500,000 a year.
Iran has low endemicity for hepatitis B virus and hepatitis C virus infections and there is a unique experience of control of these infections that can be presented to people in Middle East countries. The pharmaceutical companies in Iran produces the drugs needed for control of HCV and HBV infection such as Tenofovir disoproxil, Peg Interferon, Sofosbuvir/daclatasvir and Ledipasvir with very low prices and high efficacy. Sadeghi F, Salehi-Vaziri M, Almasi-Hashiani A, Gholami-Fesharaki M, Pakzad R, Alavian SM. Prevalence of Hepatitis C Virus Genotypes Among Patients in Countries of the Eastern Mediterranean Regional Office of WHO (EMRO): A Systematic Review and Meta-Analysis. Hepat Mon. 2016;16(4):e35558.
United Arab Emirates
United Arab Emirates, especially Dubai, Abu Dhabi, Ras Al Khaimah is a popular destination for medical tourism. The Dubai Health authority has been spearheading medical tourism into UAE, especially Dubai. However, hospitals providing medical tourism are spread all over the seven emirates. UAE has the distinction of having the maximum number of JCI accredited hospitals (under various heads). UAE has inbound medical tourism as well as people going out for medical treatment. The inbound tourism usually is from African countries like Nigeria, Kenya, Uganda, Rwanda, etc. The outbound can be categorised into two segments - the local population (citizens of UAE) and the expats. The locals prefer to go to European destinations like the U.K., Germany etc. The expats prefer to go back to their home countries for treatment.
In Brazil, Albert Einstein Hospital in São Paulo was the first JCI-accredited facility outside of the US, and more than a dozen Brazilian medical facilities have since been similarly accredited.
Mexico has 98 hospitals accredited by the country’s Federal Health Ministry and seven hospitals which are JCI-accredited. Mexico is most reputed for advanced care in dentistry and cosmetic surgery. Medical care in Mexico saves a patient 40% to 65% compared to the cost of similar services in the US.
In the early 1990s, Americans illegally using counterfeit, borrowed, or fraudulently obtained Canadian health insurance cards to obtain free healthcare in Canada became a serious issue due to the high costs it imposed.
In Costa Rica, there are two Joint Commission International accredited (JCI) hospitals. Both are in San Jose, Costa Rica. When the World Health Organization (WHO) ranked the world's health systems in the year 2000, Costa Rica was ranked as no. 26, which was higher than the US, and together with Dominica it dominated the list amongst the Central American countries.
The Deloitte Center for Health Solutions in 2008 reported a cost savings average of between 30-70 percent of US prices. In 2019 a knee operation in Clinica Biblica which would have cost around $44,000 in the USA cost $12,200.
A report of McKinsey and Co. from 2008 found that between 60,000 and 85,000 medical tourists were traveling to the United States for the purpose of receiving in-patient medical care. The same McKinsey study estimated that 750,000 American medical tourists traveled from the United States to other countries in 2007 (up from 500,000 in 2006). The availability of advanced medical technology and sophisticated training of physicians are cited as driving motivators for growth in foreigners traveling to the US for medical care, whereas the low costs for hospital stays and major/complex procedures at Western-accredited medical facilities abroad are cited as major motivators for American travelers. Also, the decline in value of the US dollar between 2007 and 2013 used to offer additional incentives for foreign travel to the US, although cost differences between the US and many locations in Asia are larger than any currency fluctuations.
Several major medical centers and teaching hospitals offer international patient centers that cater to patients from foreign countries who seek medical treatment in the US. Many of these organizations offer service coordinators to assist international patients with arrangements for medical care, accommodations, finances and transportation including air ambulance services.
Asia and the Pacific Islands
Ctrip's 2016 Online Medical Tourism Report indicates that the number of travelers who enroll in the oversea medical tourism through its platform increased fivefold over the previous year, and more than 500,000 Chinese visitors are expected to go on medical tourism. The top ten medical tourism destinations are Japan, Korea, the US, Taiwan, Germany, Singapore, Malaysia, Sweden, Thailand, and India. Regular health checks made up the majority share of Chinese medical tourism in 2016, representing over 50% of all medical tourism trips for tourists originating in China.
All twelve of Hong Kong's private hospitals have been surveyed and accredited by the UK's Trent Accreditation Scheme since early 2001.
Medical tourism is a growing sector in India. India is becoming the 2nd medical tourism destination after Thailand. Chennai is regarded as "India's Health City" as it attracts 45% of health tourists visiting India and 40% of domestic health tourists.
In August 2019, the Indian government made it easier for foreigners to receive medical treatment without necessarily applying for a medical visa. These initiatives by Indian government will help Medical Tourism market to reach around $9 Billion in 2020. Furthermore the major reason for foreign tourist to choose India is because, It boasts 38 hospitals accredited by the Joint Commission International. 
As medical treatment costs in the developed world balloon—with the United States leading the way—more and more Westerners are finding the prospect of international travel for medical care increasingly appealing. An estimated 150,000 of these travel to India for low-priced healthcare procedures every year.
India is increasingly becoming popular with Africans seeking medical treatment overseas, because of it boast highly qualified doctors and state-of-the-art equipment, and the treatments are approved by the World Health Organization (WHO) and the US Food and Drug Administration.  Many patients from Africa prefer Apollo & Medobal healthcare, which are headquartered in Chennai in India’s state of Tamil Nadu. Cosmetic surgery, bariatric surgery, knee cap replacements, liver transplants, and cancer treatments are some of the most sought out medical tourism procedures chosen by foreigners.
The majority of the foreign patients seeking medical treatments in Malaysia are from Indonesia, with smaller numbers of foreign patients coming from India, Singapore, Japan, Australia, Europe, the USA and the Middle East. In 2008, Indonesians comprised 75% of all foreign patients receiving care in Malaysia; Europeans, 3%; Japanese, 3%; Singaporeans, 1% and citizens from Middle Eastern countries, 1%. By 2011, Indonesians comprised 57% of all foreign patients in Malaysia as the number of patients of other nationalities grew.
Health insurance companies in Singapore have recently permitted their policyholders to be treated in Malaysia where services are cheaper than in Singapore.
In 2008, it was estimated that on average New Zealand's surgical costs are around 15 to 20% the cost of the same surgical procedure in the USA.
Singapore has a dozen hospitals and health centers with JCI accreditation. In 2013 medical expenditure generated from medical tourists, mostly from more complex medical procedures, such as heart surgery, was S$832 million, a decline of 25 percent from 2012's S$1.11 billion, as the hospitals faced more competition from neighbouring countries for less complex work.
Foreigners seeking treatment for everything from open-heart surgery to fertility treatments have made Thailand and its accredited hospitals a popular destination for medical tourism, attracting an estimated 2.81 million patients in 2015, up 10.2 percent. In 2013, medical tourists spent as much as US$4.7 billion, according to government statistics. As of 2019[update], with 64 accredited hospitals, Thailand is currently among the top 10 medical tourism destinations in the world. In 2017, Thailand registered 3.3 million visits by foreigners seeking specialised medical treatment. In 2018, this number grew to 3.5 million.
In 2006, it was ruled that under the conditions of the E112 European health scheme, UK health authorities had to pay the bill if one of their patients could establish urgent medical reasons for seeking quicker treatment in another European union country.
The European directive on the application of patients’ rights to cross-border healthcare was agreed in 2011.
An online survey of EU migrants, mostly from Poland, Hungary and Romania, in the UK by the Centre for Population Change in 2019 showed that 46% of them preferred the health system in their country of origin. Only 36% preferred NHS medical treatment, and fewer among those from Western Europe.
Azerbaijan is a target of health tourists from Iran, Turkey, Georgia and Russia. The Bona Dea International Hospital in Baku was built in 2018 to attract international custom, and has staff from various European countries.
On December 9, 2013, the City of Helsinki decided that all minors under the age of 18 and all pregnant mothers living in Helsinki without a valid visa or residence permit are granted the right to the same health care and at the same price as all citizens of the city. This service will be available sometime early year 2014. Volunteer doctors of Global Clinic have tried to help these people, for whom only acute care has been available. This means that the Finnish health care system is open for all people coming outside of the European Union. The service covers special child health care, maternity clinics and specialist medical care etc. practically for free. It is still unclear if this will increase so called health care tourism, because all you have to do is come to Helsinki as a tourist and let the visa expire.
The Global Clinic in Turku offers health care for all undocumented immigrants for free.
British NHS patients have been offered treatment in France to reduce waiting lists for hip, knee and cataract surgery since 2002. France is a popular tourist destination but also ranked the world's leading health care system by the World Health Organization. European Court of Justice said that National Health Service (England) has to pay back British patients.
The number of patients is growing, and in 2016, France scored # 7 in the Medical Tourism Index.
In 2017 there were said to be around 250,000 foreign patients who brought more than 1.2 billion euros income to German hospitals. Some were visitors who fell ill unexpectedly, but it is estimated that more than 40 percent came for planned treatment, the majority from Poland, the Netherlands or France. There have long been medical tourists from the Middle East. University hospitals and the large municipal clinics, such as University Hospital Freiburg or Vivantes in Berlin, are the most popular destinations. Some require payment in full before they start treatment.
The Hallwang Clinic GmbH is said to be the most high profile clinic in the European private cancer industry, centred in Germany, which attracts patients from the US, the UK, Australia and the Middle East, offering a variety of different treatments, some of which do not appear to be evidence based; the clinic has been accused of selling false hope.
Health Tourism Lithuania, a booking agent, was established in 2018, focusing on the Scandinavian market, but in 2019 in response to longer waiting lists in the NHS noticed an increase in enquiries about hip replacements, in addition to the existing interest in cosmetic surgery and dentistry from Britons. A hip replacement costs £3,340, about a third of the price of a commercial procedure in the UK.
Serbia has a variety of clinics catering to medical tourists in areas of cosmetic surgery, dental care, fertility treatment and weight loss procedures. The country is also a major international hub for gender reassignment surgery.
In his address to the Federal Assembly of the Russian Federation dated March 1, 2018, Russian President Vladimir Putin stressed the need to develop health care and export services in the field of medicine and tourism.
In accordance with the decree of the President of the Russian Federation of May 7, 2018 № 204 "on national goals and strategic objectives of the development of the Russian Federation for the period up to 2024" the volume of exports of medical services by 2024 will have to be $1 billion per year. RAMT in order to implement the Decree of the President of the Russian Federation of 7 May 2018 № 204, the Federal non-profit organization Russian Association of Medical Tourism was established.
The cost of medical recourses in Turkey is quite affordable compared to Western European countries. Therefore, thousands of people each year travel to Turkey for their medical treatments. Turkey is especially becoming a hub for hair transplant surgery. Almost 178 thousand tourists visited for health purposes in the first six months of 2018. 67% used private hospital, 24% public hospitals and 9% university hospitals. The Regulation on International Health Tourism and Tourist Health came into force on 13 July 2017. It only applies to those coming specifically for treatment.
The National Health Service is publicly owned. It attracts medical tourism principally to specialist centres in London. Some private hospitals and clinics in the United Kingdom are medical tourism destinations. UK private hospitals have mandatory registration with the UK's watchdog, the Care Quality Commission).
The vast majority of medical tourism in the UK is attracted to London where there are 25 private hospitals and clinics and 12 private patient units run by NHS hospital trusts. American organisations including the Cleveland Clinic, the Mayo Clinic and Ambulatory Surgery International have established operations in London. In 2017 there was a 3% decline in the £1.55 billion market because of fewer clients from the Middle East, who perceive London as expensive. Overseas patients coming to London are now more likely to be looking for cancer treatment than orthopaedics. Income for NHS providers rose by 9% in 2018-9, pushing the Royal Marsden nearer the 50% statutory limit.
It is alleged that health tourists in the UK often target the NHS for its free-at-the-point-of-care treatment, allegedly costing the NHS up to £200 million. A study in 2013 concluded that the UK was a net exporter of medical tourists, with 63,000 UK residents travelling abroad for treatment and about 52,000 patients getting treatment in UK. Medical tourists treated as private patients by NHS trusts are more profitable than UK private patients, yielding close to a quarter of the revenue from only seven percent of volume of cases. UK dental patients largely go to Hungary and Poland. Fertility tourists mostly travel to Eastern Europe, Cyprus and Spain.
In the summer of 2015 immigration officers from the Border Force were stationed in St George's University Hospitals NHS Foundation Trust to train staff to identify "potentially chargeable patients". In October 2016 the trust announced that it planned to require photo identity papers or proof of their right to remain in the UK such as asylum status or a visa for pregnant women. Those not able to provide satisfactory documents would be sent to the trust's overseas patient team "for specialist document screening, in liaison with the UK Border Agency and the Home Office.” It was estimated that £4.6 million a year was spent on care for ineligible patients. A pilot scheme to check whether patients were entitled to free NHS care in 18 NHS trusts, 11 in London, for two months in 2017 asked 8,894 people for two forms of ID prior to non-emergency care. Only 50 were not eligible for free NHS treatment. Campaigners claimed this was “part of the Government’s hostile environment policy”, and that in Newham hospital "you will see huge signs saying you may not be eligible for free NHS treatment".
The bills issued to patients thought to be ineligible far exceed the sums actually collected. Most trusts do not have dedicated staff for the task. Ineligible patients generally live overseas, many have no money, and some demonstrate that they were eligible for free treatment after invoices have been issued. 
See also Immigration health surcharge
- Horowitz, Michael D.; Rosensweig, Jeffrey A.; Jones, Christopher A. (2007). "Medical Tourism: Globalization of the Healthcare Marketplace". MedGenMed. 9 (4): 33. PMC 2234298. PMID 18311383.
- "Medical tourism--health care in the global economy" (PDF). Physician Exec. Retrieved 16 September 2012.
- Paul McFedries (2006-05-17). "fertility tourism". Word Spy. Retrieved 2011-10-29.
- "History of Medical Tourism". Discovermedicaltourism.com. Discovermedicaltourism.com. Retrieved 2015-11-03.
- Gahlinger, PM. The Medical Tourism Travel Guide: Your Complete Reference to Top-Quality, Low-Cost Dental, Cosmetic, Medical Care & Surgery Overseas. Sunrise River Press, 2008
- Laurie Goering, "For big surgery, Delhi is dealing," The Chicago Tribune, March 28, 2008 Archived April 1, 2008, at the Wayback Machine
- Tompkins, Olga (2010). "Medical Tourism". AAOHN Journal. 58 (1): 40. doi:10.3928/08910162-20091223-04. PMID 20102121.
- Ramesh, Randeep; editor, social affairs (2013-09-12). "Hospital death rates in England 45% higher than in US, report finds". The Guardian. ISSN 0261-3077. Retrieved 2019-03-17.CS1 maint: extra text: authors list (link)
- Tung, Sarah (July 16, 2010). "Is Taiwan Asia's Next One-Stop Plastic-Surgery Shop?". Time.
- The Private Cost of Public Queues in 2005, Fraser Institute
- Wait times shorter for some medical procedures: report., Canwest News Service
- Linda A. Johnson, "Americans look abroad to save on health care: Medical tourism could jump tenfold in next decade," The San Francisco Chronicle, August 3, 2008
- Lagace, Martha "The Rise of Medical Tourism", Harvard Business School Working Knowledge, December 17, 2007. Retrieved July 1, 2008.
- "Patient Beyond Borders, Medical Tourism Facts&Statistics" Archived 2014-04-26 at the Wayback Machine Retrieved July 14, 2014
- "Medical tourism: Need surgery, will travel" CBC News Online, June 18, 2004. Retrieved September 5, 2006.
- Jones CA, Keith LG (2006). "Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare". Int J Fertil Womens Med. 51: 251–255.
- Jones C (2007). "Ethical and legal conundrums of post-modern procreation". Int J Gynaecol Obstet.
- Galewitz, Phil (2019-08-12). "To Save Money, American Patients And Surgeons Meet In Cancun". Kaiser Health News. Kaiser Family Foundation. Retrieved 14 August 2019.
- Cohen, Glenn (2012). "Circumvention Tourism". Cornell Law Review. 97 (1309).
- Day, Matthew (March 15, 2010). "Polish women encouraged to come to UK for 'free abortions' on NHS". Telegraph Media Group. The Telegraph. Retrieved 28 April 2015.
- "Ship campaigns". Women on Waves. Women on Waves.
- Joint Commission International Accreditation & Certificationweb, Joint Commission International, archived from the original on 22 July 2011, retrieved 19 July 2011
- "Accreditation Canada History". Retrieved June 12, 2012.
- "A Journal Through the History of The Joint Commission" (PDF). The Joint Commission. Archived from the original (PDF) on 2014-04-13. Retrieved 2014-04-13.
- "Medical Tourism Magazine", Medical Tourism Association, February 2008
- "Facts about Joint Commission International". Joint Commission. 2008-12-11. Retrieved 2010-09-15.
- Lunt, Neil; Horsfall, Daniel; Hanefeld, Johanna (2015). Handbook on Medical Tourism and Patient Mobility. ISBN 9781783471195.
- "INDIA: Accreditation a must", International Medical Travel Journal
- "Home". World Hospital Monitor. Retrieved 2010-09-15.
- "TB Often Misdiagnosed". American Lung Association of Illinois. Archived from the original on March 1, 2007. Retrieved 2007-03-10.
- "New DVT Guidelines: No Evidence to Support "Economy Class Syndrome"; Oral Contraceptives, Sitting in a Window Seat, Advanced Age, and Pregnancy Increase DVT Risk in Long-distance Travelers". American College of Chest Physicians. 7 February 2012. Archived from the original on 9 February 2012. Retrieved 10 February 2012.
- "Caring for Your Incision After Surgery", FamilyDoctor.org, American Academy of Family Physicians, December 2010. Retrieved July 23, 2013.
- "Compliments, Comments, Concerns or Complaints" (PDF). The Pennine Acute Hospitals. Archived from the original (PDF) on 2015-01-01. Retrieved 2015-01-01.
- "World Alliance for Patient Safety". Who.int. 2010-05-05. Retrieved 2011-10-29.
- Cusumano, Lucas R.; Tran, Vivy; Tlamsa, Aileen; Chung, Philip; Grossberg, Robert; Weston, Gregory; Sarwar, Uzma N. (October 2017). "Rapidly growing Mycobacterium infections after cosmetic surgery in medical tourists: the Bronx experience and a review of the literature". International Journal of Infectious Diseases. 63: 1–6. doi:10.1016/j.ijid.2017.07.022. ISSN 1878-3511. PMID 28780185.
- Ginger Rough (June 7, 2009). "Globe-trotting to cut down on medical costs". The Arizona Republic. Retrieved 1 January 2013.
- "Medical Tourism: Ethical Pitfalls of Seeking Health Care Overseas". Ahcpub.com. Archived from the original on 2011-07-07. Retrieved 2011-10-29.
- "Medical Protection Society | MPS UK". Medicalprotection.org. Retrieved 2011-10-29.
- Spreng, Jennifer (2004). Abortion and Divorce Law in Ireland. Jefferson, NC: McFarland & Company, Inc. p. 150. ISBN 978-0786416752.
- "IFTF's Future Now: The dark side of medical tourism". Future.iftf.org. 2006-04-19. Archived from the original on 2011-09-29. Retrieved 2011-10-29.
- Chopra, Anuj (February 9, 2008). "Organ-transplant black market thrives in India". The San Francisco Chronicle.
- "Transplants and Ethics in San Francisco". The Epoch Times. 2007-05-23. Retrieved 2011-10-29.
- David Kilgour, David Matas (6 July 2006, revised 31 January 2007) An Independent Investigation into Allegations of Organ Harvesting of Falun Gong Practitioners in China (free in 22 languages) organharvestinvestigation.net
- Lee Mendoza Roger (2010). "Colombia's organ trade: Evidence from Bogotá and Medellín". Journal of Public Health. 18 (4): 375–384. doi:10.1007/s10389-010-0320-3.
- Roger Lee Mendoza (2010). "Price deflation and the underground organ economy in the Philippines". Oxford Journal of Public Health. 33 (1): 101–107.
- Participants in the International Summit on Transplant Tourism and Organ Trafficking convened by The Transplantation Society and International Society of Nephrology in Istanbul, Turkey, 30 April to 2 May 2008 (2008). "The Declaration of Istanbul on Organ Trafficking and Transplant Tourism". Kidney International. 74 (7): 854–59. doi:10.1038/ki.2008.388. PMC 2813140. PMID 20142924.CS1 maint: multiple names: authors list (link)
- "Indian Journal of Medical Ethics". Archived from the original on 30 July 2013. Retrieved 9 June 2015.
- "Medical Tourism Creates Thai Doctor Shortage". NPR. Retrieved 2011-10-29.
- Lindvall O, Hyun I (2011-10-03). "Medical innovation versus stem cell tourism". Science. 324 (5935): 1664–5. doi:10.1126/science.1171749. PMID 19556497.
- ISSCR Guidelines for the Clinical Translation of Stem Cells. 2008 Archived June 3, 2009, at the Wayback Machine
- Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care, The New York Times
- McGinley, Laurie, "Health Matters: The next wave of medical tourists might include you", Wall Street Journal, February 16, 2008. Retrieved March 13, 2008.
- "Mini-Meds: Limited benefit plans provide cost-effective compromise" Houston Business Journal,
- Bruce Einhorn, "Outsourcing the Patients", BusinessWeek, March 13, 2008
- Greg Lindsay,"Medical Leave" Fast Company, May 2008. Retrieved October 15, 2008.
- "IMTJ MEDICAL TRAVEL AWARDS 2014". Retrieved 2014-04-25.
- Health Ministry to probe Israel medical tourism industry following Haaretz exposé, Haaretz, November 18, 2010
- "An overview of medical tourism in Israel | IMTJ".
- "Israel ranks high as a medical tourism destination".
- "Doing Fertility Treatments in Israel: Pros and Cons". Haaretz. 2015-03-09.
- "Medical tourism – why Israel?". 2015-04-14.
- "Fars News Agency :: Ahmadinejad Stresses Iran's Growing Medical Tourism Industry". English.farsnews.com. 2012-01-17. Archived from the original on 2012-02-13. Retrieved 2012-02-05.
- "500,000 health tourists coming to Iran for medical treatment". Irna.ir. Retrieved 2017-01-08.
- ": Medical tourism in SA". Mediaclubsouthafrica.com. 2009-08-06. Retrieved 2011-10-29.
- "Hospital Israelita Albert Einstein Becomes First Hospital Accredited by Joint Commission International" (Blog). PR Newswire. Retrieved 2014-11-12.
- "(JCI) Accredited Organizations". Joint Commission International. Retrieved 2011-10-29.
- "Evolving medical tourism in Canada" (PDF). Deloitte.com. Retrieved 2017-01-08.
- Farnsworth, Clyde H. (1993-12-20). "Americans Filching Free Health Care in Canada". NYTimes.com. Ontario (Canada); Canada; United States. Retrieved 2017-01-08.
- "South Korea wants to expand medical tourism beyond cosmetic surgery". Imtj.com. 2009-05-08. Retrieved 2011-10-29.
- Medical Tourism Consumers in Search of Value 2008 Deloitte Development LLC
- "I had my misgivings about going abroad for surgery". BBC. 28 March 2019. Retrieved 7 April 2019.
- Allison Van Dusen (May 29, 2008). "U.S. Hospitals Worth The Trip". Forbes. Retrieved 2012-09-17.
It narrowly defined medical travelers as only those whose primary and explicit purpose in traveling was to obtain in-patient medical treatment in a foreign country, putting the total number of travelers at 60,000 to 85,000 per year.
- Fred Hansen, , Institute of Public Affairs review article (January 2008).
- International Medical Services Archived 2010-06-12 at the Wayback Machine, Stanford Hospital & Clinics
- "2016 China Medical Tourism Report". Marcetable. 2017-01-29. Retrieved 2017-02-12.
- Indian Medical Tourism To Touch Rs 9,500 Crore By 2015, The Economic Times, posted on IndianHealthCare.in
- Hamid, Zubeda (20 August 2012). "The medical capital's place in history". The Hindu. Chennai. Retrieved 15 Sep 2012.
- Palash, Ghosh (26 November 2019). "India's Medical Tourism Market". International business times. pp. Business. Retrieved 9 December 2019.
- Pavithra, rao (26 March 2017). "India's medical tourism". Africa Renewal. pp. Health & Well being. Retrieved 10 December 2019.
- Eleanor Black Watkin (July 8, 2008). "One Company With an Eye on U.S. Customers". The Washington Post. Retrieved 1 January 2013.
- Joint Commission International (JCI) Accredited Organizations
- "The rise of 5-star hospitals in Singapore". Today on line. 8 March 2016. Retrieved 10 February 2017.
- "Medical Tourism in Thailand: When Treatment Costs and Starbucks Clash". Medical Tourism Magazine. 2015-10-13. Retrieved 14 October 2015.
- Mellor, William (19 November 2014). "Medical Tourists Flock to Thailand Spurring Post-Coup Economy". Bloomberg. Retrieved 19 February 2015.
- Otage, Stephen (12 February 2019). "Uganda: What Uganda Can Learn From Thailand's Medical Tourism". Daily Monitor. Kampala. Retrieved 15 February 2019.
- "NHS Waiting lists: targets and England&Wales comparison". Thompsons.law.co.uk. 2006-05-16. Archived from the original on 2014-02-02. Retrieved 2011-10-29.
- "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original (PDF) on 6 June 2017. Retrieved 27 January 2016.
- Worstall, Tim (22 March 2019). "NHS Not Much Cop Say Those Who've Tried Other Health Care Systems". Continental Telegraph. Retrieved 25 March 2019.
- "Azerbaijan Improves Medical Infrastructure To Lure Health-Conscious Travelers". Caspian News. 16 April 2018. Retrieved 7 March 2019.
- "History of Tourism from 1868". Total Croatia. 24 October 2011. Retrieved 27 December 2018.
- "Turku clinic offers health care for undocumented immigrants". Retrieved 2015-01-22.
- "NHS patients recover after surgery abroad". BBC News. January 19, 2002.
- "World Health Organization Assesses the World's Health Systems". Retrieved 13 October 2016.
- "BBC NEWS - Health - NHS told to fund treatment abroad". Retrieved 9 June 2015.
- "Medical Tourism Index: Destination Ranking". Retrieved 13 October 2016.
- "Das Riesengeschäft mit dem Medizintourismus in Deutschland". DW. 11 January 2018. Retrieved 7 March 2019.
- "Information on Treatment Costs". Heildelberg University. Retrieved 20 March 2019.
- "Cancer crowdfunding 'couldn't save my daughter'". BBC. 6 March 2019. Retrieved 6 March 2019.
- "The deadly false hope of German alternative cancer clinics". sciencebasedmedicine.org. 26 March 2018. Retrieved 7 March 2019.
- "Lithuania to offer Britons cheap surgery as millions stuck on longest NHS waiting list". Express. 27 May 2019. Retrieved 1 June 2019.
- "Why choose Serbia for medical tourism". Treatmentabroad.com. 2013-10-08. Retrieved 2017-01-08.
- Dan Bilefsky (2012-07-23). "Serbia Becomes a Hub for Sex-Change Surgery". The New York Times. Retrieved 2017-01-08.
- "Послание Президента Федеральному Собранию". kremlin.ru. Retrieved 16 July 2019.
- "THTC - Turkish Healthcare Travel Council". Retrieved 9 June 2015.
- Sarah A. Topol. "Turkey's Thriving Business in Hair, Beard, and Mustache Implants". Businessweek.com. Retrieved 9 June 2015.
- "International Health Tourism in Turkey". Lexology. 8 January 2018. Retrieved 13 February 2019.
- "The forgotten medical tourism destination". Archived from the original on 26 January 2013. Retrieved 9 June 2015.
- "UK: New London agency could promote medical tourism". 20 April 2011.
- "Cancer care becomes biggest earner for London's private hospitals". Financial Times. 8 February 2019. Retrieved 19 March 2019.
- "Health tourists: How much do they cost and who pays? - Full Fact". 6 September 2015.
- Hannefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard (24 October 2013). "Medical Tourism: A Cost or Benefit to the NHS?". PLOS ONE. 8 (10): e70406. Bibcode:2013PLoSO...870406H. doi:10.1371/journal.pone.0070406. PMC 3812100. PMID 24204556.
- "Immigration officers at London trust for patient charging pilot". Local Government Chronicle. 20 July 2015. Retrieved 24 September 2015.
- "Pregnant women could need photo ID to get maternity care as St George's Hospital in Tooting cracks down on NHS tourism". Richmond and Twickenham Times. 11 October 2016. Retrieved 29 October 2016.
- "8,900 checks on NHS 'health tourists' find just 50 liable to pay". Evening Standard. 29 May 2018. Retrieved 30 May 2018.
- "Trusts missing out on tens of millions from overseas patients". Health Service Journal. 19 November 2019. Retrieved 9 January 2020.
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