New research on inbound and outbound UK medical tourism,’ by academics from the University of Birmingham and University of York, raises fundamental questions on the decision process and aftercare for medical tourism. The rise in medical tourism presents potential challenges for the NHS.
Since the establishment of the National Health Service (NHS) in 1948, health services in the UK have been funded primarily through general taxation and delivered free at the point of access to individuals. However, recent decades have witnessed an expansion in the global market for health services. This has been manifest in various ways, including an unprecedented increase in the volume of patients willing to cross national borders for the purposes of receiving medical care.
People travel for cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF treatment; and organ and tissue transplantation. The UK has also experienced inward flows of patients who travel to receive treatment and pay out of pocket, being treated in both private and NHS facilities.
Health tourism to and from the UK is a growing reality as patients seek to bypass waiting lists or access treatments not available in their own healthcare system. Policymakers have ignored it. Discussions on health tourism have tended to focus on the experience and identity, rather than the potential effects health tourism has on the quality and continuity of care patients receive.
Yet the reality of patients choosing to travel for treatment raises fundamental questions about how medical decisions are made, continuity of patient care and the commercialisation, commoditisation and internationalisation of UK healthcare.
There are four key policy areas where the growth of medical tourism has major implications for the NHS:
• Patient decision making
Relatively little is known about how medical tourists make decisions on the treatments they seek and the destinations they travel to. One particular concern is how patients balance hard data like performance measures, with soft intelligence, information provided by websites, the recommendations of family and friends, when making a decision.
• Continuity of care
Continuity of care is increasingly viewed as a key factor in the delivery of high quality health care, but an aspect of care that is seemingly under threat from commercialisation. Health tourism creates challenges in this area including whether patients have informed consent for treatment, and the implications of complications, side effects and postoperative care when patients do not have accurate treatment records.
• Safeguarding quality and safety
Modern health care is an inherently complex and risky undertaking, with the potential for clinical errors and medical malpractice ever present, particularly when accessing health care in countries where providers are poorly regulated. There is little comparable information with regard to the quality and safety of care provided by many of the destinations visited by UK medical tourists.
• The economic consequences of medical tourism
For the NHS there are implications from the inward flows of international patients, and from medical tourists from the UK using overseas providers. The Health and Social Care Bill proposes removing the private patient cap for foundation trusts, opening up the possibility for NHS trusts to secure greater numbers of patients travelling from overseas for treatment. Whilst this is a new revenue stream it has serious implications for patients in the NHS.
Medical tourism is an under-researched dimension of contemporary health policy that deserves closer attention by policymakers and academics alike. The price of treatment, the speed of obtaining treatment, and the availability of treatment are all potential attractions for UK patients seeking health care abroad, and – due to recent NHS reforms – treating international patients will increasingly be a key objective of NHS foundation trusts. Focusing on this phenomenon will allow us to understand key issues like how patients make decisions about private healthcare and the extent to which the growth of medical tourism represents part of a wider commercialisation and commoditisation of personal health where relationships are governed by commercial regulation (tort and contract) rather than professional ethics.
Lunt, N, Mannion, R and Exworthy, M (2012) 'A Framework for Exploring the Policy Implications of UK Medical Tourism and International Patient Flows', Social Policy & Administration.