, Volume 2, Issue 3, pp 303–325 | Cite as

‘First World Health Care at Third World Prices’: Globalization, Bioethics and Medical Tourism

  • Leigh Turner


India, Indonesia, Malaysia, the Philippines, Singapore, Thailand and many other countries market themselves as major destinations for ‘medical tourism’. Health-related travel, once promoted by individual medical facilities such as Bumrungrad International Hospital and Bangkok International Hospital, is now driven by government agencies, public–private partnerships, private hospital associations, airlines, hotel chains, investors and private equity funds, and medical brokerages. ‘Medical tourists’ include patients trying to avoid treatment delays and obtain timely access to health care. Medical travellers also include uninsured Americans and other individuals unable to afford health care in their home settings. Destination nations regard medical tourism as a resource for economic development. However, attracting patients to countries such as India and Thailand could increase regional economic inequalities and undermine health equity. International medical travel might also have unintended, undesired outcomes for patients seeking affordable health care. With globalization, increasing numbers of patients are leaving their home communities in search of orthopaedic surgery, ophthalmologic care, dental surgery, cardiac surgery and other medical interventions. Reductions in health benefits offered by states and employers will likely increase the number of individuals looking for affordable medical care in a global market of privatized, commercial health care delivery.


bioethics biomedical hubs globalization ‘medical tourism’ 



Funding for the study of ethical and social issues related to medical tourism was provided by a William Dawson Scholar award from McGill University. Additional funding was provided by a Distinguished Visiting Fellowship in the Comparative Program on Health and Society at the University of Toronto's Munk Centre for International Studies. I would like to thank Professor Charles Bosk, Department of Sociology, University of Pennsylvania, for thoughtful commentary on an earlier version of this papaer.


  1. Appleby J. & Schmit J. (2006). Sending patients packing. USA Today, 27 July.Google Scholar
  2. Alsever J. (2006). Basking on the beach, or maybe on the operating table. New York Times, 15 October.Google Scholar
  3. Blumenthal D. (2006). Employer-sponsored health insurance in the United States—Origins and implications. New England Journal of Medicine, 355, 82–88.CrossRefGoogle Scholar
  4. Bumrungrad International Hospital. (2006). Fact sheet. URL (accessed June 2007):
  5. Canales M., Kasiske B., & Rosenberg M. (2006). Transplant tourism: Outcomes of United States residents who undergo kidney transplantation overseas. Transplantation, 82, 1658–1661.CrossRefGoogle Scholar
  6. Carrera P., & Bridges J. (2006). Globalization and healthcare: Understanding health and medical tourism. Expert Review Pharmacoeconomics Outcomes Research, 6, 447–454.CrossRefGoogle Scholar
  7. CDC (1998). Rapidly growing mycobacterial infection following liposuction and liposculpture—Caracas, Venezuela, 1996–1998. Morbidity and Mortality Weekly Report, 47, 1065–1067.Google Scholar
  8. CDC (2004). Brief report: Nontuberculous mycobacterial infections after cosmetic surgery—Santo Domingo, Dominican Republic, 2003–2004. Morbidity and Mortality Weekly Report, 53, 509.Google Scholar
  9. Chanda R. (2002). Trade in health services. Bulletin of the World Health Organization, 80, 158–163.Google Scholar
  10. Chantarapitak P. (2006). The transformation into one of the leading destinations for healthcare. Singapore Medical Association News, 38, 25–27.Google Scholar
  11. Connell J. (2006) Medical tourism: Sea, sun, sand and … surgery. Tourism Management, 27, 1093–1100.CrossRefGoogle Scholar
  12. Cyranoski D. (2001). Building a biopolis. Nature, 412, 370–371.CrossRefGoogle Scholar
  13. Doty M., Edwards J., & Holmgren A. (2005). Seeing red: Americans driven into debt by medical bills. Results from a national survey. Commonwealth Fund Issues Brief, 837, 1–12.Google Scholar
  14. Foreman J. (2006). Bon voyage, and get well! Boston Globe, 2 October.Google Scholar
  15. Foster M., & Mason M. (2006). Businesses may move health care overseas. Seattle-Post Intelligencer, 2 November.Google Scholar
  16. Garcia-Altes A. (2005). The development of health tourism services. Annals of Tourism Research, 32, 262–266.CrossRefGoogle Scholar
  17. Garloch K. (2006). High costs send patients overseas for care. Charlotte Observer, 10 December.Google Scholar
  18. Gawande A. (2003). Dispatch from India. New England Journal of Medicine, 349, 2383–2386.CrossRefGoogle Scholar
  19. Gin B. (2005). Singapore—A global biomedical sciences hub. Drug Discovery Today, 10, 1134–1137.CrossRefGoogle Scholar
  20. Goodrich J. (1993). Socialist Cuba: A study of health tourism. Journal of Travel Research, summer, 36–41.Google Scholar
  21. Goodrich J., & Goodrich G. (1987). Health-care tourism—An exploratory study. Tourism Management, September, 217–222.Google Scholar
  22. Hacker J. (2006). The great risk shift. Oxford: Oxford University Press.Google Scholar
  23. Himmelstein D., Warren E., Thorne D., & Woolhandler S. (2005). Illness and injury as contributors to bankruptcy. Health Affairs, W5, 63–73.Google Scholar
  24. Hoffman C., Rowland D., & Hamel E. (2005). Medical debt and access to health care. Washington: Kaiser Commission on Medicaid and the Uninsured.Google Scholar
  25. Hutchins J. (1998). Bringing international patients to American hospitals: The Johns Hopkins perspective. Managed Care Quarterly, 6, 22–27.Google Scholar
  26. Kerr K. (2006). Tourism and treatment: To save money on surgery, more Americans are taking trips abroad. Newsday, 26 September.Google Scholar
  27. Kher U. (2006). Outsourcing your heart. Time, 21 May, 44–47.Google Scholar
  28. Kuan Yew L. (2006). Excerpts from speech by Minister Mentor Mr Lee Kuan Yew at the SGH 185th anniversary dinner on 16 April 2006 at Ritz-Carlton Millennia. Singapore Medical Association News, 38, 12–15.Google Scholar
  29. Lancaster J. (2004). Surgeries, side trips for ‘medical tourists’. Washington Post, 21 October, A01.Google Scholar
  30. Lee O., & Davis T. (2004). International patients: A lucrative market for US hospitals. Health Marketing Quarterly, 22, 41–56.CrossRefGoogle Scholar
  31. Mattoo A., & Rathindran R. (2006). How health insurance inhibits trade in health care. Health Affairs, 25, 358–368.CrossRefGoogle Scholar
  32. Milstein A., & Smith M. (2006). America's new refugees—Seeking affordable surgery offshore. New England Journal of Medicine, 355, 1637–1640.CrossRefGoogle Scholar
  33. Milstein A., & Smith M. (2007). Will the surgical world become flat? Health Affairs, 26, 137–141.CrossRefGoogle Scholar
  34. Mooney T. (2006). Cosmetic surgery overseas ends in death for R.I. woman. Rhode Island News, 19 May.Google Scholar
  35. Moore J. (1997). Medical Mecca. Foreign patients flock to Miami seeking care and service. Modern Healthcare, 27, 30–37.Google Scholar
  36. Mudur G. (2003). India plans to expand private sector in healthcare review. British Medical Journal, 326, 520.CrossRefGoogle Scholar
  37. Mudur G. (2004a). Hospitals in India woo foreign patients. British Medical Journal, 328, 1338.CrossRefGoogle Scholar
  38. Mudur G. (2004b). Inadequate regulations undermine India's health care. British Medical Journal, 328, 124.CrossRefGoogle Scholar
  39. Mutchnick I., Stern D., & Moyer C. (2005). Trading health services across borders: GATS, markets, and caveats. Health Affairs, W5, 42–51.Google Scholar
  40. O'Toole T., Arbelaez J., & Lawrence R. (2004). Medical debt and aggressive debt restitution practices: Predatory billing among the urban poor. Journal of General Internal Medicine, 19, 772–778.CrossRefGoogle Scholar
  41. Rahi A. (2005). Westerners seek cheap medical care in Asia. USA Today, 24 September.Google Scholar
  42. Rai S. (2006). Union disrupts plan to send ailing workers to India for cheaper medical care. New York Times, 11 October.Google Scholar
  43. Ramirez de Arellano A. (2007). Patients without borders: The emergence of medical tourism. International Journal of Health Services, 37, 193–198.CrossRefGoogle Scholar
  44. Roth M. (2006). Surgery abroad an option for those with minimal health coverage. Pittsburgh Post-Gazette, 20 September.Google Scholar
  45. Samandari R., Kleefield S., Hammel J., Mehta M., & Crone R. (2001). Privately funded quality health care in India: A sustainable and equitable model. International Journal for Quality in Health Care, 13, 283–288.CrossRefGoogle Scholar
  46. Searls T. (2006). Overseas surgery debated in house. Charleston Gazette, 24 February.Google Scholar
  47. Seifert R. (2005). Homesick: How medical debt undermines housing security. Boston, MA: Access Project.Google Scholar
  48. Seifert R., & Rukavina M. (2006). Bankruptcy is the tip of a medical-debt iceberg. Health Affairs, 25, w89–92.CrossRefGoogle Scholar
  49. Sengupta A., & Nundy S. (2005). The private health sector in India. British Medical Journal, 331, 1157–1158.CrossRefGoogle Scholar
  50. Sherman M., & Betances Y. (2004). Infections prompt warning from CDC. Eagle-Tribune, 21 November.Google Scholar
  51. Singh A., & Datta M. (2005). Indian hospitals lure foreigners with $6,700 heart surgery, Bloomberg News, 27 January.Google Scholar
  52. Smaglik P. (2003). Singapore: Filling biopolis. Nature, 425, 746–747.CrossRefGoogle Scholar
  53. Starr Sered S., & Fernandopulle R. (2005). Uninsured in America: Life and death in the land of opportunity. Berkeley: University of California Press.Google Scholar
  54. Talbot M. (2001). Nip, tuck, and frequent-flier miles. New York Times, 6 May.Google Scholar
  55. Times News Network (2007). Apollo, AIMU mull medical tourism projects. Economic Times Online, 12 January.Google Scholar
  56. Travel Smart–Asia Watch. (2006). Travel and hospitality industry set to tap into Asia's US $4 billion medical tourism market. Travel Smart–Asia Watch, April–May, 1–4.Google Scholar
  57. Wachter R. (2006). The ‘dis-location’ of US medicine—The implications of medical outsourcing. New England Journal of Medicine, 354, 661–665.CrossRefGoogle Scholar
  58. Wagner M. (2006). Duke on track with $100M Singapore medical school. Triangle Business Journal, 11 August.Google Scholar
  59. Weber D. (1998). Global fees and creative marketing fill empty US beds with well-insured (or wealthy) foreigners. Healthcare Strategy, 9, 1–7.Google Scholar
  60. Wibulpolprasert S., Pachanee C., Pitayarangsarit S., & Hempisut P. (2004). International service trade and its implications for human resources for health: A case study of Thailand. Human Resources for Health, 2, 10.CrossRefGoogle Scholar
  61. Yap Chin Huat J. (2006a). Medical tourism/medical travel (Part One). SMA News, 38(5), 17–21.Google Scholar
  62. Yap Chin Huat J. (2006b). Medical tourism/medical travel (Part Two). SMA News, 38(7), 14–16.Google Scholar
  63. Yap Chin Huat J. (2006/2007). Medical tourism and Singapore. International Hospital Federation Reference Book 2006/2007, 77–78.Google Scholar
  64. Yi D. (2006). US employers look offshore for healthcare. Los Angeles Times, 30 July.Google Scholar

Copyright information

© London School of Economics and Political Science 2007

Authors and Affiliations

  • Leigh Turner
    • 1
  1. 1.Department of Social Studies of MedicineBiomedical Ethics Unit, Faculty of Medicine, McGill UniversityMontrealCanada

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