Health tourism in our country and around the world

1. Introduction
Health tourism is a subsector of general tourism that comprises medical, wellness, and spa
tourism.
Medical tourism involves people travelling expressly to access medical treatment.
People travel for wellness tourism to maintain or enhance their personal health and well-
being.
Spa tourism focuses on healing, relaxation or beautifying of the body that is preventative
and/or curative in nature.
The three forms of health tourism (medical, wellness, and spa) reside on two parallel
continuums: ‘illness-health-wellness’ and ‘curative – preventative – promotive’. Medical
tourism is associated with curing illness; wellness tourism promotes personal well-being
and spa tourism is positioned in between, aiming to prevent illness and wanting to sustain
health.
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.

2. History of Health tourism

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 sanatoria 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.
From Serbia, patients with Tuberculosis and means to travel often spent years in Sanatoria
in Switzerland.

3. Reasons for Health tourism today

a. Non-urgent medical procedures
First World countries that operate public health-care systems (Canada, UK) often have long
wait times for certain operations and dental services. 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. On the other hand, in the US, the
main reason is cheaper prices abroad. 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.
b. Cosmetic and plastic surgery
Brazil is the hub of cosmetic and plastic surgery, being the third most visited country,
below US and China, for patients needing those procedures. Brazil offers high quality
cosmetic and plastic surgical services at affordable rates, drawing more and more health
travelers to the country. Brazil is also a favorite for patients who seek special procedures
such as the Brazilian butt-lift or other specialty services from world-renowned surgeons.
Health travelers from the US save 20% to 30% on health cost if they receive their health
treatment in Brazil.
c. Circumvention tourism
It 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.
Some people travel for assisted pregnancy, such as in-vitro fertilization, or surrogacy or
freezing embryos for retro-production.
d. Transplant Tourism and Organ trafficking
High percentage is done outside of the established system and involves the donor, the
recipient or both crossing national boundaries for the recipient to access a trafficked organ.
 Organ trafficking is a form of human trafficking and is an organized crime. According to
the UN, organ trafficking falls into three categories:
 Traffickers who trick the victim into giving up an organ for no cost,
 Con artists who convince victims to sell their organs, but who do not pay or
who pay less than they agreed to pay, and
 Doctors who treat people for ailments which may or may not exist, and
remove the organs without the victim’s knowledge.
The organ trafficking trade involves a host of offenders. There is a recruiter who seeks out
the ‘donor,’ there is a transporter of the organs, there are staff of the hospital or clinic that
receives the organs, and of course the medical practitioners who perform the transplants.
There are also middlemen, contractors, buyers and the banks that store the organs/tissues.
In Bombay, for example, there have also been some cases of kidnapping where victims
regain consciousness to find that one of their kidneys was removed while they were
drugged.
In addition to con-artists and unscrupulous doctors, there are also extreme cases in which
people are outright murdered for their organs. Every year, there are suspicious deaths, in
which the victim had their organs removed. These cases are described and documented in
“civilized” western countries, and many more throughout the third world countries and in
worlds numerous warzones.
"Yellow house" case from Kosovo conflict in 1999 is well known example. According to
the reports, political prisoners in China, are being executed "on demand" in order to provide
organs to recipients. It has been estimated that tens of thousands of prisoners have been
killed to supply a lucrative trade in human organs and cadavers, and that these abuses may
be ongoing.

4. Health tourism in Serbia

a. Travel from Serbia
Intriguingly, patients traveling from Serbia abroad belong to all groups:
 people with money often choose to perform elective surgeries abroad
 complicated procedures and treatments, often in children
 fertility treatment, paradoxically. I have a family member who managed to get
pregnant via IVF in Prague, only after repetitive failed procedures in Belgrade and
Novi Sad. She is due on December the fifth and we are eagerly waiting to meet
Lola.
b. Travel to Serbia
Serbia has a variety of clinics catering to medical tourists in areas of cosmetic surgery,
dental care, fertility treatment and weight loss procedures. Serbia is also a major
international hub for gender reassignment surgery.
Belgrade is the world's gender surgery capital, even Cher’s son Chaz Bono (former
Chastity Bono) performed penile reconstruction surgery here.
5. Legal and ethical issues
Receiving medical care abroad may subject medical tourists to unfamiliar legal issues.
Some, but not all countries provide some form of legal remedies for medical malpractice.
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, 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, 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.
6. Conclusion
While medical tourism is far from new, shifting patient flow patterns and a growing
recognition of the complex ethical, social, economic, and political issues it raises are
underscoring renewed efforts to understand this phenomenon and its future.
Some of the current attention focused on medical tourism concerns its implications and
potential risks for individual patients and health care systems. Medical tourism impacts
both importing and exporting health care systems, albeit in different ways.
In my opinion health risks are the most worrying ones. Different infectious disease-related
epidemiology and exposure to diseases without having built up natural immunity can be a
hazard for weakened individuals, specifically with respect to gastrointestinal diseases
(much like “normal travelers” e.g. hepatitis A, amoebic dysentery) which could weaken
progress and expose the patient to mosquito-transmitted diseases, influenza and
tuberculosis, as well as blood-borne diseases like HIV, hepatitis B, C etc.
Patients traveling to countries with less stringent surgical standards may be at higher risk
for complications. The quality of post-operative care can vary dramatically. Traveling long
distances soon after surgery can increase the risk of complications. Long flights and
decreased mobility can predispose one towards developing deep vein thrombosis and
potentially a pulmonary embolism.
Ethical issues are second to none in cases of illegal purchase of organs and tissues for
transplantation.