Medical tourism guide

Medical Tourism is a growing concept worldwide where people travel to another country for medical treatment at lower cost or to enjoy a vacation along with their treatment.

Typically, medical tourism involves residents of high-income countries seeking medical treatment in low-income countries; often the costs are much lower. Residents of countries with national health care schemes – such as Canada and Great Britain – may travel to avoid the long waiting times such schemes sometimes bring. Others may travel for cosmetic surgery not covered by insurance. Also, couples are increasingly seeking fertility treatments abroad. Others have sought more sophisticated surgery, such as cardiology treatments, overseas.

Availability of good low-cost medical services can also be a major factor in selecting a destination for retiring abroad.

Possible benefits
The most obvious benefit is lower cost of treatment. All the professional services — doctors, dentists, optometrists, physiotherapy, lab tests, hospitals, etc. — are generally cheaper in low-income countries. Many related items, such as eyeglasses, dentures or common drugs, are also usually cheaper. However items that have to be imported, such as dental implants or certain drugs, may actually be more expensive.

Many travelers incorporate a short holiday along with the treatment as these also tend to be cheaper than vacations in their home country. Some even retire abroad in an area where they can get good cheap treatment.

Medical tourists sometimes can avail themselves of the best doctors and hospitals of a foreign country. The hospitals/clinics in medical tourist destinations may also be credentialed in first world countries and doctors are sometimes graduates of first-world medical schools.

Waiting lists are sometimes shorter in another country, for those with the means to pay. For example well-heeled Canadians may jump the queue at home by buying treatment in US private hospitals, where specialised care can be had quickly – if money is no object.

Residents of nations which criminalise abortion may find their options less restricted elsewhere; for instance, Irish patients often travel to Great Britain for treatment.

Birth tourism may allow a way around immigration laws or circumvention of mainland China’s one-child or two-child policies; jus soli countries (where anyone born in the country without diplomatic immunity is entitled to birthright citizenship) are the preferred destinations. The number of countries offering jus soli , let alone unconditional ius soli, is dropping. Australia for example abandoned unconditional jus soli in 1986, Ireland and France similarly abandoned it. Outside the Americas, jus sanguinis (citizenship by “blood” or descent) is most common.

In some cases, the foreign hospital or medical facility is actually geographically closer. This can have unintended consequences; many Campobello Island, New Brunswick kids have Maine birth certificates as it’s the only point reachable year-round by bridge, but that dual citizenship leaves these “border babies” liable for United States of America income taxes for life while living as Canadian citizens in Canada. A few decades back when the US military used conscription, these kids could be drafted.

Medical tourism also gives people a chance to incorporate local therapies — India’s yoga and Ayruvedic medicine, Thai massage, traditional Chinese medicine, … — with their ongoing treatments.

Generic drugs
Another reason for seeking treatment abroad can be the lower cost or better availability of some drugs.

As a general rule the more common drugs, e.g. most things on the WHO list of essential medicines, will be considerably cheaper in low-income countries. On the other hand, imported items such as dental implants and newer or more unusual drugs are often more expensive. There may also be differences in prescription rules; for example in China Viagra (or a Chinese copy?) and many antibiotics are available over-the-counter. In the Philippines, Viagra and Cialis are often sold by vendors walking around tourist areas; like their Rolex and Rayban products these are likely not authentic, so they may be quite risky, but they are cheap (under a dollar a pill if you bargain well) and they do work.

The most blatant example of an enormous price difference is Harvoni, the first of a group of new drugs for Hepatitis C. Previous treatments involved injections, often had quite nasty side effects, and gave only about a 60% chance of curing the disease; Harvoni is taken by mouth, has fewer side effects, and cures well over 90% of patients. Unfortunately, in the US it is patented and sells for about $1000 a pill, over $80,000 for the usual treatment of 12 weeks at one pill a day. At least two other drugs with similar properties are now on the market and cost less, but still in the tens of thousands. Many insurance schemes — including the British National Health, Canadian provinces, and many insurers in the US — will not pay for these treatments unless you are very ill, so some patients go untreated and may spread the disease.

India refused to grant the Harvoni patent on grounds it contained no significant original work — the key part of the research was done at a British university — and in India the whole 12-week course of treatment costs about $1000. This is not some dubious knock-off from a ‘pirate’ vendor; the Indian companies involved are large and reputable, and are licensed by the original developer. A 12-week vacation in India, including air fare, good hotels, and Harvoni treatment would quite likely cost less than Harvoni in the US or Europe, and other countries such as Egypt and Bangladesh also have Harvoni at low cost. There are also several groups who offer Indian Harvoni worldwide by mail order; see FixHepC for links.

For other things, the issue may be availability rather than cost. It can take years for a new or experimental treatment to prove its worth and obtain regulatory approval, and it may be approved in some countries long before others. The dengue fever vaccine, for example, was approved in Mexico, Brazil and the Philippines in late 2015 but as of mid-2017 there are many countries where it is not yet approved. Cuba has a lung cancer treatment called CimaVax that (as of mid-2017) is available only there and in a few other Latin American countries; other countries are running tests but are unlikely to approve it soon.

Important considerations
Be sure you are allowing enough time in your travel to receive follow up care. You may need to stay days or weeks beyond the date of the medical procedure itself. Be realistic about the finances of medical tourism. Sure the medical treatment itself may be cheap. But when you add on airfare, hotels, taxis, restaurants – all in an unfamiliar city – the actual cost may be close to what you would pay at home.

Next, involve your home doctor in your plans! Having major surgery in a faraway country is not a decision you should take lightly. Research – what sort of questions should you ask your doctor about this procedure? How is the procedure typically performed, and will it be done this way where you travel? Who credentials doctors and hospitals in your destination country, and what credentials do your intended providers have? You should also determine what level of follow up care your procedure may require – in the days, weeks, and even years after the procedure. Who will provide this follow up care?

If a specialised procedure entails possible medical complications, your budget should permit a follow-up trip to your distant specialist. For instance, if gender reassignment surgery in Canada is done only in Montréal, a British Columbia patient might incur an unexpected 4600km road trip to revisit the original surgeon.

Not all medical tourism is enjoyed by patients travelling away from their home country, or travelling to a third world region. For instance, migraine surgery is performed only in the US, and attracts patients from the Middle East and Africa, since their surgeons aren’t able to perform this. If you are considering travel from within your country or outside of it, be sure to explore all of your options. Seek assistance from many sources in locating the right doctor and the right country.

Don’t be surprised if insurance which would have fully paid for a medical procedure at home refuses to cover (or only partially covers) the same treatment abroad. Even within the same country, some provincial health insurance plans only reimburse what they would have paid in-province, leaving the traveller out-of-pocket. Insurers are also likely to refuse to cover transportation. Border crossing can also be complicated by the need to carry prescribed medicines; a prescription validly issued by a practitioner in one country may be meaningless in another.

Patients seeking treatment for mental health conditions, communicable disease or street drug addiction may encounter issues with immigration authorities if travelling internationally. “I’m Toronto mayor Rob Ford and I’d like to see a Chicago doctor about my crack cocaine problem” is the wrong thing to tell the US border patrol, unless the intention is to immediately turn back to seek medical treatment in-province. Gravenhurst is charming this time of year?

Consider the languages you speak and what is spoken in your country. In some countries, such as Singapore, Malaysia, India, the Philippines and South Africa, most educated people speak English. This can be an important consideration. Having a common language is not necessarily enough, though, if it is not the native tongue for both of you (“fluently” can mean different things), or you or the personnel speak it with a strong accent or with a strange jargon. There may be subtle nuances you’d better be able to convey and understand.

Lastly confirm, and double check, your plans. How can you contact family members while abroad? Do you need a special visa or proof of ability to afford treatment in order to enter your destination country?

Stay safe
In the past, some discredited or bogus doctors set up shop outside US borders to promote dubious or dangerous treatments or outright scams (alleged cures for cancer, lengthening body parts, etc.). Medical tourism today is far removed from these scammers but one must still be vigilant. At the very least, see a trusted doctor in your home country and discuss your plans for overseas treatment.

Reputation counts in medical treatment overseas. Look for top quality hospitals and clinics with well known doctors.

If anything goes wrong, don’t be surprised if your local doctor is reticent to do anything to attempt to “fix” the work done by your foreign practitioner. This is a medical liability issue; local doctors fear lawsuits if an attempt to repair another surgeon’s bungled procedure makes things worse.

Realize that, should a worst-case scenario occur, your legal avenues for making a malpractice claim or filing a lawsuit will be greatly reduced and often nonexistent. Freedom from frivolous lawsuits and huge insurance premiums are one reason why some doctors choose to practice overseas and can offer low cost treatments. On the other hand, this type of legal environment makes seeking doctors of good reputation all the more important.

Travellers might be impaired during recovery; see travellers with disabilities.

The most popular medical tourism destinations worldwide currently are:

Costa Rica : Joint Commission International accredited private hospitals, state-of-the-art-equipment, proximity to the United States and Canada, English-speaking medical personnel, highly trained doctors, dentists, oral surgeons, and cosmetic surgeons with costs generally up to 70% of what would be paid in the United States.
Greece : Greece is becoming increasingly popular as destination for high quality cosmetic surgery especially for patients from United Kingdom. Because Greece is a member of the European Union, its health industry is kept to a good standard and under thorough checks and safety regulations. In private sector the Metropolitan Hospital in Athens is regarded as being the best in Greece, and the plastic surgeons associated with that hospital are among the best. Greece is also traditionally regarded as a popular tourist destination and therefore its tourism and service sectors are well developed. The widespread knowledge of English language among the general population is also an advantage.
India : Specially for heart surgery, hip resurfacing, dental, cosmetic surgery and high end surgeries. English as a primary language is also an advantage.
Singapore : Has highly accredited hospitals and a very high quality infrastructure
Thailand : Low labour costs resulting in lower treatment costs. Some Thai hospitals have a lot of experience with sex-change surgery.
Hong Kong : High quality infrastructure and good quality doctors
Mexico: Dental care is the best deal here. Because Mexico borders the United States, Americans in border states visit for dental care and minor checks out of convenience. The quality in Private Clinics and Hospitals is just about the same.
Turkey: Istanbul is inexpensive by US and European standards for in vitro fertilization, optometry, cardiology and cosmetic procedures such as hair transplants.
United States: By far the world’s leading nation in medical research, with the most cutting edge treatment methods and infrastructure available to those who can afford it. The downside is that consultation and treatment costs are the highest in the world.
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 IFV 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.

South Africa
South Africa is the first country in Africa to emerge as a medical tourism destination.

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 7 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 comparison to US health costs, patients can save 30 to 60 percent on health costs in Canada.

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.

Costa Rica
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 U.S., and together with Dominica it dominated the list amongst the Central American countries.

The Deloitte Center for Health Solutions reported a cost savings average of between 30-70% of US prices.

Cayman Islands
Health City Cayman Islands is a JCI accredited tertiary care hospital in the Cayman Islands, a British Overseas Territory.

Cuba has historically – both before and during Communist rule – performed better than other countries in the region on infant mortality and life expectancy. Experts say that official statistics by the Castro regime should be treated skeptically. In 2016, the World Health Organisation reported the average life expectancy at birth for Cubans as being 77 years for males and 81 for females, which is higher than that of the United States.

United States
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 U.S. 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 U.S. dollar between 2007 and 2013 used to offer additional incentives for foreign travel to the U.S., 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 U.S. 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 U.S., 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.

Hong Kong
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.

India’s medical tourism sector was expected to experience an annual growth rate of 30% from 2012, making it a $2 billion industry by 2015. 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. 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.

New Zealand
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% 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 treatmenst have made Thailand and its 39 JCI-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 pumped as much as US$4.7 billion into the Thailand’s economy, according to government statistics.

The rise of Chinese tourism in Thailand, growing 31 percent per year since 2012, has lifted medical tourism in Thailand and throughout ASEAN. Of the 8.7 Chinese tourists who visited Thailand in 2016, some 27,000 came for medical treatment. Numbers are expected to grow by 8 to 10 percent by 2023. Also popular among Chinese patients are Malaysia and Singapore, largely owing to the large numbers of Chinese speakers.

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.

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.

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.

The cost of medical treatments in Turkey is quite affordable compared to Western European countries. Therefore, thousands of people each year travel Turkey for their medical treatments. Turkey is especially becoming a hub for hair transplant surgery. In February 2018 it was reported that the country was the worst place for botched plastic surgery operations on British people with Dr Mehmet Kaya of Marmaris singled out for criticism. The president of the British Association of Aesthetic Plastic Surgeons said operations were performed on people who were not appropriate for surgery, and that unscrupulous practitioners have endangered their health for profit.

United Kingdom
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. Very few UK private hospitals have gone through independent international accreditation (they have the mandatory registration with the UK’s watchdog, the Care Quality Commission), so they have not as yet measured themselves against the best clinics and hospitals elsewhere in the world.

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 7% 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”.

Source from Wikipedia