Medical Travel: What It Means, Why It Matters

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  • This article was downloaded by: [University of California Santa Cruz]On: 29 November 2014, At: 20:39Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

    Medical Anthropology: Cross-Cultural Studies in Health andIllnessPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/gmea20

    Medical Travel: What It Means,Why It MattersElisa J. Sobo aa San Diego State University ,Published online: 10 Nov 2009.

    To cite this article: Elisa J. Sobo (2009) Medical Travel: What It Means, Why ItMatters, Medical Anthropology: Cross-Cultural Studies in Health and Illness, 28:4,326-335, DOI: 10.1080/01459740903303894

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    http://www.tandfonline.com/page/terms-and-conditions

  • Medical Travel: What It Means,Why It Matters

    Elisa J. Sobo

    Markets for medical travel have grown immensely in the past few years. Theyhave attracted the attention not only of healthcare consumers, providers, andpayors but also of scholars from various disciplines. This editorial demon-strates some of the ways that anthropology can contribute to current effortsto better understand medical travel. Such contributions have more thanimportant academic implications. Properly packaged, anthropological workon medical travel can be of great value to policymakers and program plannersas they grapple with the changes that geographically and subjectively newpatterns of healthcare procurement entail.

    Key Words: globalization; health care consumerism; health services; health tourism; medical

    tourism; medical travel

    MEDICAL TRAVEL: AN EMERGING CONCERN

    Throughout time, people have traveled to natural and sacred sites in pursuitof health or healing, and we know a good deal about this kind of pilgrimage.In comparison, scholarly knowledge about contemporary travel for theprimary purpose of obtaining indicated or elective dental or biomedicalservicesmedical travelis sparse. Why? To begin, until recently,medical travel accounted for a minimal share of global trade flows. As such,

    ELISA J. SOBO is Professor of Anthropology at San Diego State University and a member of

    the editorial board of Medical Anthropology. Recent publications include Culture and Meaning

    in Health Services Research: A Practical Field Guide (2009). Correspondence may be directed to

    her at Department of Anthropology, Mail Code 6040, San Diego State University, 5500

    Campanile Drive, San Diego, CA 92182-6040, USA. E-mail: esobo@mail.sdsu.edu

    MEDICAL ANTHROPOLOGY, 28(4): 326335

    Copyright # 2009 Taylor & Francis Group, LLC

    ISSN: 0145-9740 print=1545-5882 online

    DOI: 10.1080/01459740903303894

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  • it went unnoted and so unquestioned by most. Further, and again untilrecently, medical travel mostly involved trips from economically poorernations to wealthier ones. The United States in particular has served as akey destination for medical travelers in search of advanced biomedical care(indeed, what is now thought of as cultural competence was initiallyconceived in many U.S. organizations in response to the needs ofinternational patients).1 Today, however, the tide has turned.

    On this turning, medical travel has attracted the attentions of health careregulators and policymakers charged with keeping patients safe, as well asbusiness concerns posed for great profits and those slated for losses aspatient populations migrate. The United States, for instance, could forfeitover $67 million in 2010 due to lost domestic spending and more than$100 million in 2011 (Keckley and Underwood 2008).

    Scholars, too, have taken note. To offset the possibility that medicaltravels more sensational dimensions dominate anthropologys attention,as they seem to do the publics right now, this editorial takes inventory ofsome areas set to profit from increased anthropological investigation. Butfirst, it briefly situates the change in medical travel patterns.

    THE GLOBAL BUSINESS OF BIOMEDICINE

    In part due to the liberalization of trade in services, the growing cooperationbetween private and public sectors, the easy global spread of informationabout products and services, and, most importantly, the successful splicingof the tourism and health sectors (Bookman and Bookman 2007:95),patients outbound from various North American and European nations havejoined the medical travel consumer population. In the United States, thanksto (among other things) high numbers of uninsured and underinsured indivi-duals; an increasing demand for so-called lifestyle care, such as knee replace-ments and aesthetic or cosmetic surgery; technological developmentsallowing for quicker, less invasive surgical procedures; increased awarenessof options due to word-of-mouth regarding the quality and value of out-sourced care (including Internet discussions); and increased general mediacoverage of medical tourism, the number of medical travelers is growing atastounding rates. According to Deloitte Center for Health Solutions, in2007, an estimated 750,000 Americans traveled abroad for medical care; thisnumber is anticipated to increase to six million by 2010 (Keckley andUnderwood 2008:3).2

    While some outbound travelers seek treatments unavailable in the UnitedStates, the majority of medical travel has been explained by financial logic:a hip replacement costs about $37,000 in the United States and about

    EDITORIAL 327

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  • $13,000 in India. An $80,000 U.S. heart bypass is $16,000 in Thailand (Hig-gins 2007). Using weighted average procedure price, Deloitte put the aver-age savings from the U.S. perspective at about 85 percent (Keckley andUnderwood 2008). Moreover, care procured at certified facilities is generallyof equal or better quality than the U.S. standard (Milstein and Smith 2006).

    Consequentlycritical debates regarding quality and evidencenotwithstandingsome U.S. insurance companies (such as BlueCrossBlueShield of South Carolina) and government payors (such as the stateof West Virginia) have given serious consideration to sending patientsoverseas for certain types of care or offering them cash rebates for doingso (Bramstedt and Xu 2007; Carrol 2007). In California, several insurancecompanies now offer bi-national (U.S.Mexico) coverage. Hannaford, aNewEngland-based grocery chain, offers its employees the option of flying toSingapore for a number of medical procedures (Economist 2008a).

    While saving money is serious business for insurers and consumers,making money from medical travel is also an incentive to participate inthe global health care market. Asian nations are among those that haveactively pursued transnational patient-consumers as well as programmati-cally encouraging necessary infrastructural development (Whittaker2008).3 Hotelmarketing.com estimates that the industry in Malaysia,Thailand, Singapore and India, currently worth around half a billion dollarsa year in Asia, is projected to generate more than U.S.$4.4 billion by 2012.Indias medical tourism business is growing at 30 percent per year and isforecast to generate at least U.S.$2.2 billion a year by 2012 (Anonymous2006). Similarly rosy prognostications abound in trade magazines andindustry newsletters.

    ADDING THE ANTHROPOLOGICAL PERSPECTIVE

    With more and more people around the world engaging in medical travel,the value of medical travel expertise in all fields is on the rise. The medicalliterature has addressed the phenomenon, but mostly through editorials. Interms of research, we have seen a flurry of publications on medical travelin the fields of economics and in