HISTORY AND TRANSFORMATION OF MEDICAL TRAVELTraveling in search of medical care is not a new phenomenon. Since antiquity, people with means have traveled to seek expertise, technologies, and environments for healing and recuperation. For centuries, Europeans have flocked to spas famous for their restorative waters, and peoples of the Middle East have journeyed to the mineral-rich waters of the Dead Sea. 2–4 Some royal or otherwise influential patients requested that renowned doctors come to them. James Marion Sims (the father of gynecology) from South Carolina was sought by Empress Eugenie of France, the Duchess of Hamilton, and the Duchess of Austria to be their surgeon. 5 In general, however, past tourists were traditionally wealthy patients from areas of less abundant or less advanced medical care who pursued higher quality care in areas with better technology or more temperate climates. 3

Today’s medical tourists diverge from the historical pattern of health tourism in 3 main ways: there is a much larger number of them, they tend to travel from wealthy countries to developing countries (a reversal of flow), and they are motivated by different factors, namely, by lower costs. 2–4. 6 Patients are drawn abroad by newer (often unproven) procedures performed in some developing countries, the opportunity to circumvent long wait times, and the added bonus of a vacation. 2–4. 6 Most medical tourists travel on their own accord and pay out of pocket for health services, with one exception being “outsourced” patients sent by their insurers to receive treatment abroad. 6 Blue Shield of California introduced its Access Baja HMO in 2000, an outsourcing plan that allowed members with employer-sponsored benefit to receive healthcare services from Blue Shield–approved providers in Tijuana, Mexico. This was the first cross-border health plan in the United States. 7 Most medical tourists, however, tend to seek elective and cosmetic procedures, which is a primary reason why this industry could potentially have a great effect on plastic surgery within the United States. 1. 6

What initiated and enabled this transformation in international health travel? The answer is a combination of social, industrial, and economic developments in both lower income and developed countries. For one, the world has gotten smaller owing to more efficient air travel that enables more people to reach overseas locales. The internet has also facilitated medical tourism by providing consumers with access to information about foreign hospitals and accreditations, helping advertisements reach potential patients, and making it easier to find providers and book travel. 6 The modernization of technology, medicine, and medical facilities in low-income countries that have become destinations has similarly fueled this transformation. Many have expanded their biomedical sectors and funding to attract more medical tourists. The vice president of the United Arab Emirates constructed Dubai Health Care City to entice tourists from the Middle East and elsewhere. 3. 6 Opened in 2002, Dubai Health Care City now attracts foreign and domestic patients and offers a comprehensive list of health services, including plastic surgery. Cosmetic procedures have become an integral part of medical tourism because they are not covered by insurance and the costs overseas are much lower. 3


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