Hostname: page-component-7d684dbfc8-zgpz2 Total loading time: 0 Render date: 2023-09-26T06:23:29.971Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

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

Published online by Cambridge University Press:  01 September 2007

Leigh Turner
Biomedical Ethics Unit, Department of Social Studies of Medicine, Faculty of Medicine, McGill University,3647 Peel Street, Montreal, Quebec H3A 1X1, Canada E-mail:
Get access


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.

Copyright © London School of Economics and Political Science 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Appleby, J. & Schmit, J. (2006). Sending patients packing. USA Today, 27 July.Google Scholar
Alsever, J. (2006). Basking on the beach, or maybe on the operating table. New York Times, 15 October.Google ScholarPubMed
Blumenthal, D. (2006). Employer-sponsored health insurance in the United States—Origins and implications. New England Journal of Medicine, 355, 8288.CrossRefGoogle ScholarPubMed
Bumrungrad International Hospital. (2006). Fact sheet. URL (accessed June 2007): Scholar
Canales, M., Kasiske, B., & Rosenberg, M. (2006). Transplant tourism: Outcomes of United States residents who undergo kidney transplantation overseas. Transplantation, 82, 16581661.CrossRefGoogle ScholarPubMed
Carrera, P., & Bridges, J. (2006). Globalization and healthcare: Understanding health and medical tourism. Expert Review Pharmacoeconomics Outcomes Research, 6, 447454.CrossRefGoogle ScholarPubMed
CDC(1998). Rapidly growing mycobacterial infection following liposuction and liposculpture—Caracas, Venezuela, 1996–1998. Morbidity and Mortality Weekly Report, 47, 10651067.Google Scholar
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
Chanda, R. (2002). Trade in health services. Bulletin of the World Health Organization, 80, 158163.Google ScholarPubMed
Chantarapitak, P. (2006). The transformation into one of the leading destinations for healthcare. Singapore Medical Association News, 38, 2527.Google Scholar
Connell, J. (2006) Medical tourism: Sea, sun, sand and … surgery. Tourism Management, 27, 10931100.CrossRefGoogle Scholar
Cyranoski, D. (2001). Building a biopolis. Nature, 412, 370371.CrossRefGoogle ScholarPubMed
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, 112.Google Scholar
Foreman, J. (2006). Bon voyage, and get well! Boston Globe, 2 October.Google Scholar
Foster, M., & Mason, M. (2006). Businesses may move health care overseas. Seattle-Post Intelligencer, 2 November.Google Scholar
Garcia-Altes, A. (2005). The development of health tourism services. Annals of Tourism Research, 32, 262266.CrossRefGoogle Scholar
Garloch, K. (2006). High costs send patients overseas for care. Charlotte Observer, 10 December.Google Scholar
Gawande, A. (2003). Dispatch from India. New England Journal of Medicine, 349, 23832386.CrossRefGoogle ScholarPubMed
Gin, B. (2005). Singapore—A global biomedical sciences hub. Drug Discovery Today, 10, 11341137.CrossRefGoogle ScholarPubMed
Goodrich, J. (1993). Socialist Cuba: A study of health tourism. Journal of Travel Research, summer, 3641.CrossRefGoogle Scholar
Goodrich, J., & Goodrich, G. (1987). Health-care tourism—An exploratory study. Tourism Management, September, 217222.CrossRefGoogle Scholar
Hacker, J. (2006). The great risk shift. Oxford: Oxford University Press.Google Scholar
Himmelstein, D., Warren, E., Thorne, D., & Woolhandler, S. (2005). Illness and injury as contributors to bankruptcy. Health Affairs, W5, 6373.Google Scholar
Hoffman, C., Rowland, D., & Hamel, E. (2005). Medical debt and access to health care. Washington: Kaiser Commission on Medicaid and the Uninsured.Google Scholar
Hutchins, J. (1998). Bringing international patients to American hospitals: The Johns Hopkins perspective. Managed Care Quarterly, 6, 2227.Google Scholar
Kerr, K. (2006). Tourism and treatment: To save money on surgery, more Americans are taking trips abroad. Newsday, 26 September.Google Scholar
Kher, U. (2006). Outsourcing your heart. Time, 21 May, 4447.Google Scholar
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, 1215.Google Scholar
Lancaster, J. (2004). Surgeries, side trips for ‘medical tourists’. Washington Post, 21 October, A01.Google Scholar
Lee, O., & Davis, T. (2004). International patients: A lucrative market for US hospitals. Health Marketing Quarterly, 22, 4156.CrossRefGoogle Scholar
Mattoo, A., & Rathindran, R. (2006). How health insurance inhibits trade in health care. Health Affairs, 25, 358368.CrossRefGoogle ScholarPubMed
Milstein, A., & Smith, M. (2006). America’s new refugees—Seeking affordable surgery offshore. New England Journal of Medicine, 355, 16371640.CrossRefGoogle ScholarPubMed
Milstein, A., & Smith, M. (2007). Will the surgical world become flat? Health Affairs, 26, 137141.CrossRefGoogle ScholarPubMed
Mooney, T. (2006). Cosmetic surgery overseas ends in death for R.I. woman. Rhode Island News, 19 May.Google Scholar
Moore, J. (1997). Medical Mecca. Foreign patients flock to Miami seeking care and service. Modern Healthcare, 27, 3037.Google ScholarPubMed
Mudur, G. (2003). India plans to expand private sector in healthcare review. British Medical Journal, 326, 520.CrossRefGoogle ScholarPubMed
Mudur, G. (2004a). Hospitals in India woo foreign patients. British Medical Journal, 328, 1338.CrossRefGoogle ScholarPubMed
Mudur, G. (2004b). Inadequate regulations undermine India’s health care. British Medical Journal, 328, 124.CrossRefGoogle ScholarPubMed
Mutchnick, I., Stern, D., & Moyer, C. (2005). Trading health services across borders: GATS, markets, and caveats. Health Affairs, W5, 4251.Google Scholar
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, 772778.CrossRefGoogle ScholarPubMed
Rahi, A. (2005). Westerners seek cheap medical care in Asia. USA Today, 24 September.Google Scholar
Rai, S. (2006). Union disrupts plan to send ailing workers to India for cheaper medical care. New York Times, 11 October.Google Scholar
Ramirez de Arellano, A. (2007). Patients without borders: The emergence of medical tourism. International Journal of Health Services, 37, 193198.CrossRefGoogle ScholarPubMed
Roth, M. (2006). Surgery abroad an option for those with minimal health coverage. Pittsburgh Post-Gazette, 20 September.Google Scholar
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, 283288.CrossRefGoogle Scholar
Searls, T. (2006). Overseas surgery debated in house. Charleston Gazette, 24 February.Google Scholar
Seifert, R. (2005). Homesick: How medical debt undermines housing security. Boston, MA: Access Project.Google Scholar
Seifert, R., & Rukavina, M. (2006). Bankruptcy is the tip of a medical-debt iceberg. Health Affairs, 25, w8992.CrossRefGoogle ScholarPubMed
Sengupta, A., & Nundy, S. (2005). The private health sector in India. British Medical Journal, 331, 11571158.CrossRefGoogle ScholarPubMed
Sherman, M., & Betances, Y. (2004). Infections prompt warning from CDC. Eagle-Tribune, 21 November.Google Scholar
Singh, A., & Datta, M. (2005). Indian hospitals lure foreigners with $6,700 heart surgery, Bloomberg News, 27 January.Google Scholar
Smaglik, P. (2003). Singapore: Filling biopolis. Nature, 425, 746747.CrossRefGoogle ScholarPubMed
Starr Sered, S., & Fernandopulle, R. (2005). Uninsured in America: Life and death in the land of opportunity. Berkeley: University of California Press.Google Scholar
Talbot, M. (2001). Nip, tuck, and frequent-flier miles. New York Times, 6 May.Google Scholar
Times News Network (2007). Apollo, AIMU mull medical tourism projects. Economic Times Online, 12 January.Google Scholar
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, 14.Google Scholar
Wachter, R. (2006). The ‘dis-location’ of US medicine—The implications of medical outsourcing. New England Journal of Medicine, 354, 661665.CrossRefGoogle Scholar
Wagner, M. (2006). Duke on track with $100M Singapore medical school. Triangle Business Journal, 11 August.Google Scholar
Weber, D. (1998). Global fees and creative marketing fill empty US beds with well-insured (or wealthy) foreigners. Healthcare Strategy, 9, 17.Google Scholar
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 ScholarPubMed
Yap Chin Huat, J. (2006a). Medical tourism/medical travel (Part One). SMA News, 38(5), 1721.Google Scholar
Yap Chin Huat, J. (2006b). Medical tourism/medical travel (Part Two). SMA News, 38(7), 1416.Google Scholar
Yap Chin Huat, J. (2006/2007). Medical tourism and Singapore. International Hospital Federation Reference Book 2006/2007, 7778.Google Scholar
Yi, D. (2006). US employers look offshore for healthcare. Los Angeles Times, 30 July.Google Scholar