Funded Projects

An International Comparative Case Study of the Health Equity Impacts of Medical Tourism in Developing Countries

(Canadian Institutes of Health Research, 2012-15, $527,353)

Project Lead: Valorie Crooks

Project Team: Jeremy Snyder, Ronald Labonté, Rupa Chanda, Walter Flores, Gustavo Nigenda, V.M. Suresh, Prasanna Saligram, Vivien Runnels, Corinne Packer

Project Trainee: Rory Johnston

Project Research Coordinator: Misty Lockhart

Our goal is to examine the health equity impacts of the travel of medical tourists from more-developed nations, such as Canada, to developing nations. Our specific focus is on health equity impacts as demonstrated by positive and negative health system and policy change across the domains of: health human resources, domestic government involvement, investment, private health care, and public health care. Our objectives are to:

1. characterize the scope and scale of the medical tourism (MT) industries operating in 6 case study (namely: Barbados; Guatemala City, Guatemala; Monterrey & Mexico City, Mexico; Bangalore & Chennai, India) sites;
2. examine the on-the-ground impacts of MT for local health care practice and local populations;
3. explore how the impacts of MT may threaten or enhance health equity;
4. assess contextual differences between the sites that affect equity impacts; and
5. identify beneficial system-, practice-, and individual-level responses by various Canadian stakeholders to the impacts of MT on developing country populations, health care practice, and health equity.

Risks, Roles, and Responsibilities: Understanding the Experiences of Canadian Medical Tourists' Caregiver-Companions

(Canadian Institutes of Health Research, 2011-14, $211,935)

Project Lead: Valorie Crooks

Project Team: Rory Johnston, Paul Kingsbury, Jeremy Snyder, Leigh Turner

Project Trainee: Victoria Casey

While a number of stakeholder groups are commonly discussed in relation to medical tourism, no consideration has been given to a very important one: the friends and family members who accompany medical tourists abroad (namely their caregiver-companions). Our research shows that these individuals take on important responsibilities and provide very important care for patients while at home and abroad, to the point where the medical tourism industry may very well depend on their unpaid work. For a number of reasons, it is truly concerning that the voices of these caregiver-companions have remained silent, including that they themselves are likely being exposed to health and safety risks through involvement in medical tourism. In this qualitative study we will give voice to this group through examining the depth and breadth of their experiences. We aim to uncover how prepared they are to take on care responsibilities, what motivates them to go abroad with medical tourists, and what their roles are while abroad, among other things. We also want to understand how providing them with help, such as through producing informational tools, might ultimately assist with maintaining their own health and wellbeing in addition to that of medical tourists. Ultimately, we will produce new knowledge that promises to spark new debates regarding the ethics of medical tourism while also providing the information needed to generate Canadian policy and practice responses to medical tourism.

Developing a Website to Inform Canadian Patients about Ethical Issues in Medical Tourism

(Canadian Institutes of Health Research, 2013-14, $22,478)

Project Lead: Jeremy Snyder

Project Team: Valorie Crooks, Krystyna Adams, Kitty Corbett, Rory Johnston

Many ethical concerns have been raised in connection with medical tourism. Medical tourists may have difficulty determining the quality of care abroad and are challenged in accessing follow-up care for their procedures once home. Medical tourists’ home countries may be exposed to increased costs and infectious disease as a result of their residents traveling abroad for care. Many of the countries serving as destinations for medical tourists may have trouble taking care of the health care needs of their own citizens if public resources are shifted into private care for international patients. In order to better inform potential medical tourists about these ethical concerns, we designed the website medicaltourismandme.com. This website uses stories from former medical tourists to communicate both the potential positive and negative impacts of medical tourism on medical tourists and third parties.

Understanding Ethical Responsibility for the Effects of Medical Tourism in the Caribbean

(Canadian Institutes of Health Research, 2013-14, $24,707)

Project Lead: Jeremy Snyder

Project Team: Valorie Crooks, Krystyna Adams, Rory Johnston

The Caribbean is an increasingly popular destination for medical tourists and many Caribbean nations are investing in medial tourism developments. While these facilities have the potential to bring new income into these countries and encourage health worker to remain in their home countries to practice, medical tourism raises ethical concerns as well. In order to better understand the forces promoting medical tourism development in the Caribbean and to plan for continued research in this region, we traveled to St. Lucia and the Bahamas to meet with local medical tourism stakeholders. These experiences have led to three published commentaries on medical tourism development in the Caribbean and are being leveraged into further support for research on medical tourism in the Caribbean.

Informing Canadians about Ethical Concerns with Medical Tourism: Towards the Development of an Ethical Buying Guideline

(Canadian Institutes of Health Research, 2011-14, $97,128)

Project Lead: Jeremy Snyder

Project Team: Valorie Crooks, Rory Johnston

Project Trainee: Krystyna Adams

This project was motivated by an interest in better informing potential medical tourists of ethical and practical concerns associated with medical tourism. We built on a tradition of developing ethical guidelines seen in other areas with identified ethical concerns, including coffee and other food items, apparel, and travel. An information sheet aimed at informing the decision-making of potential Canadian medical tourists was developed through: 1) reviewing consumer guidelines in ecotourism, the responsible use of public health resources, and medical volunteering abroad; 2) Canadian medical tourism stakeholders; and 3) former medical tourists. The final version of the information sheet can be seen here:

http://www.sfu.ca/medicaltourism/resources.html

Is It Really About Sun, Sand, and Stitches? Planning for Research on Jamaica’s Developing Medical Tourism Industry

(Canadian Institutes of Health Research, 2012-06, $24,066)

Project Lead: Rory Johnston

Project Team: Valorie Crooks, Meghann Ormond, Jeremy Snyder

Project Research Assistant: Cristina Temenos

This planning grant was used by our team to travel to Jamaica for two weeks in October, 2012 to connect with key Jamaican stakeholders. Our team was successful in:

1. developing on the ground collaborative networks that will sustain ongoing research into medical tourism in Jamaica; and
2. gaining insight into the current state of planning and development around medical tourism in Jamaica

This research trip laid the groundwork for future investigation that will document the development of the medical tourism industry in Jamaica and the wider Caribbean. This research will ultimately offer a better understanding of the implications that a larger medical tourism sector poses for the health systems and economies of the Caribbean region.

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Understanding Canadians' Use of Medical Tourism for Hip and Knee Surgery

(Canadian Institutes of Health Research, 2011-12, $17,221)

Project Lead: Valorie Crooks

Project Team: Keri Lynn Cameron, Vera Chouinard, Rory Johnston, Jeremy Snyder

The primary goal of this grant was to enable our team to take the necessary planning steps that lead to the development of a program of research focused on medical tourism for hip and knee surgery by Canadians. The funding enabled us to:

1. review relevant aspects of the existing literature regarding patients’ experiences of domestic hip and knee surgery;
2. conduct a secondary analysis of our existing dataset of qualitative interviews with Canadian medical tourists specific to those who went abroad for hip and knee surgery (n=18 procedures) to identify common and distinctive elements of their experiences when compared with the existing literature on domestic surgeries; and
3. identify research and practice priorities based upon our review of the primary data and existing literature.

These activities were undertaken in 2011-2012.

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Research Planning to Investigate the Impact of Medical Tourism on Family Medicine Practice

(Canadian Institutes of Health Research, 2010-11, $24,909)

Project Lead: Valorie Crooks

Project Team: Jeremy Snyder, Shafik Dharamsi, Rory Johnston

Project Research Assistant: Alex Wright

This research development project involved holding a series of consultative meetings with family doctors in British Columbia to explore their:

1. knowledge of medical tourism;
2. anticipated or experienced impacts of having a patient pay out-of-pocket to go abroad for health care; and
3. perceptions of the responsibilities they hold towards patients who choose to intentionally go abroad for care (e.g., assisting with decision-making and follow-up care).

These consultations were undertaken in 2012. They offered important insights regarding the impact of medical tourism on family medicine practice in British Columbia.

Click here to access a one page summary of Canadian Family Doctors' Roles and Responsibilities Towards Outbound Medical Tourists.

Medical Tourism in British Columbia

(Michael Smith Foundation for Health Research, 2011-12, $50,000)

Project Leads: Valorie Crooks & Jeremy Snyder

Project Research Assistants: Cristina Temenos & Mary Choi

The activities associated with this project culminated in the production of a policy ‘white paper’ that addresses the important question: What ethical and practical responsibilities do British Columbia’s health care system and health care providers hold for providing after-care for British Columbians upon return from private medical care abroad? Our main activities were: a jurisdictional scan of current approaches to follow-up care for medical tourists in Canada and other selected countries; a review of public perceptions of medical tourism and follow-up care responsibilities in Canada as found within media and online sources; and the striking of a panel of experts to address the ethical implications of British Columbians’ pursuit of medical tourism and the province’s after-care responsibilities. This project was undertaken by special request of the Michael Smith Foundation for Health Research.

Medical Tourism in a Lower Middle Income Setting: Founding a Canada-Mongolia Research Collaboration

(Canadian Institutes for Health Research, 2011-12, $24,766)

Project Lead: Jeremy Snyder

Project Team: Valorie Crooks, Rory Johnston, Craig Janes, Tsogtbaatar Byambaa

Mongolia is increasingly a source of medical tourists for nearby countries actively promoting medical care to foreign patients. The grant enabled our team to develop collaborative research networks in Mongolia, which will ground future comparative research examining the impacts of MT on a diverse array of health systems. We traveled to Mongolia in April, 2012 to undertake our proposed research development activities.

Click here to access a one page summary of Outbound Medical Tourism from Mongolia.

Disseminating Research on the Ethical Dimensions of Canadians' Decision-Making in Medical Tourism

(Canadian Institutes of Health Research, 2011-12, $20,984)

Project Lead: Valorie Crooks

Project Team: Rory Johnston, Paul Kinsbury, Jeremy Snyder

Project Research Assistant: Jamison Miller

This funding enabled our team to disseminate the findings of our Catalyst: Ethics grant beyond an academic audience. Our dissemination plan involved: creating a summary report that conveys the most significant findings of our research using approachable and appropriate language for multiple audiences; developing a mobilization strategy for disseminating the report to multiple audiences on a global level (which will include translating the final report into multiple languages); creating a single-page ‘fact sheet’ about our research findings aimed at a Canadian health professional audience; and developing a mobilization strategy for disseminating the ‘fact sheet’ so that it will reach multiple health professional audiences across the country. We expect these activities to have a significant impact as they will result in the translation of academic research findings into meaningful messages for medical tourism stakeholders in Canada and beyond.

Click here to access the final report in English, French, or Spanish.

Minimizing Canadian Patients' Health & Safety Risks in Medical Tourism

(Canadian Institutes of Health Research, 2011, $11,669)

Project Lead: Valorie Crooks

Project Team: Jeremy Snyder, Paul Kingsbury, Rory Johnston, Leigh Turner, Janet Bristeir

Project Research Assistant: Victoria Casey

The primary goal of this research development activity was to hold a consultative meeting with patient health and safety coordinator decision-makers from across British Columbia to explore their:

1. knowledge of medical tourism;
2. awareness of the risks inherent in this practice, including any known negative health outcomes experienced by British Columbians who have gone abroad as medical tourists; and
3. views regarding desired health systems responses that can increase awareness of risks and minimize negative health outcomes.

This meeting will assist with developing applied, practice-focused health system interventions to address patient health and safety issues in medical tourism in British Columbia.

Click here to access the final report 'Understanding the health and safety...'

Click here to access a one page summary of Health and Safety Risks in Outbound Medical Tourism by Canadian Patients.

Medical Tourism in a Developing Market: Toward a Canada-Barbados Research Agenda

(Canadian Institutes of Health Research, 2011, $23,600)

Project Lead: Jeremy Snyder

Project Team: Valorie Crooks, Paul Kingsbury, Rory Johnston, Leigh Turner

Project Research Assistant: Alex Wright

The goals of this research development project were to:

1. hold a series of face-to-face meetings with researchers, decision-makers, and stakeholders to learn more about the Barbadian context of medical tourism and assess the potential for new research collaborations;
2. tour medical tourism facilities in Barbados with potential research collaborators to aid in the planning of new, collaborative research regarding medical tourism;
3. determine the existing and planned regulatory procedures aimed at addressing the positive and negative effects of medical tourism in Barbados
4. identify specific meaningful future research questions and objectives; and
5. enhance trainee capacity through the planning of this research collaboration.

Our research development trip to Barbados took place in April, 2011.

Click here to access a one page summary of Barbados' Medical Tourism Sector.

Dissemination of New Scholarship on the Ethics of Medical Tourism

(Canadian Institutes of Health Research, 2010-11, $12,658)

Project Lead: Jeremy Snyder

Project Team: Valorie Crooks, Rory Johnston

Project Research Assistants: Krystyna Adams, Alex Wright

These funds were used to disseminate new research on medical tourism that was presented at the International Conference on Ethical Issues in Medical Tourism. This included editing and disseminating a special issue of Developing World Bioethics, and developing and distributing a short synthesis document that summarizes key issues put forth in this special collection. The synthesis will be distributed to various medical tourism stakeholders and will be made available in six languages.

Medical Tourism: Developing a Canada-India Collaboration

(Canadian Institutes of Health Research, 2010, $17,485)

Project Lead: Valorie Crooks

Project Team: Jeremy Snyder, Rory Johnston, Paul Kingsbury

The goals of this research development project were to:

1. hold a series of face-to-face meetings with researchers, clinicians, decision-makers, and stakeholders in a city in southern India;
2. tour medical tourism hospitals in this city;
3. determine the meaningful focus of a collaborative research agenda centred around the patient’s perspective of medical tourism that considers the contexts of both the destination country and departure country;
4. identify specific research questions and objectives to pursue jointly with Indian collaborators; and
5. involve student trainees in the development of this research collaboration.

These research development activities were undertaken in February, 2010.

Ethical Issues in Medical Tourism

(Canadian Institutes of Health Research, 2010, $14,975)

Project Lead: Jeremy Snyder

Project Team: Valorie Crooks, Rory Johnston, Paul Kingsbury

Project Research Assistant: Krystyna Adams

The goal of this project was to host an international conference focused on examining ethical issues in medical tourism. The objectives of the conference were to:

1. raise scholarly and public awareness and promote new research on ethical issues in medical tourism; and
2. encourage the development of new partnerships, both nationally and internationally, among researchers interested in examining the ethics of medical tourism.

This conference was hosted in June, 2010.

An Ethics Approach to Canadians' Decision-Making in Medical Tourism

(Canadian Institutes of Health Research, 2009-11, $92,353)

Project Lead: Valorie Crooks

Project Team: Jeremy Snyder, Paul Kingsbury

Project Trainee: Rory Johnston

Our guiding inquiry question for this exploratory study was: how do Canadians decide on medical tourism for elective surgical procedures and to what extent do their decisions reflect particular ethical considerations?

Our research aims were to:

1. create a decision-making framework regarding medical tourism for elective surgery that incorporates potential ethical considerations encountered and considers how they are justified; and
2. undertake interviews with Canadian medical tourism facilitators and Canadians who have engaged in medical tourism in order to test and refine the framework and to generally enhance our knowledge about the Canadian context of medical tourism.

Click here to access the final report in English, French, or Spanish.

Click here to access a one page summaries of:

• Canadian Patients' Decision-Making in Medical Tourism
• Ethical Concerns about Canadian Patients' Involvement in Medical Tourism
• Canadian Medical Tourism Facilitators' Business Practices