Friday, 15 June 2012

Recent North American PhD dissertations and MA theses on international medical travel

Ackerman, S.L. (2009) 'Operating in Eden: Cosmetic surgery tourism and the politics of public and private medicine in Costa Rica', PhD dissertation, Anthropology, University of North Carolina-Chapel Hill. Online. Available HTTP:

This dissertation offers an ethnographic account of North Americans' journeys to Costa Rica to undergo cosmetic surgery. I situate Costa Rica's booming medical tourism industry in a confluence of historical, economic and cultural conditions, through which Costa Rica is made attractive to North Americans, a regime of private sector expansion and state contraction is promoted, and the national medical program on which most Costa Ricans rely is transformed. In focusing on the everyday practices of patients, clinicians and workers at recuperation facilities, I consider how the desires and practices of middle class North Americans are intertwined with uncertainties about health care access and national identity in Costa Rica. The ethnography is organized around three sets of spaces through which medical tourists and their caretakers pass. The first includes popular media and web forums, where specific imaginaries of Costa Rica are produced,medical travelers are mobilized, and cosmetic surgery is normalized as a technology of self-improvement. The second is the hotel, particularly recovery hotels that cater to visiting patients from North America. I consider how the affective labor of local caretakers combines with tropical landscapes, and a discourse of personal rebirth, to move guests through a period of post-surgical liminality and to depoliticize medical services. The third set of spaces, public and private hospitals and clinics where bodies are enhanced or repaired by plastic surgeons, reveals a shadow medical and labor migration from Nicaragua that underwrites Costa Rica's affordability for North Americans. Throughout, I discuss areas of overlap, and tension, between public and private medical facilities, particularly the state's persistent subsidies of the private sector and the lived, material effects of neoliberal discourses on patients' desires, professional identities and medical practices. The dissertation illustrates that a desire for a fully integrated self is not the only type of belonging negotiated by the various actors involved in Costa Rican cosmetic surgery tourism. A constellation of national, transnational, moral and aesthetic claims to membership intersects with the provision of private medicalservices for North Americans, and I examine how the successes or failures of these claims are embodied and lived.

Dalstrom, M.D. (2010) 'Medical migrants in the US-Mexico borderlands', Anthropology, University of Wisconsin-Milwaukee. Online. Available HTTP: 

This study examines medical migration, briefly defined as the movement of people across borders for healthcare. It was conducted along the United States-Mexico border, focusing on the impacts that medial migration has on the healthcare system, patient practices, and quality of medical care in the area. Previous studies have illustrated that Americans actively pursue healthcare opportunities in Mexico, but there is little literature detailing the institutional structures and cultural beliefs that enable or encourage people to do so. This study examined the hypotheses: 1) that Americans cross the border for healthcare predominately because of lack of insurance and high medical cost, 2) that similarities to the US medical model are the primary criterion that patients use when they choose a medical provider in Mexico, and 3) that nationalism is an important component which overshadows patient safety when medical professionals frame medical tourism. Research took place over an eleven-month period in McAllen, Texas and Nuevo Progreso, Mexico. Participant observation was conducted at health clinics, dentist offices, and pharmacies in both the US and Mexico. Further research was conducted at RV Parks in Hidalgo County, TX. Additional information was gathered through interviews with medical professionals, community leaders, medical migrants, border guards, insurance companies, and medical tourism brokers. This project is important because it expands upon the previous research on medical migration to examine how healthcare inequalities, poverty, and policies influence individual healthcare decisions and options. It also contributes to understanding the various components that link the US to Mexico and some of the policy concerns that each country faces. Until the practice of medical migration is understood, we will not know the different reasons why people believe they need to go abroad for healthcare, nor will the factors that influence choice (i.e. location, practitioner, treatment, advertisements etc.) be fully realized. Through understanding the dynamics of this practice, the risks associated with traveling for healthcare can be reduced and overall patient health increased.

Darwazeh, D. (2011) 'Medical tourism: Establishing a sustainable medical facility', PhD dissertation, University of Waterloo, Canada. Online. Available HTTP: 

Imposing the principles of sustainable development on medical tourism is vital to maintaining the three pillars of a strong nation, namely, the environment, the economy, and the local community. The three research objectives of this thesis are: 1) to determine the primary factors that motivate foreign patients to travel abroad for medical services; 2) to define the role that stakeholders play for developing the medical tourism sector; and 3) to develop an implementable framework for establishing a sustainable medical facility. These objectives help lay the foundations for a medical tourism facility that would respond well to the future demands of international patients, and would remain competitive with other medical facilities in the global market while also improving local quality-of-life and remaining within ecological constraints. Therefore, this research adopts a case study methodology to examine a framework developed through the literature review to determine how it fits in reality. In addition, this research provides a starting point to define further the primary roles of the medical tourism network for developing the medical tourism sector.

Eissler, L.A. (2010) 'The lived experience of seeking health care through medical tourism: An interpretive phenomenological study of Alaskan patients traveling internationally for medical and dental care', PhD dissertation, University of Hawai'i at Manoa. Online. Available HTTP: 

A growing number of people from many countries are traveling internationally to obtain medical care. The purpose of this study is twofold: (a) to explore the experiences of international travel for the purpose ofmedical or dental care from the perspective of patients from Alaska and (b) to develop insight and understanding of the essence of this phenomenon. The study is conceptually oriented within a model of health seeking behavior. Using a qualitative, interpretive phenomenological design, a purposive sample of fifteen Alaskan medical tourists who have experienced international travel for the objective of medical or dental care were individually interviewed. The data was analyzed using a hermeneutic process of inquiry to uncover the essential meaning of the experience. The hermeneutic analysis of the participants' narrative accounts allowed the themes of Motivation, Research, Obtaining Care, Follow-up, Advice, and Future Health Care to emerge. Sub-themes are used to further categorize data for increased understanding. The thematic analysis provides insight into the essential structure of the lived experience of the medical tourism phenomenon. Improved understanding of medical tourism provides further information about a modern approach to health seeking behavior. The conceptual definition and model for health seeking behavior are updated. Increased understanding of the experience of obtaining health care internationally and motivation for this nature of health seeking behavior from the patient perspective is needed in the global health care arena. Nursing professionals will benefit by being better able to advocate for patients' choices in health seeking behavior, counsel regarding medical tourism options, provide follow-up health care after medicaltourism, and actively participate in global health policy discussions.

Grant, L. (2009) 'Reproductive tourism: The case of India - A feminist critical discourse analysis of Indian gestational surrogacy', MA thesis, Sociology, Lakehead University, Canada. Online. Available HTTP:
Within an increasingly globalized medical community, people have begun to travel outside of their own geographic locations in order to obtain various medical procedures. Reproductive tourism is one of the latest developments of health tourism and can be understood as individuals obtaining some type of reproductive assistance from outside of their home jurisdiction. India has become a major reproductive tourist destination for foreign couples seeking gestational surrogacy services. I refer to this situation as Indian gestational surrogacy tourism. This paper uses a feminist critical discourse analysis in order to analyze media representation of Indian gestational surrogacy tourism . Indian gestational surrogacy tourism can be understood as being presented as an ethical master narrative within which discursive frames are used to argue either for or against Indian gestational surrogacy tourism. Those presenting this as a positive development use discursive frames that promote India as an ideal destination for gestational surrogacy services. Conversely, those who are critical of this practice use discursive frames that present legal, ethical and dehumanization concerns.

Lee, C.A. (2012) 'Health care at a crossroads: Medical tourism and the dismantling of Costa Rican exceptionalism', PhD dissertation, Health and Behavioral Sciences, University of Colorado-Denver. Online. Available HTTP:
Based on a year of ethnographic fieldwork, this dissertation explores the development of the global medicaltourism industry in Costa Rica and the social, ethical, and ideological implications that its growth may have for the existing socialized health care system. This study seeks to understand the ways in which medical tourism, as a model of global neoliberal health care, affects how Costa Ricans think about delivery of and state responsibility for health care. The research draws deeply on the social, economic, political, and cultural contexts in which medical tourism is unfolding. It addresses the ideological tensions and contradictions that surroundmedical tourism, as the line between conceptions of health care as local and global, socialist and capitalist, public and private, blurs to accommodate this emerging industry. Rather than emphasizing the view of medicaltourism from the top, the focus is on local perceptions, understandings and engagements with medicaltourism. Grounded in the experiences of Costa Rican health care providers, educators, policy makers and citizens, this paper tells the story of a system in flux.

McDonald, E.A. (2011) 'Risky Embodiments: Momentum and Medical Travel in the Paris of South America'. PhD dissertation, Anthropology, Rutgers, The State University of New Jersey. Online. Available HTTP:

This dissertation examines the emerging phenomenon of transnational medical travel to Buenos Aires, Argentina based on fifteen months of fieldwork between 2006 and 2008. Ethnographic data were gathered through the observation of medical consultations and surgeries, interviews with doctors, patient coordinators, and hospital administrators, as well as living with transnational patients during their preparation for, and recovery from, surgery. Although crossing borders in order to seek out health has long existed under a variety of circumstances, with the turn of the 21st century, global biomedical services have emerged on a larger scale – wrapped within the neoliberal vernacular of the nascent “medical tourism” industry.

Miller-Thayer, J.C. (2010) 'Medical migration: Strategies for affordable care in an unaffordable system', Anthropology, University of California-Riverside. Online. Available HTTP:
Approximately 45.7 million people in the United States are uninsured and unknown numbers of this population are underinsured, severely limiting their access to medical care. To address this problem, people use innovative strategies to increase their access through cross-border care options. The U.S.-Mexico border provides unique challenges and opportunities for healthcare in this context. The lower cost of medical and dental procedures and medications in Mexico makes that country an attractive alternative for low-income populations in the United States. Thus segments of the U.S. population practice transnational medicalconsumerism in an attempt to optimize their health by using the resources available in both countries. This practice has economic benefits for the people who access healthcare at an affordable rate and for the medicalmarkets of the country providing the care. Drawing on data collected in the field in 2002, 2004, and 2005, this dissertation presents some of the complexities and dynamics of medical pluralism occurring at the U.S.-Mexico border.

Ramos, C.E. (2008) 'Crossing the border for dental care: Factors related to dental health among the South Texas border region', School of Public Health, University of Texas-Houston. Online. Available HTTP:
Objectives. The purpose of this thesis is to understand the underlying socioeconomic characteristics affecting dental insurance coverage, yearly dental visits, and factors related to visiting a dentist in Mexico among border region residents. Methods. Using data from the Border Epidemiological Study of Aging, dental utilization in the previous 12 months, dental visits to Mexico, and dental insurance (proxy) were calculated utilizing logistic regression. Three different models were utilized for the dependent variables adjusting for diverse socioeconomic characteristics such as gender, age, marital status, income, education, years of residence in the United States (for immigrants), English proficiency, general health status, employment and dental insurance.Results. After adjustment, diverse variables were significant for the three different models calculated.Conclusion. Although the Mexican health market constitutes a viable option for dental services for border residents, dental insurance and dental yearly visits were lower in this region when compared to national averages.

Rudra, P. (2011) 'Impacts of medical and wellness tourism centers on the communities around them: Case studies in Delhi and Kerala', PhD dissertation, Geography, Rutgers. Online. Available HTTP:

Over the past decade or so the movement of patients and wellness seekers across borders, over long distances, has increased and India has been the destination of choice for many. This is private sector led growth, but the government has provided support in terms of subsidies and its promotion. With the alignment of governmental support and other enabling circumstances, many new centers-both corporate hospitals and Ayurvedic wellness centers-have opened in India. The case studies for this research were centers in Delhi, formedical tourism, and Kerala, for wellness tourism. This study involved assessing the impacts of these centers on the local communities around them, in terms ofmedical, economic, and infrastructural consequences. Another question was whether these centers formed enclaves, of varying degrees, where the impacts were focused, or were there significant benefits for these communities from the centers being there.

Rutherford, A.S. (2009) 'India health: Impact of medical tourism facilities on state health and economy', MA thesis, Political Science, Iowa State University. Online. Available HTTP: 
The following study is an investigation of the impact on the health of local populations spurred by the medical tourism industry. More specifically the study explores a possible increase in life expectancy in areas surrounding medical tourism facilities in India. There are ten Indian states examined in this study; five states are host to a leading location of Apollo Hospitals, and five are not. Despite the small sample size, the chosen states present a good representation of Indian states based on size, wealth, and health indicators. The findings show that the presence of Apollo Hospital Medical Tourism facilities may lead to increased life expectancy of Indian state populations.

Saiprasert, W. (2011) 'An examination of the medical tourists' motivational behavior and perception: A structural model', PhD dissertation, Oklahoma State University. Online. Available HTTP:

The objectives of this study were to (1) examine the structural relationship of medical tourists motivational behavior and perception model; (2) assess the moderating effect of repeat visit on relationship between motivation and perceived destination image, perceived quality and perceived value, perceived quality and overall satisfaction; (3) examine the differences between international medical tourists' profiles on motivational behavior and perception; and (4) recommend medical tourism strategies in order to facilitate the medicaltourist expectations and strengthen services for future competition. Respondents were international medicaltourists travelled to Thailand. The total of 376 medical tourists participated in this study. ANOVA and independent sample T-Test were applied for the significant difference on medical tourist motivational behavior and perception. Structural equation modeling by LISREL 8.80 and hierarchical multiple regression were used to examined the causal links among constructs. Results revealed that international medical tourist motivation (attraction and opportunity) positively influence the perceived medical image. The perceived medical image also positively influence perceived quality on bothmedical staff and supporting services. Furthermore, medical staff quality also positively influences the perceived value and overall satisfaction of international medical tourists. Finally, the perceived value and overall satisfaction also positively influence the behavioral intention by word of mouth recommendation, repeat visit, and willingness to pay more. This study further found the moderating effect of frequent visit on perceived quality of and perceived value. Moreover, the results indicated that international medical tourists were significant difference on their motivational behavior and perception. This study suggested that the corporation between hospitals and government should be implemented in order to be successful as medical tourism destination.
Song, P. (2008) 'Biotech pilgrims and medical entrepreneurs: Cultural encounters from cyberspace to China', PhD dissertation, Harvard University. Online. Available HTTP:
"Biotech Pilgrims and Medical Entrepreneurs" follows the efforts of Chinese doctors and their foreign patients to cure what conventional medicine has deemed incurable. Based on 24 months of multi-sited fieldwork at high-tech medical centers in urban China, I argue that the conjunction of market-driven reforms and Internet-based communication technologies has reconfigured the quest for experimental therapies on a global scale. I develop the concept of biotech pilgrimage to explore how faith intertwines with technology and travel as patients and doctors push the boundaries of conventional medical treatment in pursuit of a therapeutic miracle. My ethnographic study highlights the crucial role of the Internet in mediating these new transnational health-seeking practices, exploring how online discussion forums have fostered a new social movement of patients, families, researchers, and doctors who cross national borders to pursue experimental therapies. My dissertation also analyzes how changes in the political economy of health care have encouraged Chinese doctors to experiment with lucrative biomedical interventions for foreign patients, transforming China's urbanmedical system into a laboratory for entrepreneurial tactics that blur the boundaries between public and private, legal and illegal, ethical and unethical. The pursuit of high-tech therapies by medical entrepreneurs is not just about making money, but also about professional ambitions and national salvation--a cultural phenomenon I frame as technonationalism. "Biotech Pilgrims and Medical Entrepreneurs" synthesizes key concerns in medical anthropology, ethnographic approaches to globalization, and the anthropology of Chinese culture and society. I examine the specific ways in which cultural values, economic pressures, and geopolitical histories engage experimental medicine on the level of lived experience. By foregrounding what is at stake for Chinese doctors and their patients from around the world, I explore how both groups deploy hope in "cutting-edge" medicine as a survival tactic to transcend the danger and uncertainty threatening their lives and their futures.
Vindrola Padros, C. (2011) 'Life and death journeys: Medical travel, cancer and children in Argentina', PhD disseration, Anthropology, University of South Florida. Online. Available HTTP: 
Recent studies on the Argentine public health system have demonstrated that the lack of medical resources in different parts of the country force pediatric oncology patients and their family members to travel to Buenos Aires in order to access care. This internal migration poses difficulties for these families as travel and resettlement are expensive, lead to the separation of family members, and interrupt the child's schooling. This dissertation was designed to document the everyday life experiences of traveling families in order to understand the barriers they faced while attempting to access medical treatment and the strategies they used to surmount these obstacles.