Monday, 29 February 2016

New book: Transnational Aging: Current Insights and Future Challenges (Horn and Schweppe, eds, Routledge, 2016)

Transnational Aging: Current Insights and Future Challenges 
Edited by Vincent Horn and Cornelia Schweppe
Routledge, 2016


This book focuses on the diverse interrelationships between aging and transnationality. It argues that the lives of older people are increasingly entangled in transnational contexts on the social as well as the cultural, economic and political levels. Within these contexts, older people both actively contribute to and are affected by border-crossing processes. In addition, while some may voluntarily opt for adding a transnational dimension to their lives, others may have less choice in the matter. Transnational aging, therefore, provides a critical lens on how older people shape, organize and cope with life in contexts that are no longer bound to the frame of a single nation-state. Accordingly, the book emphasizes the agency of older people as well as the personal and structural constraints of their situations. The chapters in this book reveal these aspects by approaching transnational aging from different methodological angles, such as ethnographic research, comparative studies, quantitative data, and policy and discourse analysis. Geographically, the chapters cover a wide range of countries in Africa, Asia, Europe, North and South America, such as Namibia, Thailand, Russia, Germany, the United States and Ecuador.

New book: Amy Spier's 'Fertility Holidays: IVF Tourism and the Reproduction of Whiteness', NYU Press.

Fertility Holidays: IVF Tourism and the Reproduction of Whiteness
August, 2016 - ISBN: 9781479849109 - Link:

Each year, more and more Americans travel out of the country seeking low cost medical treatments abroad, including fertility treatments such as in vitro fertilization (IVF). As the lower middle classes of the United States have been priced out of an expensive privatized “baby business,” the Czech Republic has emerged as a central hub of fertility tourism, offering a plentitude of blonde-haired, blue-eyed egg donors at a fraction of the price.

Fertility Holidays presents a critical analysis of white, working class North Americans’ motivations and experiences when traveling to Central Europe for donor egg IVF. Within this diaspora, patients become consumers, urged on by the representation of a white Europe and an empathetic health care system, which seems nonexistent at home. As the volume traces these American fertility journeys halfway around the world, it uncovers layers of contradiction embedded in global reproductive medicine. Speier reveals the extent to which reproductive travel heightens the hope ingrained in reproductive technologies, especially when the procedures are framed as “holidays.” The pitch of combining a vacation with their treatment promises couples a stress-free IVF cycle; yet, in truth, they may become tangled in fraught situations as they endure an emotionally wrought cycle of IVF in a strange place.

Offering an intimate, first-hand account of North Americans’ journeys to the Czech Republic for IVF, Fertility Holidays exposes reproductive travel as a form of consumption which is motivated by complex layers of desire for white babies, a European vacation, better health care, and technological success.

Saturday, 20 February 2016

Upcoming conference: IMTJ Academic Conference on Medical Travel and Cross-Border Healthcare - Madrid - 25-26 May 2016

IMTJ Academic Conference on International Medical Travel and Cross-Border Healthcare

For the conference's scope:
For the most up-to-date conference programme:

(subject to alterations)

Wednesday, 25 May 2016
- Meghann Ormond and Neil Lunt, co-organisers

Session 1: Cross-sectoral governance of medical mobilities
- Andrea Whittaker – ‘Medical travel and its discontents: Home country reactions to the departure of medical travellers for care overseas’
- Arturo Vargas Bustamante – ‘Developing the medical travel industry in Latin America: Comparing different public/private organizational arrangements in Costa Rica, Cuba and Mexico’
- Sabina Stan – ‘Transnational patient mobility and healthcare mobilities and governance processes in Europe: towards a rising European healthcare system?’
- Zsofia Papp – ‘Patient or traveller? Lessons learned from health tourism development’

Session 2: Social and economic impacts in destinations
- Meghann Ormond – ‘What are medical tourism’s effects on its destinations? A healthcare and socio-economic impact assessment at the sub-national level for Penang, Malaysia’
- Michael Guiry – ‘The Economic Impact of Medical Tourism on Countries’ Travel and Tourism Sector: An Exploratory Investigation’
- Beth Kangas – ‘Building a Destination around a World-Class Medical Center: Rochester, Minnesota, the Mayo Clinic, and the Destination Medical Center’
- Juan Bosco Gimeno – ‘Impact of tourism on Spain’s private healthcare sector’
- Sunita Reddy – ‘Corporatization of Health Care: Medical Tourism and Medical Markets in India’

Session 3: Health equity impacts in receiving countries
- Johanna Hanefeld – ‘How medical travel affects health systems - evidence from mixed methods research in South Africa’
- Valorie Crooks – ‘Do people in patient's home countries care about the health equity impacts of medical tourism abroad? An examination of Canadian stakeholder perspectives’
- Alejandra Giraldo – ‘Health tourism in Spanish public health centres’
- Valorie Crooks – ‘Medical tourism development in Guatemala: An empirical examination of health human resource impacts’

Thursday, 26 May 2016

Session 4: Cross-border care arrangements
- Maria Teresa Martinez Almanza – ‘Border medical tourism: The case of Ciudad Juarez, Mexico’
- Tomas Mainil – ‘Putting the EU Cross Border Health Care Directive into practice: A UK perspective with EU policy implications’
- Betty Rouland – ‘Emergence of a transnational care network: Private services and Libyan migrants in Sfax, Tunisia’
- Ricardo Pagan – ‘Health tourism trends in the United Kingdom: Are they net exporters of health services?’

Session 5: Intermediaries
- Jacqueline Sanchez Taylor – ‘Contested tourism: Parallels between sex tourism and cosmetic surgery tourism’
- Lila Skountridaki – ‘Issues of Trust between Medical Tourism Facilitators and Medical Doctors engaging in the Transnational Healthcare Market’

Session 6: National strategies
- Neil Lunt – ‘Medical travel: what we know and why we don’t’
- Jin Ki Nam – ‘Globalization of healthcare in Korea: Policy and political issues’
- Leyla Bayan – ‘Key factors in selecting Tehran as a medical tourism destination’
- Maria Kuklina – ‘Prospects of development of medical tourism and its informational systems in Russia: The case of the Baikal region’
- Daniel Horsfall – ‘The end of medical tourism?’

Session 7: Overview of key themes in medical travel studies and agendas for future research
- Neil Lunt, Meghann Ormond, Andrea Whittaker, Valorie Crooks, David Bell and Ruth Holliday, followed by a moderated discussion including all conference participants


Session 1: Cross-sectoral governance of medical mobilities
Andrea Whittaker and Chee Heng Leng – ‘Medical travel and its discontents: Home country reactions to the departure of medical travellers for care overseas’
  • Much of the scholarship on IMT addresses the impacts and benefits of IMT on receiving countries. These have centered on equity concerns. By contrast there have been few studies of the impact of international medical travellers’ home countries and the local reactions to the departure of citizens to pursue medical care overseas.  In this paper we trace the various reactions from consumers and governments in the US, Indonesia, Nigeria, Australia, United Arab Emirates and the UK to the growth in travel of citizens overseas for care.  Concerns include the financial losses to the local health system, inequity of access, safety concerns, the incursion of costs to the public health system by returning patients and the loss of public confidence in the local health care system.  In some cases reactions to medical travel reflect long-standing geopolitical rivalries and local politics as much as medical issues. We trace the responses by various governments and the medical travel industry to concerns from consumers and health officials, including regulation, promotion of the local health system, investment and strengthening in the local health system and co-option.

Arturo Vargas Bustamante – ‘Developing the medical travel industry in Latin America: Comparing different public/private organizational arrangements in Costa Rica, Cuba and Mexico’
  • ·    This study uses a comparative political economy approach to analyze the role of different government and private organizations in the development of a rapidly evolving medical travel industry in Latin America. The study first constructs a typology to characterize the emergence and development of the medical travel industry in developing countries, focusing on the role of government institutions and private organizations. This framework considers two main dimensions to characterize coordination arrangements, degree of centralization and privatization. This framework is later tested with empirical evidence from three Latin American countries that have experienced different public/private organizational arrangements in the creation and promotion of their respective medial travel industries. The case of Costa Rica illustrates the case of a centralized government strategy to develop this industry in close coordination with private organizations. The case of Cuba demonstrates the organizational arrangements of a primarily centralized and centrally planned government strategy with very limited private involvement. The case of Mexico displays a decentralized strategy with a plurality of public/private organizational arrangements at the central, regional and local level. In each case we identify the main factors that encouraged the development of the medical travel industry and analyze the specific markets that that each country has targeted. We conclude that two factors explain the rapid development of a medical travel industry in this comparative study, the higher degree of centralized authority given to a professional government entity and the effective coordination between this entity and private organizations.

Sabina Stan – ‘Transnational patient mobility and healthcare mobilities and governance processes in Europe: Towards a rising European healthcare system?’
  • ·         The paper argues that the governance of transnational patient mobility in Europe has to be approached from an encompassing perspective that includes other types of healthcare mobilities and of healthcare governance in the European Union. Starting from this perspective the paper argues that, while healthcare services have traditionally been seen as being relatively insulated from the process of European integration, we are already witnessing their re-configuration in a rising European healthcare system. The paper therefore uncovers the structuring lines of this system by concentrating on three interrelated processes that contribute to linking European healthcare systems into a larger EU-level one: 1) ‘horizontal’ healthcare governance through the diffusion of healthcare privatisation reforms across the EU; 2) intra-European mobility of patients and healthcare workers; 3) ‘vertical’ healthcare governance through EU directives, ECJ rulings and bilateral investment agreements. The paper argues that, while transnational patient mobility provides, together with healthcare worker mobility, the human glue to the rising European healthcare system, the process of healthcare privatisation provides its dynamo. Indeed, as privatisation leads to segmented labour markets and inequalities of access to services, it thus also fuels the mobility of healthcare workers and patients. These mobilities in turn feed into the use of and employment in private healthcare services. The resulting vicious cycle of privatisation helps construct an increasingly uneven European healthcare system, in terms of the distribution of access to services by patients, of wages and working conditions of healthcare workers, as well as of financial control and policymaking both among and inside EU countries.

Judit Sulyok and Zsofia Papp – ‘Patient or traveller? Lessons learned from health tourism development’
  • ·   Ageing population with good health conditions and a keen for travelling with leisure purposes is an important segment for a lot of destinations and facilities. In accordance with the European Union’s goal – supporting healthy ageing and increasing mobility of seniors –, the paper presents lessons learned from a health tourism product development funded by the EU Cosme programme. From the European Union point of view, the supported project linked to health (including medical and wellness) tourism are mainly initiated by tourism stakeholders. Probably this is also a reason why these projects (including Off to Spas) focus on tourism product development – with a lack of sharing knowledge between different projects. The presentation therefore puts an emphasis on interpreting the lessons learned from the project management and product development process. The 15 month-long ‘Off to Spas’ project’s main objective is to create a new health tourism product attractive for seniors outside of the summer season. The paper is based on a comprehensive research background, including secondary analysis, primary research of the potential travellers, and the feedbacks of two study tours to the involved destinations. The outcomes highlight important implications for medical tourism development. On one hand, the project’s destinations have both strong emphasizes on medical tourism services, on communication of the healing effects. This is not always perceived the same by the potential travellers. The consumer survey among the potential travellers pointed out that Swedish seniors consider themselves healthy, open-minded with a lot of travel experience all over the world that results an important challenge for the destinations with strong healing attractions and services.

Sunita Reddy – ‘Corporatization of Health Care: Medical Tourism and Medical Markets in India’
  • ·    India is one of the preferred destinations for the international patients, owing to the one-tenth cost, English speaking, well-trained medical doctors and the state support. While the overall perception about medical tourism is positive and useful for India’s economic growth, a critical public health perspective on the growth of corporate health care shows that there are many misplaced priorities, where medical markets get the boost. India had a presence of private sector since Independence, but post health sector reform, the growth and nature of private and corporate health care changed drastically. Post nineties, health policies clearly promotes growth of private and corporate sector, at the cost of State subsidies. Seeing health care and medical tourism as a business proposition, the business houses have invested in building corporate hospitals and hire reputed physicians. The growth of corporate hospitals, have led to rise in cost, differential treatment to its own patients over foreign patients and two-tier system. Those who can pay get the ‘best’ services and those who cannot depend on the weakening and overloaded public health institutions. The growth of these corporate sector is again skewed in terms of locations and also in catering to only those services which are in demand globally and do not cater to the epidemiological needs of the country. The terms and conditions set forth by the State to serve some percentage of the poor are often violated and there is no power to regulate.

Session 2: Social and economic impacts in destinations
Meghann Ormond and Lim Chee Han – ‘What are medical tourism’s effects on its destinations? A healthcare and socio-economic impact assessment at the sub-national level for Penang, Malaysia’
  • ·    Medical tourism has begun to receive significant attention from national governments around the world given its widely-touted potential to drive economic and medical services development. The Malaysian government, for example, has identified medical tourism as one of the country’s most important economic growth sectors. Yet medical tourism is not evenly spread out across the country, nor are its effects. Rather, they are concentrated in specific sub-national regions. The Malaysian state of Penang, for instance, currently hosts more than half of the country’s total medical tourist visits. Expecting the sector to continue to thrive and significantly contribute to the state’s economy, the Penang state government is also very supportive of the sector’s growth. However, though medical tourism is considered economically promising, the state government is also concerned with ensuring the quality of and access to healthcare for local residents, especially those belonging to the middle- and lower-middle-income groups. While some research has pointed to the potential for medical tourism to exacerbate already existing healthcare inequities in medical tourism destinations throughout the world, scant scholarly work has actually examined this empirically. This paper seeks to contribute to filling this gap by presenting early findings from a study supported by the Penang state government’s think tank, Penang Institute, that analyses secondary data gathered from a range of Malaysian ministries in order, first, to identify effects of medical tourism to Penang on local medical costs and the public/private distribution of healthcare resources and, second, to estimate the costs and benefits that medical tourism brings to local economic actors.

Michael Guiry – ‘The Economic Impact of Medical Tourism on Countries’ Travel and Tourism Sectors: An Exploratory Investigation’
  • ·         Using Euromonitor Passport Health and Wellness Tourism industry data, the research will investigate the impact of medical tourism on countries’ travel and tourism revenue generated through inbound medical tourism. For the purpose of the research, medical tourism encompasses inbound travel that has the purpose of some kind of medical treatment regardless of complexity. The country travel and tourism revenue includes expenditures for travel and tourism services, such as hotels, travel within the country, car rental, travel retail etc., by inbound medical tourists and accompanying persons. Medical expenses are excluded from the data. Countries that will be investigated over a five-year time period include Australia, Columbia, Czech Republic, Hong Kong, Indonesia, the Philippines, Poland, Singapore, Spain, and United Arab Emirates. Similarities and differences in travel and tourism revenue impact across countries will discussed, explanations for the findings proffered, and implications for internal and external destination branding will be explored.

Beth Kangas – ‘Building a Destination around a World-Class Medical Center: Rochester, Minnesota, the Mayo Clinic, and the Destination Medical Center’
  • ·         Much of the literature on the development of medical tourism destinations has focused on locations not already known for their advanced medical services. While replete with attractive tourist amenities, destinations such as Malaysia, Thailand, Barbados, and Jamaica have had to – or will have to (in the last two cases) – convince international travelers that they offer specialized care comparable to (or even exceeding) that available in the United Kingdom and United States. The literature has hailed Harley Street in London and the Mayo Clinic and Cleveland Clinic, among others, in the US as the original destinations of biomedicine-seeking travelers. While studies acknowledge that the September 11, 2001 terrorist attacks and ensuing visa restrictions in the US rerouted transnational medical travelers to destinations in Asia, few if any explore the current efforts of these original sites to secure their status as global medical destinations. This paper investigates the collaborative undertakings of the state, county, city, medical facility, and private partners to make Rochester, Minnesota, home of the Mayo Clinic, a destination medical center (DMC). In 2013, Minnesota legislature passed a “DMC law” to position the Mayo Clinic and Rochester as the world’s premier destination medical center and center for health. This paper draws on DMC board meetings archived online, legislative documents, newspaper articles, reports, and local observations to explore the negotiations of a 20-year economic development initiative with community concerns for affordable housing, respect for existing architecture, improved public infrastructure, and quality of life. It illustrates place-making as a dynamic process.

Juan Bosco Gimeno – ‘Impact of tourism on Spain’s private healthcare sector’
  • ·    Spain is working hard to be a prime destination for healthcare and medical tourism. High quality healthcare with excellent private clinics, prestigious and worldwide known doctors and treatments, can match with the leading position of the country in the general tourism market. Within this frame, the information about what are nowadays the facts and figures of the impact of tourism in private healthcare sector will result in relevant information for those -service providers and coordinators- who are involved, or want to approach, in international patients' treatment to prepare further activities to accomplish their aims. The object of the study is twofold: 1) detailed knowledge of the flow of international patients currently treated in Spain including geographic and demographic aspects (origin, destination, ages...), healthcare (diseases, treatment, duration...), but also motivational aspects (expectations, results, satisfaction...), and tourism; and 2) evaluate the impact in areas of economic significance (employment, training, performance ...) and other relevant areas of healthcare, at strategic level, in resources' administration, and patients'' management. In addition to plotting a series of profiles on the state of health tourism focused on health care, it is expected to identify areas of value to service providers: best practices, strengths and opportunities.


Session 3: Health equity impacts in receiving countries
Johanna Hanefeld – ‘How medical travel affects health systems - evidence from mixed methods research in South Africa’

Valorie Crooks – ‘Do people in patient's home countries care about the health equity impacts of medical tourism abroad? An examination of Canadian stakeholder perspectives’
  • ·         The international medical tourism literature suggests that destination countries can experience both health equity gains and losses resulting directly and indirectly from the development of a local medical tourism sector. For example, it is often reported that medical tourism helps to reverse brain drain and bring in foreign revenue, both of which can have health equity gains for the local population. At the same time, other research suggests that there may be a re-direction of local policy resources and a shifting of health care priorities in order to ramp up a medical tourism sector, both of which can contribute to health equity losses. After conducting a large, multi-year study of the observed and potential health equity impacts of medical tourism in Mexico, Guatemala and Barbados we created vignettes highlighting the real health equity impacts that emerged from our findings and shared them in 20 interviews conducted with Canadians we broadly conceive of as stakeholders in the practice of medical tourism. More specifically, interviews were conducted with key informants who have expertise in health law and policy, patient advocacy, health care administration, international patient travel, patient safety, and other sectors that are directly impacted by the outflow of patients abroad as medical tourists. In this presentation we share the vignettes and the perspectives offered by the participants. We show how a single vignette can be simultaneously interpreted as having negative and positive health equity impacts and in doing so reflect on the challenges of assigning responsibility for mitigating the harms associated with this global health services practice.

Alejandra Giraldo – ‘Health tourism in Spanish public health centres’
  • ·         One of the main concerns of Spanish citizens has been how to maintain the quality of and the universal access to the public health system (CIS, 2011), therefore one of the issues that has been in the spotlight is medical care for foreigners. Public opinion and the media assumes that there is a high volume of tourism in public health centers. This paper analyzes this phenomenon. The first part of the work quantifies and characterizes hospital care dispensed to patients who reside abroad but are treated in Spanish public centers. This descriptive analysis shows that a percentage of these patients come to Spain because of the difference in quality between the health systems of their own country and the Spanish health system. This health gap acts as a catalyst for patient movement. Finally this paper sets an econometric model which aims to predict how foreign patients will cross the border in order to be hospitalized in Gynecology and Obstetrics Departments in Spain because of the differences, in comparison to their home countries, in two indicators: maternal mortality and public expenditure per capita PPP.

Valorie Crooks – ‘Medical tourism development in Guatemala: An empirical examination of health human resource impacts’
  • ·         Guatemala is a Central American country that is actively seeking involvement in the international medical tourism market. Championed by various local groups, health care clinics, and health care providers, a modest number of clinics and hospitals are taking measures to expand their private-paying international patient load. While ample scholarly research suggests that there are both health equity gains and losses to be had for countries developing medical tourism sectors, there is little on-the-ground research in these very countries that offers empirical perspectives related to health equity impacts. In this presentation we report on 50 interviews conducted with representatives from four stakeholder sectors in Guatemala: public health care providers, private health care providers, civil society, and government. Among the issues examined in these interviews, we asked participants to offer realized and potential (i.e., forward-looking) impacts of medical tourism sector development on health human resources. Here we examine these realized and potential impacts and conclude by discussing the complexity of determining the health equity gains and losses stemming from each.

Session 4: Cross-border care arrangements
Maria Teresa Martinez Almanza – ‘Border medical tourism: The case of Ciudad Juarez, Mexico’
  • Medical attention is one of the key issues of the 21st century. This is, in part, due to individuals and governments facing complex problems related to contemporary healthcare, such as cost, access, and change in needs linked to demographic circumstances. In view of the growth in demand for medical treatment by American patients in Mexico, this research will examine medical tourism at the border between two countries, the diaspora, and more specifically, the distinct phenomenon affecting the social and health systems at the Juárez, Mexico/El Paso, USA border. This presentation draws on 69 in-depth interviews with key healthcare stakeholders to explore Juárez as a medical tourism destination. The interviews were performed from 2013 to 2015. Grounded theory was selected because it uses qualitative analysis to generate theoretical propositions based on empirical data. The following macro categories emerged from the analysis: context of the destination, context of the market, product and commercialization strategies, and the border. The study describes the reality and particularities of this border medical destination.

Tomas Mainil, David Botterill, Vincent Platenkamp and Olaf Timmermans‘Putting the EU Cross-Border Health Care Directive into practice: A UK perspective with EU policy implications’
  • ·         The take up by UK patients of the opportunities under the EU Directive on cross-border health to seek treatment in another member state is the start point for an analysis of the importance of the political dimension in the core system dynamics of the EU national health systems. A case study of patient outflows from Wales adopts a multi-method approach. It draws upon secondary data in the form of government reports on waiting lists for health care, collaboration with a health journalist and the use of FoI requests in an action research project, previously unpublished data on uptake of the EU directive by UK patients, and an individual patient experience of negotiating treatment to receive hip replacement surgery in Belgium. A critical realist analytical frame explores the political realities of the implementation of the EU directive in the UK. At the macro-political level In the UK, the political sensibilities that are potentially offended by seeking cross-border health care implode around 1) the implied rejection of the NHS concept by UK patients, 2) being seen to favour continued relations between the UK with the EU at a time when a referendum on the UK's membership is planned, and 3) to be complacent on migration and border control issues in the face of persistent, unplanned, increases in population. The diverse political attitudes of the four different administrations in the UK towards models of patient choice in health care suggests a further undermining of any expansion of EU cross-border health care patient mobility. At the micro-political level, the patient case reports how she had to work against the ignorance of her own GP. She had to live with the consequences of;  'upsetting' the economic and professional power base of the local consultant surgeon, rejecting the conditions of the NHS Wales with its undue waiting times, and having to bear the additional anxiety of dealing with a complex and fledgling administration system surrounding the Directive. The study indicates that for a UK patient to exercise her or his rights under the Directive the patient risks; offending powerful interests, an engagement with emotive political debates, and financial uncertainty on costs of treatment. Implications for the EU of the position found in the UK are discussed, including the importance of building a  framework to deal with these challenging developments at a micro, meso and macro level that challenges the dominant narratives and power distributions in national health care systems.

Betty Rouland, Sébastien Fleuret and Mounir Jarraya – ‘Emergence of a transnational care network: Private services and Libyan migrants in Sfax, Tunisia’
  • ·         This paper shows the interdependence between the emergence of a transnational health care system and the rise of the number of Libyan patients in Sfax. The Tunisian private care sector has gone through different phases over the past two decades: it emerged as "medical tourism" during the nineties, suffered of the Arab revolution in 2011 to then be completely overwhelmed by the flows of Libyan wounded soldiers. Today, the sector manifests a new dynamism related to the geographical position in Sfax, the southern door of Tunisia. The method combines a survey amongst Libyans in four clinics and interviews with different actors in the private health care sector. On the one hand, the results attest that political instability in Libya has encouraged the proliferation of private polyclinics and related services. Moreover, it has produced new spatial configurations around the health facilities (properties, real estate), a transnational transport network (Libyan ambulances, cross-border taxis) and an informal economy. On the other hand, the Libyan migrants interviewed display heterogeneous migratory characteristics related to the political chaos in Libya, thus "re"-conceptualizing the debate on "medical tourism" in the region. Despite the problems at the Tunisian-Libyan border, the proximity of Sfax, the lack of sanitary infrastructures in Libya and the quality of the services in Tunisia contribute to the construction of a "transnational" care network.  Both health professionals and Libyan people are actors of such processes of "bottom-up" globalization, contributing to economic development and growing south-south migration as well as producing new forms of "transmobility".

Ricardo Pagan – ‘Health tourism trends in the United Kingdom: Are they net exporters of health services?’
  • ·         The study investigates the inbound and outbound health tourism in the United Kingdom (UK) to determine if the UK can be considered as a net exporter of health services. Although there is an increasing number of studies analysing the phenomenon of health tourism, little empirical data are available. This paper contributes to reducing this gap by providing reliable data on health tourism flows for the British case. Using microdata drawn from the International Passenger Survey (IPS) for the period 2000-2014, we estimate the flows, number of nights and expenditure of tourists looking for medical treatment who complete international visits of less than 12 months’ duration to and from the UK. In addition, we analyse the main destinations of UK residents (outbound health tourists), and country of origin of overseas residents (inbound health tourists). The results show the upward trend of inbound and outbound patients (163 and 364% during the period 2000-2014, respectively), the strong seasonality in outbound patients (lower during the summer), and the significant increase in the levels of expenditure of overseas residents since 2005. Poland, France, India and Hungry are the chosen countries by UK residents to be treated, whereas Irish Republic, Spain, United Arab Emirates and Greece are the main countries providing inbound health patients. Public policy considerations are given.

Session 5: Intermediaries
Meredith Jones - TBA

Jacqueline Sanchez Taylor – ‘Contested tourism: Parallels between sex tourism and cosmetic surgery tourism’
  • ·         This paper will draw on recent research on cosmetic surgery tourism and my long-standing research interest on sex tourism to think about the parallels between the two industries. Although tourism made important economic contribution to some developing countries during the 1980s and 1990s it has also created social problems. One of these has been the development of an informal sex industry that operates around tourist destinations and incorporates local women, men and children. Western male sex tourists or  ‘expatriates’ often act as mediators who help to shape and market this informal sex industry. They are sources of information, telling others about opportunities and helping sex tourists to access sexual services. Cosmetic surgery tourism has also been led by Western female mediators. Usually patients, who often are one of the first to have had cosmetic procedures abroad and spotting a gap in the market, use their experience and knowledge to facilitate the travel and surgery of others. This paper will pay particular attention to how Western mediators have shaped the development medical tourism or sex tourism in different destinations by drawing on aspects of their own identity as well as the tropes about the destination that allow patients to travel in order to experience cheaper surgery or sexual services. It will argue that their interests in doing so go beyond the economic as cultural and social constructions about gender and race also play an important role in motivating and developing their business.

Lila Skountridaki – ‘Issues of Trust between Medical Tourism Facilitators and Medical Doctors engaging in the Transnational Healthcare Market’
  • ·         Trust plays a central role in business relations; more so in emerging fields. Trust works as a connecting tissue promoting the smooth/efficient function of the markets; whereas high levels of trust among partners may require long-term efforts, and its absence may inhibit the development of fruitful commercial arrangements. This paper examines facets of the developing relationship between two important actors in the transnational healthcare market: ‘medical tourism’ facilitators and medical doctors (MDs) engaging in the niche field. The empirical focus is on the latter, and in particular MDs practicing in Greece and Turkey, an emerging and an established destination for medical care correspondingly. Study participants are plastic and dental surgeons who work for or own small medical practices -as opposed to large organisations- and, as a result, deal with the commercial aspect of transnational healthcare in addition to the clinical part of patient care. Rich qualitative data shows that MDs express concerns over the commercial practices of facilitators, perceived to be undermining the interests of both MDs and patients. Particularly, concerns over commissions and fees; and interference in the patient-doctor relationship inhibit the development of high trust towards facilitators. Interestingly, the comparative study shows that (despite expressing concerns) Turkish MDs are more open to business with facilitators; the majority of Greek MDs resist what is perceived to be facilitators’ pressures to control prices and the ‘rules of the game’, and are more reluctant to proceed to business arrangements which overall delays the development of the Greece as an established destination.

Session 6: National strategies
Neil Lunt – ‘Medical travel: what we know and why we don’t’
  • ·         The past decade has witnessed growing academic and professional interest surrounding patients who travel abroad to receive medical treatments. There has been much media coverage – of individual patients, of unusual places, of life-saving and life-changing treatments, and medical mishaps and the risks travellers face. Discussions have typically involved a great deal of hyperbole regarding future market development and how it will benefit or impact detrimentally on systems and patients.  In recent years the academic literature on medical tourism has burgeoned and a first wave of ‘discovery and description’ publications documented the novelty of medical tourism and its broad characteristics. Something of a second wave of scholarship since 2010 includes more detailed empirical investigations of particular aspects and local development. This second wave has drawn from across disciplinary settings, identifying medical tourism as a complex phenomenon that escapes straightforward categorisation.  Discussion is organised in three parts: first, highlighting what we know about medical travel at the level of patient, provision and health system; second, identifying the continued gaps in knowledge and exploring why such gaps continue; and third, sketching the likely routes of empirical and theoretical studies of medical travel given they are emblematic of broader cultural, political, economic and social changes associated with globalisation.

Jin Ki Nam – ‘Globalization of healthcare in Korea: Policy and political issues’
  • ·         In 2009, Korean government made its blueprint mapping out 17 new national growth engines, including global healthcare, which will drive the national economy over the next decades. Since then, Korean government has pursued the policy for globalizing healthcare and executed many strategic plans. During the initial phase, the policy focus was on boosting inbound medical tourism. Since 2012, the strategic weight was shifted toward developing outbound market, indicating export of hospital system to other countries. Korea's medical tourism income was just $59 million in 2006, but rose to $500 million in 2014, nearly 10 times over a 8-year period. This policy for globalizing healthcare requires the revenue and human resources to execute the strategies. However, Korea is suffering a shortage of medical manpower. In 2012, Korea had two physicians per 1,000 people, much lower than the OECD average of 3.1. In spite of the financial crisis of some public hospitals, government has spent a lot of money for supporting the private hospitals or clinics for medical tourism. In order to penetrate into foreign healthcare market, Korean hospitals need capital fund. Since Korean hospitals are not-for-profit organizations, it is very difficult for them to attract capital fund. Hence, Korean government tried to change the medical law for loosening the regulation. The opposition party and some NGOs have expressed negative opinions toward the globalization policy. They are so much concerned about the negative effect of this policy since the globalization of healthcare would entail privatization of healthcare. Hence, there has been a political argument concerning the globalization of healthcare.  The purposes of this presentation are as follows: 1) To explain the current policy and trend of globalization of healthcare in Korea; 2) To review the political issues regarding the globalization of healthcare.

Maria Kuklina – ‘Prospects of development of medical tourism and its informational systems in Russia: The case of the Baikal region’
  • Medical tourism is becoming a lucrative segment of the service economy and more than 50 countries claim state support for it. In Russia, it is just beginning to develop. Currently, Russia is more often the source of international patients than the destination. However, the devaluation of Russian currency has changed these patterns, reducing the number of tourists going abroad and increasing the number of foreign tourists attracted by the low cost of tourist services, including medical services. Responding to this demand, the list of services and the number of hotels is growing, though not evenly around the country. The post-soviet legacy of sanatorium resorts across Russia could be developed to attract international tourists, but they have not been significantly modernized since the collapse of the Soviet Union and they suffer from a lack of investment in infrastructure, marketing and collaboration with tourist firms. Yet their unique balneal resources have been preserved. In this presentation, I discuss the challenges facing the development of medical tourism in Russia, the prospects of combining medical tourism with other tourism offerings in remote regions, and places in which Western and Eastern medical practices and services encounter one another. I draw on the example of the Baikal region where, though recognized as one of Russia’s leading tourist destinations and home to developed Tibetan medical practices, medical tourism opportunities are not yet widely known. The presentation is based on an analysis of four resort areas (Ivolginskii, Arshan, Baikalsk and Angara) where I conducted interviews with personnel, tourists and local inhabitants as well as examining medical facilities’ records and medical tourism websites. Policy implications for the development of medical tourism in the Baikal region will be given, with emphasis on the development of information systems that play a crucial role in marketing strategies, investment and collaboration between tourist firms, resorts, other healthcare centers, government and tourists themselves.

Daniel Horsfall – ‘The end of medical tourism?’
  • ·         A thorn in the side of any academic researcher with an interest in medical tourism has long been the issue of numbers. Just how many people are involved in medical tourism? From early, speculative and rather fanciful estimates running into tens of millions, more recent headline figures have settled around the 5 million mark per year, globally. Whilst arriving at a number that inspires confidence in both academic and industry sources represents an advance of sorts, in many ways the numbers have become peripheral to some of the more important emerging issues related to medical travel. The first of these is that medical tourism is quite simply not what it was once purported to be. Nearly all of the academic studies of the phenomenon have sought to capture the commercialisation of healthcare and have often started with a focus on the advertising of services to individuals who then travel for treatment. While there is plenty of evidence of such journeys happening, the bulk of medical tourism involves people travelling across borders for care, travelling to their countries of birth or places of familial connection, or care being organised through politio-cultural relationships.  The low numbers of ‘typical’ medical tourists is hidden by and, in turn, hides much wider activity and developments in the field of healthcare export and transnational or global healthcare. In some cases, national governments are driving an expansion of domestic health systems in order to capture this international activity but rarely is this in order to attract conventional medical tourists.

Presenters’ biographies
(In alphabetical order by surname)

Juan Bosco Gimeno
Juan Bosco Gimeno holds an MBA from IESE Business School and a law degree from Universidad de Navarra. He works as a consultant for healthcare and tourism sectors, focused on quality management and patient safety. Most of his professional life has been concentrated in the healthcare and tourism sectors holding executive positions in hospitals as well as in tourism companies. He has significant experience in promoting, managing and owning hotels; founding Historic Hotels of Europe, Haciendas y Estancias de México, among other initiatives. He implemented the landing in Spain of the US healthcare provider company Community Care Systems; contributed to develop strategic management for private clinics in Spain. He speaks at national and international congresses and lectures in postgraduate programmes. 

Valorie Crooks
Dr. Valorie Crooks is a health geographer specializing in health services research and Associate Professor at Simon Fraser University (Canada). She currently holds a Canada Research Chair and a Scholar Award from the Michael Smith Foundation for Health Research. 

Alejandra Giraldo
Alejandra Giraldo is Assistant Professor in the Department of Applied Economics at UNED (Distance University of Spain).  

Michael Guiry
Michael Guiry is an Associate Professor of Marketing at West Chester University in West Chester, PA. He earned his Ph.D. in Marketing from the University of Florida, an MBA from Duke University, and a B.S. in Agricultural Business Management & Marketing from Cornell University. His research interests include medical tourism destination branding and positioning, medical tourism service quality, and cross-cultural consumer behavior. Dr. Guiry’s research has been published in journals such as the Journal of the Academy of Marketing Science, Journal of International Consumer Marketing, International Journal of Behavioral and Healthcare Research, International Journal of Health Care Quality Assurance, International Journal of Leisure and Tourism Marketing, and Health Marketing Quarterly. 

Johanna Hanefeld
Johanna Hanefeld is head of the Anthropology, Politics and Policy Group in the Department of Global Health and Development, and  Senior Lecturer in Health Policy and Systems Research at the London School of Hygiene and Tropical Medicine (UK). Her work is situated within the field of health policy and systems research and focuses on the political economy of global health. Current research focuses on health systems and medical travel and migration, policy analysis of evidence to policy uptake, trade and health, governance and health inequalities. She recently co-edited The Handbook of Medical Tourism and Patient Mobility (Edward Elgar). 

Daniel Horsfall
Daniel Horsfall is Lecturer in Comparative Social Policy at the School of Social Policy and Social Work, University of York (UK). Author of several publications on international medical travel, he recently co-edited The Handbook of Medical Tourism and Patient Mobility (Edward Elgar). 

Jin Ki Nam
Jin Ki Nam is Professor at the Department of Health Administration, Yonsei University (Korea). He is trained as a medical sociologist, and received his MA and PhD from University of Illinois at Urbana-Champaign in the US. His research areas are medical tourism, healthcare service design and U-Healthcare. He has worked with several government agencies(Korea Health Industry Development Institutes, Korea Tourism Organization) to promote medical tourism in Korea. He has published in Medical Tourism: Structure & Trends (2013), Medical Tourism: Service Marketing (2015), and Handbook on Medical Tourism & Patient Mobility (2015). 

Beth Kangas
Beth Kangas conducted research in the 1990s in Yemen – and Jordan and India – on patients and their companions who sought medical care outside of Yemen. This first ethnographic account of international medical travel highlighted that traveling abroad for medical care was not limited to the wealthy and elite; patients who lacked readily available resources sacrificed greatly to seek care abroad. The study also provided an early example of medical travel occurring from the South to the South. Kangas now resides in Rochester, Minnesota, where she is studying the development of the Destination Medical Center. 

Maria Kuklina
Maria Kuklina is Associate Professor in Economics at Irkutsk State Technical University (Russia). She has worked in the fields of industrial enterprise management and regional economics and teaches information technology, information technology innovation and information technology management. Her research interests include electronic systems of reservation in tourism, tourism development in the Baikal region, development of the systems of reservation in Baikal region and medical tourism. She has authored over 15 peer-reviewed articles. 

Neil Lunt
Neil Lunt is Reader at the School of Social Policy and Public Sector Management, University of York (UK). He is currently Director of the MPA (CASPPER) Programme, Pathway Lead (Social Policy) for the White Rose Doctoral Training Centre, and contributes towards SPEAX within the Department focussing on East Asian social policy. Author of several publications on international medical travel, he recently co-edited The Handbook of Medical Tourism and Patient Mobility (Edward Elgar). 

Tomas Mainil
Dr. Tomas Mainil is Senior Lecturer at the Academy of Tourism, NHTV Breda University of Applied Sciences, the Netherlands. His PhD focused on transnational healthcare and medical tourism and their relation with health region development.  He has co-edited a special issue on transnational care in Social Science & Medicine and a Palgrave Macmillan volume on medical tourism and transnational health care. 

Maria Teresa Martinez Almanza
Maria Teresa Martinez Almanza is researcher and professor at the Universidad Autónoma de Ciudad Juárez, México, located at the Mexico-USA Border.  Holds a Bachelor in Business Administration in Economics, a Masters in Education and a Masters in Foreign Trade. Professor Martinez has significant experience in international project management for funding, having managed major international health projects. Her research interests are related to borders, diaspora, and health tourism. She is currently completing her doctoral training at the University of Girona in Spain. Her doctoral thesis is related to the development of medical tourism destinations. She studies the particular medical tourism case of Ciudad Juarez, border city between Mexico and the United States. 

Meghann Ormond
Meghann Ormond is Assistant Professor in Cultural Geography at Wageningen University (The Netherlands). A human geographer, her research is mainly focused on the intersections of transnational mobility, health and care at a range of scales. She is the author of Neoliberal Governance and International Medical Travel in Malaysia (Routledge, 2013) and numerous journal articles and book chapters on 'medical tourism', migrant health, cross-border and intra-regional healthcare development, personalised medicine, and international retirement migration. Her work has appeared in such journals as Social Science and Medicine, Health and Place, Globalization and Health, Maturitas and Mobilities.

Ricardo Pagan
Ricardo Pagan is Professor of Economics at University of Malaga (Spain) and Head of the University’s Chair "Tourism, Health and Wellbeing". 

Zsófia Papp
Zsófia Papp is a Research Fellow with the Hungarian Academy of Sciences’ Centre for Social Sciences (Hungary). 

Sunita Reddy
Sunita Reddy is an Anthropologist and Associate Professor at Jawaharlal Nehru University, New Delhi (India). Her areas of research are women and child health, disaster studies, medical tourism, surrogacy.  She is the author of Clash of Waves: Post-tsunami Relief and Rehabilitation in Andaman and Nicobar Islands. She is a founder member of ‘Anthropos India Foundation’, a trust which promotes visual and action anthropology and has a dynamic website She is also a president of an organization called ‘SATAT’ which works for empowering women and children. She has published extensively in peer-reviewed journals. 

Betty Rouland
Betty Rouland is a Research Fellow at the Institut für Humangeographie, Goethe-Universität Frankfurt/Main (Germany). 

Jacqueline Sanchez Taylor
Jacqueline Sanchez Taylor, of the University of Leicester (UK), has undertaken international ethnographic research on sex tourism, child and adult prostitution and sexual exploitation with a particular focus on female sex tourism.  She is currently conducting qualitative research on breast augmentations and has contributed to an international ESRC project on cosmetic surgery tourism entitled ‘Sun, Sea and Silicon: Cosmetic Surgery Tourism’.  She is interested in the global markets for cosmetic surgery and sex tourism and her publications focus on theoretical questions about the intersections of class, gender, race, embodiment. 

Lila Skountridaki
Lila Skountridaki is a Lecturer in Management and Sustainable Practice at the University of Stirling. She completed her PhD at the Department of Strategy and Organisation, Strathclyde University Business School, UK. Her PhD examined the role of medical professionals in the internationalisation of healthcare and the entrepreneurship of medical doctors. She has studied Economics at the Athens University of Economics and Business and the University of Amsterdam. Her research interests include the internationalisation of healthcare, the professions, and business ethics. Before starting her PhD, Skountridaki worked for Quality Control and Accounting Departments in the private sector in Germany and Greece. 

Sabina Stan
Sabina Stan is a Lecturer in Sociology and Anthropology in the School of Nursing and Human Sciences, DCU, Ireland. Her research has dealt with healthcare reform in Central and Eastern Europe, European east-west migration, transnational healthcare practices in Europe, the rising European healthcare system, and collective action in response to healthcare privatisation and mobility in Europe. She has published with CNRS Editions (Paris), Routledge and Rowman and Littlefield, as well as in journals such as Social Science and Medicine, Journal of the Royal Anthropological Institute, Labor History and European Journal of Industrial Relations. 

Judit Sulyok
Judit Sulyok is Senior Lecturer at the University of Pannonia (Hungary). Her courses include strategic marketing, health tourism, and tourism marketing. She is the coordinator of the ‘Off to Spas’ project, funded by the EU Cosme programme. She has significant experience in tourism research and marketing, having worked for years for Hungarian Tourism Ltd. and gaining international experience as a member of the ETC Research Group. 

Arturo Vargas Bustamante
Arturo Vargas Bustamante is Associate Professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health (USA). He specializes in health care equity and in the comparative analyses of health care delivery systems in Latin American countries. His research has been published in reputable health policy journals such as Health Affairs, Health Services Research, Social Science and Medicine, among others. As part of his professional experience, he has worked for the Inter-American Development Bank, the California Program on Access to Care and the Health Care Financing Administration of the Mexican Ministry of Health. 

Andrea Whittaker
Associate Professor Andrea Whittaker is ARC Future Fellow and Convenor of Anthropology at the School of Social Sciences, Monash University, Melbourne, Australia. She is a medical anthropologist working primarily in the fields of reproductive health, biotechnologies and medical mobility/ travel with a special interest in Thailand and SE Asia.  She is currently undertaking research on medical travel in Thailand and Malaysia as well as reproductive travel in Thailand and the region, funded by the Australian Research Council. Her major publications include Intimate Knowledge: Women and their Health in Northeast Thailand (2000), Women’s Health in Mainland South-east Asia (2002), Abortion, Sin and the State in Thailand (2004), Abortion in Asia: Local dilemmas, global politics (2010) and Thai in vitro: Assisted reproduction in Thailand (2015).