Medical Tourism and Transnational Health Care Edi IM by

David Bonerill Cot!llffMtf"'fllllitml t/JIi>oMity. UK

Guido Pennings Glint, U .. I...,.Jry. 1kf:I~'"

and

Tomas Mainil NlrTV _ Uoo1>omiI')I TIw NtlhtrI<JrUI

palgrave macmillan

* s.~I"",. i"t rod..:,ion an<! edi'o<'" matte, 0 ~id Bott«ill Guido Ponning. an<I lorna< Ma inil 2()B Individual. <I>aj>'." 0 Ro>pK'ivo autl>on MI3

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No ~ion of .hi. publication may .. ropmducod, <<>pied Of " .,,,mined ..... with wr~t.n pormi.>ion or in .<"e>r"""'. wilh tho pr""ision, olt .... Copyright. Do<ign. and Patent< I.e. 1988, '" UI'Idoi" .n. tom" of any lk~ "".milt ing lim iloO <opyirlil i.","", by lilt Copyright Li<onsil'!i "'&<""y. Sail,,,,, House, &-.-10 Kirby 51_. london Eel N 81S.

""Y ponon ..t.o <10<. ~y ~horilOd iK' in ,. lotion to th" publ", .. ion ""'1 .. Habl. to criminal. pro,,",,"';"" and <"'~ d..im. for domago •.

TIlt aut""" _ •• _ed lilt;, .;gIIts to .. IOenlifi<d os 1M .... It>o<. of lhi. _ in "",<><dane. wilh tho Copyright, Do~gn. ond Patent. Act 1988.

F~" publiohod lO13 by PAtGRAV[ MAC MltLA.N

PoIgr • • • Moe",.I,," in tho UK i. an ;",print of MiKmilian Publi",," ... Um~od, ,egi.1Oftd in Engta,.., company nu .... ' 785998. of """r.dmill .. 8o'i"8"ol<o, H~"'iro RGl l 6J(S.

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Contents

Usr 0{ 11m", r"bI" anti Fi1"''''

Lblo{O>"',;/NJ'ar.

II""", II .. f.<Iila"

Acl ""M'I"t(t'III"'''

h"rod,,,,'lon /),1';<1 Ilou..,.;)~ ro .. ", M,,;,,;) (1)>0/ Gil;'/(; I""''';''J'

I'art I Too r isl! a s Patic""

2 Sldn"'. 11.01,11. Tourl'm and ,ru, [VeT·!',.",nl Threa, of

,'11

"III

. 111

iJ<.,h, Ninet",n,h-C.nIUlY Spa and Se.sonal T,.,,,1 1 J D"vid M, 811K~

J A W.y Thr<>u;h the M .. " fJ<plorlng Dlfk= .nd (}\, .. I.p' lktwrtn Wei In.,, .nd Modlcal To",j,m Pr",'jdc" 30 Cotnrlior Voi~ "",II,,,,,;,,, /I, Lri'(f

-I Coring lor Non·r<,ldenu In Borbod.,., fJ<aminlng I h< Implication. oI 1noo...nd T,.",n.lion.' ModiC.I Dr< lor l\,bliC and ""Iv". IIe.llh Dr< . 6 """',,' S""kr. \,,,Iorl< II. Croot>. ul.!~ rum .... , ~o'" /01"'>1<"'. /I",,,, F,~"". W"r" KoIiI"~"kj. M"I)' CIw>i "",/ K'~II'''' M"""

S TourlU, with s."..,,,, Dhablllty II"J/f 1."'/0"

I'"'' II Patie"" a . To uriSh

6 8<-,ulyand tto. 8<-o<h: M.pp ing Cmm.U. Surgory Touri,m R",h I/ol/j,~,y. K,ne I/""Iy. 1),,0<11k11. f.m;fy /I,ml .. , M<'Mli/h "'n<>. El>prll, I'ro/»" ",,,I h"~U<'Ii,,, S""d,.;, 1",/01

7 C"",·lIordcr RcprodllCliw ca", Around the World: R«cnt eo""",'.";,,, W"""" V"" Hoof ",,<I Gu;,'" p",,,j"J'

8 Tro"'pl,,,, Touri.", TI.,,,,,,, D. S<hj",", ",1</ f("",,"om/ RI",,""

9 The lUlOpean C"m·lIotder Pa,letlt as !Io,h Clr i<erl and Con,ume" "ublle l1.allh and 11",, ['1> Sy"on' ImpHea'!<>n, To",,,, M";,,i/, Mull COl"'''''' ",,,I I(aj .llklwl,.."

Pa rt III Ent'l!, gl~m~nts wi l h M~,<li~al Tourism: Polky. Mml~gcmcn ~ and BUline .• s Responses

10 O",><II.n MNlcal T""ol Coml"n'" .nd 'he Gk>ball""k>n of

131

lleal,h carc lSI 1.<'(11' 11",,..,

II The [,hie.1 ~I ""'l!.m.'" 01 M<"<lk.1 Toml;m G,,;'10 p"",j''15

", 12 lI.be,,,,o •• T,a"",.lIo".1 110.1'1> care .nd Cros • .o!I"".II,m 19~

T"",,,, .It";,,II, Vi,.. ... " PI"''''~'''"P "'"' 1M",,,,, .11""",n.""

13 The Iml'><:' 0/ MNkal Tou,Io1l1 In ww·.nd Middle·lncom. Commies 208 JII'I;", .11",/1"", ,ff,,,,,",-" Rkl".,,1 n . S,.iII, ",,,I RU/,II 0,,,"11<,

14 The Impac' 01 'he Internet on Medical Tourism 22J

/)'''';" Ho"fi"'. /I,'~iI tum. /1"",,,,/, Kill." ""'"'''''' 1/11"",_1</ "",I Rkh<",' n. Sm;'/,

IS Tow.rd, . Moo.1 0/ S"".!nablc lI.allh Pe"inorlQn M.nage", ... " I\a>e<l oolloal'h R<gloo. Tom", .11,,;,,11, K, ;'/' V;",,;', D,,,·" /I<)"";/!. Vh ...... '1 P"'I"'t",,,P. r,"'I(I. "II! 1-""" aM IImmll! .II,~I.m""s

IM,X

Boxes, Tables and Figures

1 ~.1 ClfCu""",,,c,, 1I~e1y to Itw. llda'e gua"'''ee> 2:12

Tllb)""

9.1 l)"poloi;yM.lnil .... I. 141 10.1 DnO<liOn modic.1 ,,,,,,I<m rompal1l... 156 10.2 Cro .. ·l>or~., ",«.Ilc.1 ".",,1 comp .. "I... 164 10.3 Co"'I"nk1 , ,,ar~ ... I"g medlc.1 ".,,,,1 rOf -CCSVI, ... ,h18' 'rid

'libera1ion pro<<<.Iur~' 168 1O.~ Comp,"i .. nlarkOllng medlco l ".",,1 lor _ISh, 10 ... urgery 169 10.5 Co"'I"niM n,arkOllng In,ur'"« prod""" enabling a.c:c",. to

carc in 'h' US 171 10.6 MOOlcal tr.,..1 comp.I1Y markelll1g h"'"h ",,,'1«'< ' "

US <1II"n< 173 1 ~.1 Type; of m«.ll<.1 ''''''''''' m .. and ,heir key r •• ,ur.. 226 1 ~ .t 1 ... ,,111.11011 Io<>tlom prol11ott-d hy 'Il< w"",,,I'" In 'he web

""'I€w n9 15.1 1.<-\'01, 0/ ~ .. tIlall,," 111'''''!l"",el1l lH

Fillur~

2.1 Elag"idlL."cra. I907.p<»I<or~ H 2.2 Engll'h I'h.,m""y. 2(111. c.lI«.I '110'11',' In Elaedel<e, (IS"",

p. ~OOl 2S 1.1 TYJlOloIo' of medic.l om! _II" ... , ,,,,,,I'm pro'1M"

15.1 Th~fC'I<.1 r"u"d., 10m 0( d .. tln,"on m.n.gemenl

"'

" '"

Contributors

~l'}'>L)'1UI ,w"m. Is .......... h '"';I .... '" In 'hI: Iolfdlal Thurl .............. h Group. SImon Fralft Unl>"..,.,y. Butnaby. Oonad.>.

a",id IIdl I. SWIo< I.«.u ...... In CrL.ic., lIu .... " Gtos"phy In 'h~

Ilq>o"~" ofGqrophy. Unh..,nltyof l.<>ed •• UK.

I).vid M. lInlce I •• "I,lLln8 fellow In 'he Bu,ln ... School.,.hI: Unh..,,,lly 01,,,,, W,,>! of ElLKI'!Ld. H""ol. UK.

11,,[>" Ch.nd. I. rrof .. "" In f.conomk. and SocI.1 SC .... """ •• Ih. Indl.n "".ILYI. of M""gomo",. 1lo"ll.1ore (11MB). Indl>.

Mary CIL<>! I •• ont.",1> ","".n' In lhe M<'<IIC.I T",,,hn. 1Inn"'1> Group. Simon Fro"" Un" ...... 'y. Burnabf. Conad.>.

Ma .. Coo"",e" Is .n ....... m p'-"'" In Eu,..,..,n PublIC ' .... IIh. o.p.LI"'<"'" olln' trIUlLlon:.ll 11ahh. M ... .ulchl Unl...,.;I,y. Maw.rlrh •• , he NotLhtrlaoo ••

Valort ..... CrooI; . " . n •• "",Ia'. prof<$_ In 'he n"".n....." of Gq"phy. Simon F",,,,, Unh'tf1.I,y. Ik"naby. Conada.

~o:t ' h Di n"le '" """lor IKL ......... a' ,he A<:a<I"",yofTou,' .. n , Br<'dI Unl .... • .lLy of Applit<! Sclencn. 81<'<1., 'he N<1htrl:.m'h.

lI~nry I"r."" I. Prof •• "" ~m.,iLu, In 'h. ~ac ... I'y of M«Ik.1 Scl<<><n, Unl,,,,,.I.yof ,h. W .. , Indle> ,Co,,, Hill).

Johanna lIancfdd I •• ..." ...... In GIob.iII PublIC lIe.l,h !'olley'" lhe School of 5o<1.1.,l<Il'<>IlIk.' Sc~. Unlnnllyof Edin .... "h, I:<Iln .... 'lh. UI<.

1<.,. Itardy " • ..." ...... In \l'oIt.oo Employmtrl. kl.' I<> .... !.ftd. Unl' .... • .I.y ... Inn. 5(1'0'''. lHd .. UK.

1I ... 'h ltulll<uy " I'rok>_ of G<-ndn.oo Cul,u", In ,he Ccn,,,, for in'.,.· dhdpll""ry C<:nde< S'ud .... Facul,yof [due.olon. Social Sclen<n.nd La ... Unl ........ 'yof toc.J .. 1.e<'<I .. UJ(.

fl.",., n""I.1I ... Ioc." .... In Cornl"'r.,h" SocIal!'olky In .he ~""""'" 01 Social !'olley and SocIal \Vor~. Unl,..",;'y of Yor~. Vort. UK.

,.11\

Emily lIu"t~r I •• ,..,..,.rrh ... i".", in 'M ' '''''',,'~ for 1",<t;><1I\"O Media .nd learning, U""'~""Y of T<,<hnology. Sydney, Aum.h •.

Itory Joh","on "a Phi} ,"ooe'\I In 'he o.".rt",en' 01 Geog"phy. 51"'0" Frase, U" l,,,,,lty. Rm""by, canad • .

Mcmlith J"n", IS. ""HOr 1<,<""", wl1h ,he In";'''10 for I",c,aeti'''' M""" .ml Learning, a, ,he Unl"""lty of T<,<hTl<>logy, Sydu"y. Aum.h •.

La"", Kad.,,...kl w", mo" "-",,on(ly • r=>fch .»I".n' In 'M M""ical Tou,'.m Re>e.rch G,oup, Simon fla ... Unl ,,,,,lty. Burnaby. canada.

1I."".h King I •• t~.chlng r.,lIow In ''''' Ikp""m~'" of Soc;"1 Polky .nd Socia l Work, Unl'""lIyof York, YOfk, UK.

JClln lfer 11. laing '" ><nlor 1<'<'10'''' In 'he ikpanmen' of Mark""ng and T"",I.m and Ilo'pltali(y. La Trobe Unh'o,,'(y. Bundoora. Au",.Ii •.

Ncil Lun, I •• ",niO' I""""." In Socl., Policy a"d !'ublic M.n'gemellt I" ,he 1:1<1"''' me,,( 0/ Socl., Policy ."d Social Work. Unln"i(y of York. yo,k, UK

A"gie I.u'her I •• ",,,lor '""um i" 'h~ cardiff School of M.nageme"" cardiff Metropollt.n Un;"erOltr, carolff, UK.

Moll", ~bni"cz AI,"TCz i •• rhD "ud<!m In ,ho Dopanm.", of Global 1I". ',h ."d Ik"'lopm~"', London School of 11Yl! i.~« Troplc,' Modicln_, London. UK ,

IIc.,.m.n Meulemar" " , prol"""r In ,h" l)epartm.", 0/ Sociology, Unh"""y.,1 An'w~fp, An'"",rp. llelg'"m.

Kal Mlt'h.'""n i, an ."',,.'" profe,,,,,, In ,h. (}ep""m~n' oIln'ernational 1I~.lth. M.a,"lch, Unl'·~"lty. M. , .. "lch,. 'ho No,horl.nd,.

Vincent j'la'"nkamp " an a,,,,,,,lato profo!>or and Di='Or 01 'he ~n"e fo' Cr<»Hultural Unde,,'and lng (CCU). NIITV Unh,",.lty of Applied Sclc,,,,,,,,. ~r<:da. 'he Ne'herland,.

F.l'I""h Probyn I, Prof",,,,,r 01 Gond'" and Cultural S,ool ... , 'ho Unl'"""lty of Sydney, Au",.'I • .

R"",,,,ond Rh(l<!", " I'rol .. "" of Medic.1 W""",,,,,, .ml Direc,,,. 01 ~i"",,,Ic. F.d""o,'on a t Mou'" SI",1 School 01 Medi<I"~; Profe."", 01

Philosophy at 'ho G • .>d"" .. Com«, CUNY; .nd rrof ... o, of Bi"",hlco .nd M:IOC",'. Program Di,,,,,,O. of ,he Union·Mount Sin.i 8i"",hl<o I'rosT3n\.

Jacqueline So ncheT. Taylo , b • '«,u"" 'n ,h. [)epa"men' of Sociology, Uni,>er<Uyol l..,iCe" •• , ~,." UK.

Tho m., [). Schl.no', M<dlcol [)I"",'o', lh'.' Tron,plantatlon and 1JI,,,,,'o' 01 Clinical lI.pa'ology a' 'h" MOl"" Sinai M«llc.l Ce,,'., and I, rrof....,. of M«Ilcln ... Mou,," Sina i School of M«Ilclne, Now Yor k. NY,

Rlch . rd [). Smith I, P,of""o, of 1I •• Hh Sy".m F.<:<>nomlc, .nd!)can of .h. Faculty 01 Public Hoallh .nd Policy. l.on<lon School of lIyglen •• nd Troplc.l M«llclne, london. UK

j L""n, y .~n ~-d ... I, an .,,'mnt pr-o/e;<o." 'he Fan,hy of He.l,h """">C<-<. Simon F, • .." Unl,-.""y, Burn.by. ConOOa.

l.ei gh Tu,,'~, Is.n .,:IOCi.,. professor in ,,,. Cem .. fo, Bloe1hks. School 01 PubliC Ile. lth and CoII<ge 01 I'h."nacy. Un;"",,"y 01 ~linn=t.,

Minnesota, USA.

Wan,,'" I'an lloof " • l'hD "lKkn' at 'ho S;o.,hiC' In""u,. GlK:rlt, [)epa"",on' of l'hllo>ophy and Morol Sc"'n~, Ghent Unl,,,,,"y, Be'gium.

fr,,",ei' ,-an Loon i,' prob>o' In 'ho [)epa"m.n. 01 Sociology, Unlvmily 01 An'""rp. An'",e,p, So'glum.

Corneli. \''';8t I, Adlunct R"",.rch fellow a' Cu"'n Unl,..","y, I",,,h, Amualla.

About the Editors

LMvlo.l !IoU"ri li I. a r=I""~ ""a<!~onl<, rrofeooor Emcrll". I" I~~ w,,"~ O:nl'" fOf Tho",,", R ...... "'h, In ca,o.liff Me""r"li!>n Unh..,,,IIY. UK, .no.l Vi.I,lng R .... fCh Fcllow., Ihc Uni"cr>lly or W""onln" c,. UK. In 2011 hc w ••• "Uiting schol>< 01 Ih~ Caim. ,"m"",o. Jarn", Cook UnlwfS"Y. "nd In 2012 w., .ppolll1cd ~ ";OIllng scionll" 01 FAPESP, Illc Sao Paulo State R\X~fCh COIm(il, Cimpina. S,. ,C UntvmilY, Bra"!. Ik 11.1 llttn in Ihc ".nS":,,,l of embli,hinS Tou,iSrI1 S,lId i.,., _legitim"" fi<' ld 01 highN cdu· ~.'ion ewOl 'Il<> P'''t 20 ~.". In ad<!illon. h~ h •• "",tt'd With" numbe, ()f "x,.rn.1 and Irnlustry I"'flrl.", i'tcllldi''lI Too,i"" Co"""rn. ,,"c 1""1 ... Tauri" _,0.1, til<> Too,l'm Trai"lng Fo,um 10' W,le. and ,he fllghd FAluc.· tlOn Aca<lemy Subj"" NNwu,k for l1o.pll"fl1y, l.-,j.u",. Sport .,,0.1 Touri.m. 11;, 1IJOW """n' ,("".1< h 11 .. ''''ph.<I;t'd 'Il<> impOrt.n~ of linking TO"'I"" Studl .. to the phllo"'phi". m",hod. and "'ncop" of ,he socl.1 I<~nc ..... ovldenced In ",n"Ib."lo,,, In K.,. C .. , .... ",,,;I! T"",ism N"",«I, (20IZ) .nd Thulj"n lIP,,' Clj,n<: KRj' Thm,,,, (2010). D.vld ". ",,,I,,,,..,, fo' ."...., .. 1 pub_ lI>hlng hou<e> .nd ex'orn.1 ."".00' of "",-",reh qn. llly 10' nnl,'."i'"" .nd """arch bodl ••.

Gui do Pcn,,',,!r' I. P'ofe.",' of ~'hk •• n(! aloe,hlcs at G~em U~,\"C"lty,

Bclj;I"m. II~ I, .100 Afroll.,,, i.e<'u"" In 'h~ Faculty of 1'<)1111< •. P.ychol­"IIf, So<IoIogy .nd Inl.,n.tlonal $,,,dl,,,,, cambridge Unl,..,,,lIy and G"",. Prof",,,,,, on 'E'hlcs In il<1>,od"o;U'", Mcdlcln ... at Ihe F ...... lty of Medicine .nd Ph .. ",ac .. "k.1 S<lenct< ,he F,.., Uniw"i,y 8n,,,,I •. Since 2005, he I •• h. dll<'<IO' of 'h~ al",,'hl<. In,tI,u'e Gl>en, raIG ). III, gene,.l ''''e","" .re ,he ,'hlc.1 problem. os.socla't'd with me<llcolly .»ISlcd ,ep""'"",lon .nd generic<. incl,~1i'\l; ,",x .. I.e'iolt. "'P,od""ti"" '00""". game,. don.· ,IOn , pren ... 1 and p~mplan .. t lon genetiC di'gn",i •. lie h •• publi.h." 'pproximately ItIO ."Icle. In ;mern.tion.1 10 .. ", .. 1, .nd t>oo~, and gi'''''' nun",IOU' p,""'n"'lon' a, Im .. n.,lon.1 rong'''''''' ' lie". m<mbe, of 'h~ T., k FOIQ on E,hie< .nd Law 01 'ho Europe.n So<k.y 01 II"m.n Rep""'''''. ,Ion.nd Emb,yology (FSHRE), 'he Belgian NallOn.1 Ad"hory Comml""" for Bioc,hj<. and ,ho f«l .. al Comml"lon On ,""'''''h On emb,yo' in ,'iuo.

To",.> M. lnl! i. l<c,u«" and R=archor .. Bred:> Unl,,, .. lIy of Applied S<~""",, the No,hoTf.nd •. He i. =pon.lblc fo, ,he """.Kh nnit 'T,.",n.llon.1 heallh c.", In ",ndlng and ,=I"lng con,ex,,' .t 'he Cen'", fOf CrmHullural Und." .. "dlng .,,0.1 "'oe.1r<he, .t Ihe R"",arch Ce",,,, fOf l.ongltooln.1 .nd Ufe eou"" S.ool •• (C fl.l .O), Unh",.lIy of A"'''''''p, !l<lglum, lie ob'alned.n MA In So<lology (Medical So<IoIogy) .nd an M5c

ill QyO"",,,I.,. Analrs;' .nd p""·""',ly work<d >t ,ho UnlnrSi'Y 01 Ant .... rp (Dol'''''''''''' of SociOloj;y) .nd ,ho UnlwrSity of Ghe", (Dop"n",o", 0/ Ct,,~al Pr<>tlitt 3"d PrimarY j{~. l lh Core) On he. llh·~I'l~ ,ubi~1S. Iii. m.ln on'.='$ ' ''' gIobaU .. ,Io" a"d he.1lth. tho d;maI1lIC' of tr.",,,a'lon.1 h .. ltb ca,. .nd tho l"to",.1 a"d ex,,,,,,al <har;><''''I''I<' of tho tr.",,,.lion,1 h •• lth u><r.

Acknowledgements

The cdllors wou ld Ill«: 10 Ih.n ' Ihe man.gemen. le.m oIlhe Aca<.!<",y of 'lOu,I,,,,. NHT\' 8'00' Unl,..,,,lly 01 ~pplloo Sclen"" •. for 11"", g~".IOU' '''ppor' Ihroo&hou, Ih~ p"'pa,.,ion oIlhi' ''01'''''0. Thor would .,,,, lil:.,.o Ih.,," Nt<" l.o,d for hi. ronITibuliOO I" ,ho 10 .. 0, , .. go. of ,ho p"'par,lIon of ,hi. ",.n".nlp'.

.111

1 Introduction lJ.m"tlllolterill, TOII/", M<I;";/ "'''/ Gllido 1"''''';''.'(5

Fro", j~. l"'''iX'<''lw. of Ih~ oca<lcml .. 3,,,,,,,1.,«1 with medicine '''~

lourl.m ... " will "" au, • po.Won ,h., i • ...,plkal 01 the ,.rm 'Me<lic.1 Tourl,m' ~(., th. "'''C time cmbr"" .. a ,lruc!Ural bonding be"'''''''' two dl,II,,,,, and "",.,Ia,e<! 1'01"',., ,.""",pllo"" In ,he of<leri"g of cootemporo,y """i.l life. Mc~lkhw and ,wri.", h .. " !>«:om. clear ly """,.,ed In conte",· "oury popnl" <0"«10< .. ".,,.. 1<1<'<1;':1"<1"'1'11,,, anything but. pkas",.bk .~""M.nce •• nd IOU';.", presum.,. a healthy dl.posltion 101 parlkipa1ion, lVe '1);'" ,ha, 'hi' JX>pula, ron""I',lon of ,t,e "'I'>r.'jon 0/ ,ou,ism and m«lkir>c igno"" • h;"o.k.1 ron,lm,lty of line.go hom the .igh,,,,,,,,h. ~n"'ry p""ull 01. 'o,,~ at mort> and 'I"" to ,,,,,,nhclh«ntury nohOm of holkl.ly>" ",,,,,ker ",.11". through glob.>l !,'''leIn m<>bU;IY In 'h~ ~, ... , for <utllng-odge m«lk •• Intc,,"nlion ' In "'<ailed I",tr • .,abk rundllion., Oiscipllnary dil'i,ion> wi,hln Ihe """.rch a.,.demy h .. " reinforced Ihe "'p' ."Iion belW<.'en medicine and lourl"n In roP"lar cull""" bullho"," now an omorgon' <hallong~ 1o ""Ih ink 'ho mMl<ine-lourl.m nexu., In Ihi. dynaml< .pace . nd under Iho Inn""nce of tr.n>nalional <o""umptlon, Iwo ''''y contr.,,'ng ".dlllo"" of I_'ern 'hough' are now confronllng e<>ch ,,'her.

In.ernalion.1 .ourl.m n\arkel< o"o l,-ed quickly following 'he olvillan rede_ pieyon"nl of aircraft '''''hnologlos d"nioj>ed during .he Se<;ond World W.r. Today 'ho>< ",ar k." .re ch"o<:lo,'scd I>y • P"""'" of <:<:>""nual rell,.-en"on of a myrlO<! of new "'I!!1le"ta.iem In orde, to provide no,'.1 "",'1<", '0 >all.t. """"'''\€'I demand (predomlna"lly l\1e>t.r" but Illcrea,h'gly """><>rolll.l1 l. An "lCrea.'''~ly "'1,hl>lka,ed ."ay of ",«II. '"dlllologl •• com",u"lc.'., ,he OI'all.bllilY of CU"OIl1'pa<~''d 100."1,, .. ""',011<",, AI ,"" >a"'<: "me, Ihe .... "h'gly o",,,ip,,,,,,,,, d",I,. of places to del..,,,,,, as lou"'m d",'h,otio,,, a, • d,'n, '0' """"""'k d.,.."op""",' """ok,,, a w1de rallge 01 p,I"ale. publiC .IId not.I"',profil .. a~<holde".

The n,,'di<.l ""or h" """n <on",i,-ed Irom an entirely diller<nl ralj(). fl ak, 10 Car. for, ."" """"fully cur<, Ihe ill <III .. " 0' pa"''''' I" ord., ,,, do Ihls. nallom ha'" in""'lro heal'ily "1'0, SC>'Of.1 ",nluri", in Ihe

o<n,m"I,,,,,n 01 n>«lica l ~xl""I<e and technologieal "'phi""'ation. TIl",. the history and dynamie, o( tOUr;'''' .nd "'<'IIiCi"~ have """n pr<'llica.<'II 0" dill,,,,,,t P'''''''P''. in diff'mlt time Irarr~ .lId .",d.r ,'ery dill_nt clrru'm'a,,~. II~-or. ,he «p.ratlon 01 'h~ m<'lllcin" ."d 'ou rbm "",. t"" ii being chal",,,&<'11 by • neW (oml "I l"'~nt .nobility _ a W",', 01 i",.",.tion.1 he.lth..,,,,e use" In ",ar<:h. 01 h.al,h ",Iu'lon', Today, 'h~

p<mlbIIlU", of f",dlng ' '''.a'"",n!' .1Id< 'he n...,Uy p .. oc,lbod bound"l .. of ,,>!lon.1 health..,a .. 'Y>' em, and Ian heodlong 1"'0 'he ephemeral and n .... lng Invon,lon, 01 lou,hm mar~.I<"". A new m .. ~et.drh-.n .rhos In health e.re I. fo!(lng 'he p,eviou.ly ",pply-.ldc domlnaled h",I'h ='or '0 Incorpo,aI. many 01 ' he demand _led Indu,,"y eh>l.., • .,.I,,,,,, .,.,><laI<'II wI,h 'ou,1.m. 11,·,=, we ot»en'e a ·'ou,ls"fte."on· 01 h,,,, lth co", emerging 'h'''''gh 'he .adop'lon of ,,,,,,I,m pracu"", 00' "m. of courlC, dependen' 0" IClen"" a"d 'echnology-Ied ,nedl,. 1 expert "'''''''e'''- The ""ntempo· <Of)' IIn~I"g 01 n>«li<I"" .n" lou,l.m p,.,...,,,,. we wool,1 .,S ..... a dyn.mi< window tnto 'he ela,h of powe, be'ween global copllal In,....,men, In 'he .. ,,1r:<> Ind"",I .... n" I" ImPK' upon nolion. o( >0<:1.1 welf.re .n" n.lion.1 cll;.cn 'hip.

The mowmen t from medical tou,ism toward, lran,natlonal health can'

0", booL Utle ,ull8"''' oome ambiguity by 'tl< Indu.1on 01 two 'ern,,: n>«l· leal .ouriSm ~,," tran""""".1 1 ,~al'h c ..... In 'hI> seelio" we ,"pl.i1l ,he 1""'0" ,ha' ~f<'Ilte th.t .ml>igu lty. In r<'ttn' Y"'''. p.1'I<'1I' mobility 0<,0<> narlonol borde" h., b«-omo 3 <o","," u.lI>«1 phenomonon. For exa mplo, European pe"pe<U,-o •• nd p,ac'iC'" are dllle",n' from Asian or Amorican ono>. Europ"~n n>!iOn' ha,,, wdl.dn'olopc<i 10<1.1 =urltr modd, of hoal'h care boS«! on .ho common tenor of health a. 3 ><>clal good . nd occo>, '0

health care.,. ,lgh' of cIU",,,,hlp. In ,h I> con."" •• "IOO._OOrd.,. health c. ", I. a mo", <om."",. ly uS«! term III til< deba.", In 'he f.ufOpean lJnlo" .I>ou' ""'(ylns ,h ... Ja"d. oIl"Ulen" for h.al'h care aero" nalion.1 borders . nd be'""",n n."on .1 heallh 'Y>"""', More ":e,,,."Y. oome F.uropean coun"I"" . " ch a, ".""any .nd ''''' lJolI<'ll ~j"grlo." . ha,,, =O!Inls<'ll 'h.' II<.lth co", I •• 100 'Ipe fo, m .. ~'" developmen, • • lthough >Uth dl"""I0", 01 polky.re .!Ill clearly ro"ralned wI'hln puhliC I .. alth go.ol._ Polley dlrecHon •• uch a, thest within European "., .. h"" oflen ""'n ;lCcomp.nled by Ihe In'roduc· 'Ion of th" ,on" ' nl<'llicol 'ou'"'''' In ""dltion to ,he more """,n",nly u<ed <ro,,·!)Order h •• ltl, care,

In 0 co"'l'l",ely difktem co",ex,. "",,,,"ie. In A,I •• nd on the Arne,i<.n comin<". wer •• 1",,)'> "lOK of"'" '0 p ,It'.tI<ed nKXkI. of ,ho 1'""'1<10,, 01 tl<al'h c .. "'. Tltcrdore, On .h .... co",;nen". ,Ite 'orn1> ,,>«Iieal ,,,,,,;,,,, and ",edicol t, .. ,,1 ar. ,nore co",m .. ",ly ,, ><'d, .nd ,hey ' . k. on a ,""Ieolly dill"",n, ,h.p' .nd form from 'h< limited uS< of ' h~ '''rm i" • European

rono .... For .um.,I •• In m,ny A'i.n nallon, ,I>< ""'ph,,;. i' m""h mo~ on mar'''' dcwlopnli'n, • • nd medle.1 '''''ri'''' " -., a, an 0PI",,,uni,y '0 drive ooo,,,,mlC p",,!"'rity in 'h~ ~Ion. n"". medical ''''' ri'm in Asia "ch. rac' .... >ed by gonrnmon" a, • groMh Indu,",y """Ivlng incre.Slng number< of im.rn.,ion,1 medi<.1 '''''rim. The mar~." of n,edlC. 1 '''''ri'm .~ al>o In<IN'ingly in"a.regKm.l, wHh pa"en" " ..... lIlng ,,1,hln "'1;ion<. for ex.mpl •• lrom Au.".Ii. '0 Th. iland Of. In 1"lIn Am",IC., from Columbia '0 Hr",IL

M«llcal 'oml,m" ,hu, mo,. '1>O<Ia .. ,d ,,1,h ,h. pKwl,lon of h .. hh c.,. 0" Ih. ba,l, 01 ""'-<)/-pocl«."' 1 .. ·lor-..,"'~ which, In ''''''. Io<a'o, med -1c.1 ,,,,,,I'm o. an hwlolblc .'pofl, <10,,-" '0 o'hcr fo,m, of 'ou,I,m. and wi,h ~lCal ""Uen" 'm.,«l . , 'our'" con.um.". Ho~-.r •• , we ,how In 'he chap'." of ,hI! boo~. 'ho d l1llnc'lo" ""'"'''''' 'ho old 'crm. _ medICal ,,,,,,I,m and cro .. .borde, he.lth caro _ I, now I .. , "'y '0 draw_ We propo,., 'h«do,< ~ ,l<W ",·~ .. ,chin~ 'oo '" I" 'hi' 1;0;.0, ', <1<1< - ' .. n",~Ii(>".1 t,callh .. n: . Tho ",., 01 'hi' 'crm woutd .ld bo.h 'ho <on.umer of medICal ."",t,m . "d the <1,1 .. " of ho.l,h ... ", 'Y"cm. 10 ""'''' .asily =og"i,., ,he cmcflling .. ,01 ".",n. Hon.1 """"ures .,,~ ".,wo," 'h., ... ~ 10 .. ,,'e all p.tle"". Funh«. "'< I'ropo'" , h .. ".n,na'io".1 hc.I,,, ,'re <"" Id !><ron,. •• lOW",

GI"""I pa,Ien' ",""lilly f,a"Ii''''''''~, which ""lid, 0" 3 Iogk 01 "an",",.,nal I,eal,,, r<8i<>ns (r<gi<>"31 d.'\"Olopm~'" "' • '"el\lcie for p>r ie", mobill,y). ".",n.,Io,,,1 organ;""lon' I,,,,,h OS ho'pl1.1 chain, ."d in'''''ne< Kh~on"J .nd ,u1l.inabl~ heal,,, d,,"ln.'ion managemen' Igovemmmlal .",,,ring of ,h. d",·elop,lI(."n, of ",,'k'" mOOih,y).

Tourism "lIdic> aca.demlC, and Ind",,,y praCIIUonc,. 'end '0 "gn<" In .erm. 01 mark", devdopmen' .nd 'rea' medlc. 1 'ourlom ••• 'ou,l" KUV' lIy wllh product>. ",rvlC., and <U1lom",., '0 ,Il<." exdu>.Ion 01 'he wid", implICations 01 mroic.1 'ouri>m fo, n.llon.1 heal,h ,yuem •. Prol.sslo,,.I, within ,h. h",I'h..:. re .,,"or ",'" lrom ""y d ilf""-",,, J>01ltlom comparm ." 'heir 'ouri>m <oun'e'pan •. Medical prncllllon"". lor example, deba'e .bo." medical tourl.m . nd ,ross_border he.llh ca,., In '",m, 01 medl _ c. 1 4uaHty and ,he erh lC.l con"-"l""nc .. for l",ern.,lonal ""lie"" wi.hln h~al1h<.'" 'Y"I<"H'_ Wha •• ,.", 'he d illonmc .. ""'W<."e!l these 'wo rommu _ ,,;'1 .. 01 p,oc'l .... re. we "'IQ!'" 'hey would do well to bogln '0 odop' • more Inclu." .... w.y 01 _ng one .no.h",'. In'e,e1l •. Thinking In 'e",,, 0/ u.mna1ion.1 rqlo<1.1 "",,,,,,,rts mig '" ma~. roll.oo .. 'lon J>01.lble betW<."en a f,,11 ""&e of "'~."olde" who """,Id g.l" irom ""tie, ""'""'K local ."d global "",len'"'' bolh el,l .. m .",1 ., co"""",,,,. A, • co""I"",lon '0 ,I,,,,,, ",~om."" we ",,'11 •• he ,eode, '0 ,hi" • • """, eoch chap'.' fmm. triad 01 4 ..... t .,"';

1. Wh.,.", ,h. publIC he.lth f'C"I""",h",] 2. Ilow I, ,nark~ d""'''1'1II.''' rep"""med? 3. b ,he,. .ny "\'"l<n<~ 01 in'CS"'ion 01 th.", "",1110"']

Thecri'iCal ",ade, Will oI>scr'~ ,h .. , a, thIS "age In ". fo,matlon, ~'Id<.'n"" 01 the imeg"hOn 1"'!,Ii«l by ou, ntod<!l of tran,natiOnal h .. lth c.,. IS diff>cult to f",d, Th~ main dh'ldo In ,h. f",ld h ,hat botw"en 'm«lleln.' on the on~ hand

.nd 'tOY,i'", ' On th. ot l .. " The ulti",". I'mpose 01 thl< book I. to brldgt' the di,-Id., Wh~n "artlng on thl. book, the «1110", a. rel',"",ntall,·'" 0/ tho 'W<> .Ide" lound out (h.( (hoy knew alm<»( no(hlng about each othor'. 1'<',,~tI,.. on m«llcal (oyrl,,,, . Thc main bon.fn rcsuiling Il<)m (h. brlng_ '''11 tog",h ... 01 dlllo"",( dl><lplln ... , prn.nt«lln thl' book may lie In tl>< I"", (h., 1'<',,~tI, ... , and (M undorlylng .. ","'pUon., .'" broyght '0 tho fo", and ""nfronted . Th. I'<'''P<'<U,.., adop'ed '0 pr.",n' the phenomenon of m<dlca l tOU",m canno' be neu".1 or obfocll,,,, Th. g<>al I, not to ",Ieet ',h.' right or ''''''' appropriate oppr~h . Th",., is no 'vlcw from nowhe",' , ",,,ry r.", .. ch.r In",1tahly h •• to adopt a poolUon from which to "ucry medlc.1 tou,l.m, it"""",." t>elng ."-.'" of one'. 0"''' .nd ,he others' »<"1'<'<0'""" and aboo' the Implication. and r.",I<Hon, of the I'<'''I>«U'"''', I, alroody' groa' O<I" ' ''''g •. At the sa",e (ime, it I •• n unea.y mix 1>0<."", of ,he ongo· i"8 dl«u .. lon. on how. ' ",edic.1 ,oy,;,,' .hould lie delin«l, Thi. i. rel.,ed to the ~""'hOn of ' to wh.t .... nt • ",,,,,rlstiC" PUTp"'" or de",ent .hould be present' , '11Iooe who..., the ,ro .. ·oo,d.., pa,l<1n •• lu" • patient 1001:· iTI8 for " .. ,"' ... " .brood Will obi«t '0 the , ... ", ' ",ediC.1 'OYr;" ' , '" "",n os thl< potlen' chooo<-< hI< de"ln,"on, In PO" 1>0<."", of ito auracll\'On"" a; • ,'ocallon =<ln, ,h ... rm h I"'rf«tly ",,,,jble, The .. "'" ambiguity <xl'" on ,he '''pply Side: <OIne c"''''''in m.y try '0 .t"OCt fomgn 1"'"'''' by pl.y_ i"1l tho to",I'm <:.rd fth. nOn,tl<'O'm.n' ",1 .. «1 a;p«") "'hll< oth'm may j"" attempt '0 pull in .. many patlen".! poo,jble, In (ho I.ttere."" It d"", no. m.tto, ",he", (ho clinic I, located, S.III, ",-on In (ho I.ttor c."" .our!!m '''''egle> .nd kno",ledge m.y bo u>cd to obtain re.ul",

The ba,k element underlying modle.1 tourl,m !! una,'allablllty: people n_ 0' doslre something (h •• I, not on oflor at home or .ho' !! not on oIfer In ' he rlgh' <o,><lIUon •. Th.,. condl' km. Include, amon~" o. he .. , a,-.lIabill'y within a reasonable time, artord.blll(y and good quall'y, n... 'so",ethlng' .h., I""'ple wan' m.y be •• ""~ (hlgh . tech or " .. ><lard), body ",ate,I.1 (organ., egg., etc.) or '1>«1( .. Inte,ventlon •. Thl. ba.l< """,'ure <an be pre><n(ed by •• " .. ,,1 dualltios: ,upp ly olld dom.nd, home country and d.,U"atlon country, pa'I<1" and provider, and SO OIL Th.,. 1"'''l>«tI, ... a", cl,.,ac'erl>«ll)y dlrt"",nt foco ... In te,,,,. of patlen' autonomy, st ... ""liga. tlon., ""n"n.",lalisa,lon, 81"""lisa,."" ,h. nat,,,,, of m«lkln • • nd lteal,lt, alld so on . Fundamenta l <hoI« ... 111 h"" to lie made. 1\'111 we try to stop (he COitl ,nfflCl.lb.Hon of he.ltlt c.re .nd pu( . m .. llnl'm <lfon Into ",.Intaln· i'l8 "'!ultablea.c<<s. '0 )",.Ith car< at hom.? Will " .. gin In '0 ,h. I'"".ur<, largciy orlgln.ting in budg<1.ry limitatiOn; and .'~r_glOl\'ing m«liCal n_; ."d JlO'.lbllltie>, I)y .hnpllfyirl8 ."d facilitathtg c,o",oord., ,nOl"nltn" whlk contlOlling .nd ,nOnitOrlng ,h. ,",'olu'lon to p""~nt derail",.n,,?

IVhilc ,he fu nd.m~nt., qocShom.", 'arg.'~ I»scd on .. hieal "al~, .'·i· d."c~ Will ~ n~ed oro ",hOI""" dOCi'ion ,. mado '" ord .. to m,'. 'uro that tho .WOn. p<'rforrnod. the org,,,, ... ,k)na l >true"","',n" in pl~. IOJlly "'p"''' ,~eho]", •. Middle way. th.t IT>mpromi>< /:>01\\"""n tho ",ark., and the public h •• ',h<a", ,),>,om , and ~t_" comunle" and patior", may ~ f",md. Th. COO~ .bout whe,. to pi.., •• h.l»l.nc. I, our> '0 make.

SI ruCi ure " f Ih e I..,.)~

ThO "rue'u,. 0I,~ book organl .... '~ ronlrll>."k)n. of au.hor> In.o ,h= pa,,,. Th. fi", ',,"0 ~r" ,.,11«1 Iho ,,"I>II,hed dMde ~I ... ""n .ourl"" and modlcl .... ref.,red 10 alx,,"o. 1'." I _ "Tour'." a . Pallonl<' _ fo..,;ro'l1ld, 'he .hl/' In ldontl1y from 'he ,ourl" 10 Ihe ~lIc" •• la'g.'Y from 1ho 1'<'''1>''< ' tI"" 01 .~ <:01l""p .... , mo<Iol, and pr"",kel. 01 ,,,,,,'.m <:01l."mp1lon . In Part II _ 'ra,len" • • Tou,'",' _ .he ",m.n.": .hif. In ,he oppnsi,., d iroctlon dl.· plaY' 'he '""'Y ~"Ic",n' p,=""upollon."" ho""h .,,,,,,.,,,h« •. 'ft "'" '" -' F."tanSlcm.n" ",Uh Med;';al Tourl,m , ""lky. M.n.S''''''''' and Bu,;'..,,, R<:>pon"'" _....., u>< Ihe word ..... ,.ngl.m."'. '0 comider how the ".mi· tiorl from medicol 'OUr;"" to Iran"1>.io,,.' h •• "" car. ,a~ .. ilS form Wi.hin ."""if>< poll,y, man'g""''''' ' and 1>u.'n" .. I"~,

r." I _ Tourh" as l'.,kn "

In Ch'pte. 2, Da,'ld M. Hruce remind, '" ,h.t "","<OlIlng.o '''~e 'he wale,,' "'a, • prtfw«l "l"k)n O"~r .nd above medical ir"."'.n.io,,, <loon to ho,,,e b«:.u"" pri<>r '0 around 1850, ,u<h in'm'enlion wa> ralher mOre l i~dy

'0 WI ,han C"fe. Through ,he ~g<o'l 01 gUide boob "oro by '""n'" a, patl."", Brue. ~I"" a ,'hid pk."r~ of "1>"<" of health, ,k~n'-'" and d •• , h and of 'ouri,m In 'he nlnote"",,,h ccn.ury. In Chap,., 3, Cornelia Voigt and j.nnlf.r 11 , laing b,lnS 'h~ hl"mkal continuity of 'ou,l,m and medici"" up.o d ••• wl.h a 'w.-n'y.fi,,' centu.y coneep,ual mapping of ,he

dlff."""", .nd o,,,,'ap' be1ween " .. II""" .nd medlc., .""rl.m p""'ldo,,, They P""'1de ba<kground Inform •• lon on ,h. b .. ",de, .,,,.Ironment of health <art and We"~m "",.ume' culture ,ha' haw Inn...,nced medIcal and well" ... ''''''',m provide". Th.y p ...... n' r,," p",,'lde, model. where the line. be1ween ",<.'dkaland ""lines< 'ourl,m ha"'~ I>lu"..:I, .nd.hoy dlocu" a •• a. fo, IUlure .... arch .

In Chap ... 4, jeremy S"yder .nd hi. 'ea", of c.,..",oo" pro"Id •• ""dy of ""n·, .. kI .. ,,\ h.",!, <a,. on ,he pop"lar lou,I.\ d •• lln.Hon I.'and 01 11>,1»<10 •. II>tl>a<lo> h •• a" .... I>llshed hl"",y o( provklb'g heal'h cart '0 III ,·"".,Ion.", o,h<1 a"it:>he.n , .. lden1S . nd , more """'''''y, ,I,e ,,,,al l "'" growinl; num~" of m«lical 'ou,l", _l<in" (cnUl,y care. lIr>wing upo" 11< <>p",;en« In d",."lop irt.g toeni,m ",,,'Ice,, 'M B>jan gowrnm~n. I. au",,· .I".,~ pro,n<)1lng 'h~ d"\-'<Iop"",n, of • m<:dle.' lour;,m l!1d .. ",y, InclU<llnS tho f"",Ii .. 1ion 01 ,,,. d",."lop,ncnt 0(. ntld·Sittd pr;'· ... h"'pit., co, ... lng

p,lm>rlly '0 n>r<lico l 'Omlm. Tho .",hOl' con,I"M ,h .. 'M d""dopmc", 01 ",.,Ii,.1 ,ou,I"" ""'iCes In flarb.>dos c.rrles With It not only ,he pot .. ",I.1 1o, IO'~ «Onoml, g.ln, bu, .110 "gnlfi<an' ,!S~. '0 h •• I,h Otjul1y II mi<· manal!"'i Of.,1t u"'''JUI.,«I. The fma! chal"'" (Chal"e-r S by Angle ""th",) in ,hi. 1"" 01 ou, b<w;)~ examl,,,,. ,,, .. ,,"1m with ",,100, dl ..,bi l l1~ . L"th", pro,·ld .. a ",,,,III,,,, .nd illumln.ting ""COUnt 01 how the m«lieal condi""n 01 cen·Ie.1 .plnal cord Inlury ImJ>l'C" tho tour I,m asplrallon, 01 people ,,1,h ... ,Iou. dl..,blll,y. Through 'hc lI,w .'perle'~ and pe=pllon, oIlndl · vkl""ls wi,h «rvleal 'pln.1 cord Injury, l,u'her pl<)vld", Imlj!hts In'o til;, rlsts ta~.n by 'ourl", wt-.o a .. pallon" In their .,.."yday II' .... . Thl. chapt", clo ... by hlghllghllng th. pos.lbl. polley Impllcallon •• h •• could I""UIt ••• andlor onh.""" parllcll'atlon In .our l.m lor Indh'ldua" wI.h «"'leal spinal cord Inlury .nd other .lmUorly disabled group._

P • ., II _ l'allc,,"~. Tou ,hl>

Cosmetle .urgery 'ou,'.m Is one of .he most pop"lar In".""", of medlc., ,ourl.m. I" Ch'pter 6, Ruth Hollid.y ."d co-.u,hor. "plore ,he CO""",,· ,ion ""'w..,,, tI'" mental renew.1 offere.! by • tourl,,1e trip ."d the ph),>i<.l ,.new.1 ,h., folio ..... cos",.,iC inlO,Wnllon , Th~ .110 o"'p h."",.he te,,· .ion t>c.ween the a"'i<II",'ed f<:ellng of ple •• "re IIn~ed to ,h •• ourlstic pi""" ."d , I", .",iClp:>,«l f<:eling 01 p.i" lin~ '0 the op ... "on_ n"'i, an. I),>;. ,r.o .... ,h .. <IiniC' use Im'g'" of ,he <o ... ",y and <"1,,,,. '0 COn""'" .... lth de"",n" ,h .. a",ac ' pat"'n", rueh., 4uali'y 01 c ... , low COst, """pita Illy .nd <u l,,,,.1 p", .. lmlly. More ,),." fo, o,hC! fo,m, 01 medical ,,",'01, th;, 'ype 01 ~"",·bo"kr tr~a'nlal' I, bull, on m)1h, and storl'" .bout paroleula, locallon> ,

Rop'c<lL;c'h-. 'ourlsm ls. peculiar lorm 01 medical travelling •• II I. I",· 4l>On,ly 'he ""u l, 01 natlon.1 Icgi.l.llon , ~"In applie.llom 01 m«lle. lly ... Iued "'pmdoc'lon ."d g",,"'k, arc locbldden In >Otne countr"" .nd allowed In O1h.". Thl' legal dh,."lty create, .,""".1 problom. and oppor· ,,,nlile • . In Ch'p,., 7. W,mn", V.n Hoof .nd Culdo ""nnlng' foeu, on 'wo specific con'""'o,,Io>: ,h. problem of ",ymo,,' and donor .nonymlly wi,hltl the pr:>ellco of gamete don •• lon. and .he p""'I<m 01 explolt •• lon ."d comity (h,co"'patll>llity of legl.latlo", In dllfe .. n' countries) within 'he ron'",' of International cornm",<lal surrogacy. Th"", probl<m •• re 'h" ""ult 01 dl\-erg"n"" In ethical ...... I""tlon .nd are hard '0 >oh .. . The .... ..,h ... ,on of c",»·border "'prOO",,'I" e ca", I> difftcull '0 pr«llCi a. It depend. on .. , .. ral dy" .. ni< cO"di,Io", .""h ., ><lo,,'lfo< d .... lop"'.,,,, . .,hk.1 .rod religlou. <o""i<'I0,,, .• nd <hanges I" legl.la'fo"

The m"'t dram.,1e for'" of ",«Ileal tra,-.:l ling ,.~ .. 1'1""" In .1 .. con,.x, of o'g'" "an'pl''''''lon. !'top l. d",pe'''. for." o'gan and conlrom«l wi,), • long w.ilinS Ii" ., homo sed • soI,,'iOn .b,~ , Th..., d"'''I''m arc co",o",lou. ",alnly """,,'" 01 ,Jle ethlc.1 conlex, ;rt which donor org.", 'r< ob .. lrIed I" "'any d"''''''pirtg COUt",il"S. I\o,h ,h. expIOi,.tiort of poor

p«>p le and ,he u>< of oxccu,O<I pn"''''''' •• org.n dono" in ,he Propl.', R"Vubl;c of Chin. ' ·iOl .. e b.1'ie cohi,.1 I'rin<Oiple •. In Chap .. r 6. Tho",,, I). &hl."" .",1 R""'mond ~Md ... na l),«, ,I .. nu,nN"''' " .. ~". i"ued by prof",.ion. 1 "",1<11 .. on ".nopl.nI ,,,,,,I,m. They al", «rullnl'" 'h~ .rgu· mer", In ,he d<'b3 .. "" pay""", lor 01);3"" They conclL>de ,ha' ,he fi", , •• ~ of ,he "",;'lie. i. '0 adop' ""'''Ure$ '0 guaran'''' ,h. h"'hh and ",f",y 01 'he

""~O In Chap'" 9 Tom •• Mal,,11 and hi. «>-au'h"" polno QU' 'hal wHhln

,h. £urol"'.n conl.XI ,h. I"";"n, I •• , much. cUlton ., h. I. a oon· .um"f. The '«ent r.'k",,,· Rlgh" I}Ir<:<U"" exp ... m ,hi. Ido •. 1Ia>Cll on thl, duailly In til\' pallenl. ~ lypology lh'l IllC{)fpor .. ~.!>d OO'"t" ,."Iou. othor 'ypologl .. ,,,",,,,0<1 I n 'he f"-1<I I. propo«<!. Thl. Impo".n' "JM-'C' of 'he lIa " ,,,.'lona l p.Uon, ha, Impll<:.lIon, for 'ho policy dhcusslon on 'he effo<:I' of 1I.",,,.'lon.1 health caro for .he ho.llh<.", 'f"em,. O1he' """, ,lde,.,looo •• uch., ,he w;lIin~n ..... oIl""'ple to seek ho.l,h .. ",Ices .I>K>/Id, ooclo--<ronoml<: dllfe .. n<:eI be'"""n cOl',,"I .. and Ihe gene,. 1 «onoml<: ell · m.te, .1", pl.y . ,ole. finally, • nu,,,Ilo, 01 oceoarlos rega,dlng ,he 1\,,,,,,, .,"Olulio" 01 olO .. ·bo,d .. mooical IIc.II"o", . re pr"'n",d,

1'." III _ Ent."slemo"" ... It h M<"<lical Touri. ", : Po licy, .\I. n38""'0", and Ku.in~ Resl",n_

Th. [m.1 pari of 'hI! t.x:ok end, wah 'h~ ronlril>ution. of .chol." from dlf· for"", d isclplin« wbo . ", tangling with mrole.1 touri.m , Conuil>utiOn. are maM from dlsciplln .. ,uch" ~thle'. philosophy. mOOI<>1 sociology. 1,~.IIh <"COnom;<O ond >O<la l poll<y. To~"" l<>gClMr, ,he chop'<" In r.rt III a"<mpt '0 map 'he 1,,11 compl"""y and chall~ng'-" of mOOieal 'ou,l,m.

Chap(ef 10. by leigh TurnOl. pre>ont,. compreh..,lSln onn'!ew 01 'ho mOOIe.1 'o",l,m Ind",,,y in Canad •. Whil< doing so, h< dl"ing"i.h« dl!· fOrellt Iyl"" of companle< playing In 'ho f"'ld. ,,,,,h " m<"<lieal 'our!>m compo"les. ctoS,_border medical " .. 'ell""IIII •• "" ."d p,I"ate heallh Insu, · a"", compa"l ••. " detoll<"<l .".ly,I, I, """'Ided 01 (he de<'ln.Hon coun"les, 'he he.llh se,,'Ic .. m.,kN<"<l, 'ho mar~"'lng """<age and the o<Idltlon.1 ",,,'Ices 'hat are oIle~. The medical 'ourl,m Indu"<]1 grow, despl.e. pub. Il<:ly lu"deIl he.I'h<",. 'Y"e(I\ 'hat gl' ... """"" (0 medl<:ally """"""<]I ..... ment. Soort<omlngl of 'he 'f"~m In comblna.lon wI,h 'exl"'!lm"",.I' procedu .. , ""t olle~ wI(hln .he .y".m can <>rl.ln wl,y I""'ple ... k care ",,<sIde ,he """""y,

Guido """"ing. be);in' ct'ap'" II wi,h the .. ""Hon ",a, "",es. to heallh ca .. I •• hum.n rlghL ", • oo"""luen"". go"ern,"''''' I> .. 'e the .. ,~ to Kua" n '" ,hI, ,lghl. Ik .,~ ..... ,h .. ",wl,.1 ,ou,I.", ,hould tot "",n ••• htallh.(~~ $Ylltn\ rtkollll a,ld !hould bt tv)lw.lOO 1»' ,,\tM! of Olt,\;tlj' benchma ,k. 01 fa;Il«". 11""",,\'«, 'he ",hie,,1 ",·.Iw.'lon i. fCndc~ highly comrkx bc< ..... 'h< re$ul .. dill<rMl"'rldln&on ,h • .,hlcal ,hcory ,hot on< o<Iop ... Gen.ral ly 'I"'aking, rour ,I""'i'" on Ihe jm' dl",;I><,lIon of sc.1tt

'.""'Itt< ,~n "" disting"iShed "'ih'OII.ni"", q;,hr>,i,ni,m, P'i<>IiWlanlsm and ,,,m.,,,,, .. ,i.,,i,,,,. 11><' m>ln di,""u"iOn focu.., 0" t .... p,i<>IiI>ri.ni" poo i""n .i ,~ 'hI< i< ,]", n\Ol" ,On<~rn ~Xl""'...t in ,he lit ... "",o. M<."<Ilc.1 '0, .. 1,,,, .hould "ot m"~. '''''''' who 01< .lready wont oIf (1""" polle,," In d",·doping COU"tr~ w;,hou, a<<<<. 10 ""siC h0'31'h carol ,.-e" wo,se ofr. T~ br.,,, drain re;ultlns f,om 'he Inllow of f"""g" I"',~r; I. ,.~"" a. on IlIm".rlon of ,hi •• pproach. He fin.lly concl"d", ,h., go'~rnnwn" ,ho,,'d 'ogu l",c .nd cont rol 'h. d .. ·dop",cn" by adopllng ",ca ,u",. '08""""'''' f." ocr"" 10 ~ood"'luallty h •• I,h ,.1< .

In Chap'e, 12. Tom •• M.'nll. Vlneen' Pl",on~.mp .nd I'"", .. n M<"Ulcm.n. link lhe Iog><y of Ju'gon fla"",01.,· Ido .. ,,1,h tr.n,n"lon.1 ho.llh ""'. and In SO doing ",a ke 'he ca", ,h., cros.-cultural m.n.gemen, In medl •• 1 ,ourl,m .hould "". p,ofo .. lonall,lng exo",lse_ In hi' 1.,0" ....,,~.

Ju'Sen 11,""'01" drew 0 di,tlncHon \le''''''''' commonl • • H,.., ."d ""'oglc action. The .",ho" de.no",,,a .. ,hI< <l1<l1"C(lon wllh;" ",edi,al 'ou,I,,,, by lo ... pool"g hl"o'l< .nd dl'logl<.1 ways of comm"ni • .,h.., action - 'he ' Iif.world· of pa'I"'11 and medl •• , """'0' In'",acllo", - Wi,h ,he '''aregl< 10'· prof" ways 01 ",,'on In ,he ",edlcal "',,,i>'" mar~e'I'I~. ll>ey '1);'" th., by de.-elopi"~' deq>n ",1 .. "., yml;;:"tonding .,,~ SctlSi1i\1,y .nlOng 110.· pltal "off who wo, k wl,h Im.rn.llol\,1 raH.",", • """e, hal,,,,, "",,,,,,,,n il.be"".,' ,...., Ii,,.. of "<rion c",-,Id be ><hi ... ·<."<I. Fu"he'n\Ore, .""h m.n· .gtom~n ' ''''''''~1ion <",-,Id ron"ibu,~ 10 ",«ll<., 'Omi'm b«Q,nlng. more ,,,,,,'n.bk pract""'.

In Chap'<' n, Meli'" M'''in~l ~I'·a,el. RI.hard D. SmUh and R"p" Ch.nda 'a~. 'he .n .. ng l~,""n" In'o 'h~ d"''''''plng w<>,'d. Thnc ."tho" ,how ,h., low· and middl.·lncome coun"'", prm' ldlng mrol<al 'ou,i>m ..... ,'1<., may Ind'-"'.'d to.ner" from gen<"fallng fOreign exch.nge •• ",acllng _ a nd ",raining _ hcalrh pro/'mkm.I., .00 lmprm'ing facllir;", .nd q""hty 01 care. Bu' ,h.", rou n,,1e5 .100 rI,~ di,·e"lng ",.",e """""'''' '0 c.'er for forolgn poll"n" who can bring In high'" """nue>, 'hereby neglecllng 'he need, of 'he 10<" popula'lon. The .u,h", •• n.lyse 'h"'" 'y!"" of trade og,..,,,,.n,, ,hal coun"lo, can ong'g< In when pfffi'kling m<dlc.1 set,·""" '0 In'e,n.· 1I0nai I"'"en", mulll·laloral, reglon.' .nd bI·I.,.ra!. RI ·I.tora l trade offer> cou"trl", 'he grea'''' "'''I''' 10 capllall", on II", "","'(," and red,,,,e , .... "'h 01 engaging In medlcol ",ml,m, as >«-"11 In a co", ... Kly rrom • pot"ntlal U~_I"d!a """Io"'~'p.

llanlel HQ"fali and ~" 'u,hot colle.g,,.. fo<u, O!\ 'he Inle",,,, a. a""""" of d.,a f'" url"""tan" i,tl; mool<., I ...... ""n. In Chaple, H 'h.-y ,.,..'I<h de,"" 'ou"'m " ... ,,1' .. ,~at "1);'" l>o'",,,'a' medical lou,'" •. Thel' an.'y· ,I •• ho .... thai <0",,,,=1.1 .i'''' .'",ed a' IleOpk "",jJn8 dem.' '",a''''''''' .bro.>d g.rt~ .. lIy 'PPC>' "x u.moly p,of",.lort,1. TIli. appa"'" p,of~»Io[) . • 'i.m of dental 'OU,i.m ,if", m .. ~' ,h. f;>e, ,har Ionpo"'''' Infor"'>riOn I. of,." ",'»lnS from ,it"' , eon>C<j""nrly. ~e" .. 1 '''''';'''' co",,,,,,,,-, .", ",,'ik.,y to to. f"Uy Info,med of,lI »1"'<" of 'h" dent.1 ,ou,l<rn P''''''''''

Finally. 'II< .~n~ 01 fu,,, ... adop,ro by ,k,,,.l _.hm ..... '(I""iffHkr """ If _Iytou<htd bu1 01, ..... In off« •• mtanln,Je1 •. 'fh< .... 'hon .... ~ I. cia, ,ha, ..w .... 'in& ,he poor """lilY <>ilnforma.1on on <Im ... 1 ,,,,,.bm >II .. II ""rundy In,porI'"' I<> .. "' .. ,!,,"1I,y 01 '''''', ...... ,; ,"",-,'U. lor .... ny ""'''''' •• "11"~''''>' approach ...... t ..... ''\ablt nor .. ~ ..........

In the fln.l chap'" of Put III. ~ ... IS, T ....... r.l.lnll .nd hi. col· leIgun Introduu ,II< kin 01 • """~'1Dn ".. .......... ' f •• ",......~ for "."",,'1Ona1 I>tal,h no .... 'fh«,,"p'" 1lqI," wI,h. "","deration (If tll<def· 1"111< .... and COfr<q>" '''". In/ofm.n a~ly>I. 01 ".n>Mtlonall>tallh ca .... l"'",na~ "lid ....... In.>blllly_ A rno<kl h "",,,,,,,,,,«1 d •• wlIII UpOll ,he bulldlnll bIo< ~. 01 <lntl""tloll man.g"",~n ••• peclr",.ny ... ~<haldc1 ... hle.l .nd b •• ndh" ,h<otJe1. 'odem"",".',, how the IIn""s", 1><1"""," ,,"''In.'1on m.".somo", .IId ".",".tlon.1 h~. lth c ... c.n bo 00""",.,,«1. eol< . tudy • .ampl'" d.",o",,, ... how "'1l10ll.1 ""'"Iop",.n' In .. 1~Uon '0 h •• l,h .IId !wallh ca •• ".n ..,t"~ 1"..,,1« In t!w European Union,

Index

ocrommodalion, 17, 19,232 incJu.iv~. 40, 154, ISS, 163-74,

'" Iw<u ty. 89, 91 Aumalia, 3, ]7-41, 85, 8 7, 91, ]04,

188-9,243 AU>1ria. IS. 40--1. 90. 104, 160.

192, 249

Ilarba<l<M, S, 6, 37, -13-61 , IS~. 1S8, 160, 162

llelglunt, 15, 28, 103. 106, 111. 139, ]4(1.

160-2, U6-S I blogs, 84, 101,226, 236 bra in <inin, 8, 60, 179, 185-7, 213-15,

219--20 Brozl.t 3, 85, 91. 96--7, 100. lS~ 212,

m

Oon.ada, 7, 51 ,~. 57_9, 90, \02, 151-76, 185, 210

CARICOM (Corlbbean Community and Common MafkotJ. 49, 54

C hina, 7, Ill, 119, 120-1 complaint> procedure. US. 230 Co,ta Ria. +I. 81--8. %. l~L 210.

224,25] "r<rn-bonJoora. ... ,501-6, 1l1-8,176

dofinUlo ... o t 54, 99 _ ah<> guldt" ....

e rui .... hip. 52 Cuba. 159-62. 224 cu ltural proximity, 6, 85. 131--40 cul!ural .. n,IIMly. 203 ell"'. 1,5, 13.-]6, 21-2. 15,311, M , 212 Qoch Il<public, 88, 90, 101-5, 110, 229

[)en""",,- 182 dental "",.,,:.3, Ill, lSI, 161 dent;'lry. 37, 53, 88, 158, 161, 224-3 1 d"'tination

l>ea lth ""re. £5, 162. H$--{;,242 de .... loping nalion., 119, 124-5 di ... bility, 6, M-77, Ill, 180 OOnol. 6-7. 99--110. 113-28, 211

elhic31 tlwory, 2, 183, 20_5 , ' hi<:>, 7, 41,100, Ill. 189,202, ZO-I EU (Europe"" Unlon~ 101, 11"2, 131-47, ,~,

fertUity, 5, 32, 4S-9, 53-7, 99-103, 110, 157--62, 224

Hight:!,7t)...<1 10"'<0",88,96,212

gamete, 6, 96-110 Germany,2, 21.)(1,38-40,139-41. 100,

162,182, 201 , 2ZJ, 2. 7-51 globali"'tioon

0/ lH'a1lh CaR', . , U , 100, H 6, 151, 191, 195, Z08-9,2~0

gU idebook>, 13-15, 1S-19, Z2, 8.S guKlelines

cros.·l:>ord<-r ca.." 136 medkal tourism, 190-1 reproductlve m«Ikine, lOS, 111 tran' piant surgery, 122

health care de<tinations, 55, 162, 17!>-6, 242 in",,,,,,",,,, 57, 118, H4, 137, 140, 248;

marl:<>ting of, 170; prh.""" 7, 3-1, 144,154,170-1 , 174, 177,218, 221; publl<;, 18, _abo modic3L In. uran~

pri,'at~, SO, 54-8, 00, 84, 100, 140, 163.170, 174

prof<.s.lonals, 5Z-60, 67, 77, 21 4, 218, 223,235-6

... rvkn, 50-I , 84, 138, 142, 180 ,y"em, 1, 7. 49, 54-6. 84, 115, 136,

184-9,191. 199, Z48-9; natioonal, 2,5,50-1. 54-6, 138,246; ",form, 7, 18()...Z

holiday, 16, 26, 52, t>4-6. 212, Z33 C05meh< null"''Y, 85-6, 89-96 and dlloabllit}', 69- 71, 73-9

'"

with media.l t""'~~ 151, 1501-5, 166, 170,172,174

ho<pital<, l9-4O, 0 , 51 , 69, 76-7, 91 , 15l-t, 174-5, 186-7, 198, 201, ll7, ,"-'"

InfK'l;on .. 91 luxurlou., 115, 67, 9 1, 94 priv.>te. 16. 58. W~. 179, I SS,

21 4-20,241 hote'" 21, 11-10, 75 , 61, 91, 94, 154,

201 . ;>,48 Hungasy, 15, 1 7, 160, 162. Z2oI, Z29

Indi.a, 16, 102, 108-9, 153-76, 1S6, ISS, 190. 2OS--1 4. 21 7- 20

Inteme~ 71 , 84, 87, 198, 223-55 Irdand. 26. 28, I~, 108-9,

181- 2 Italy, 14-20, Z3--4, 27- 30, 101, I 10, 157,

](;0, 162. 20, z.49

juotiao, 104-6, ]]8, 120, Ill, IZ5, 116, H15, 186, 190-1

dl>trlbuU"", 179, 183

Ilbe.allsatlOfl of health ... ~, 179, 181 _ 1, 209

Malay''', 87, 159-60, 162. Z20I ma.sag<', 12,17, 19, 4 1, 89 medk.;ol cultu~, 95, 139 In ..... na'. 75. 84, _Ilho health ca re,

In .... ana' penonneL 36. 58. 101. 179. 18S--7,...,

aIJq brain d.aln profession .. 33, 39, 198, ZO-I, _alw

braIn drain; modlcaL penonn.1 medk.;ol toun""

fadlllators, 152, 155, 198, 212, 222,

= medical t .,",~, 2, 4, 6, 55, 59, 60, 13 1- 2,

116, 151-5, 162.-76, 179, 191 _1 definltlomof, 138, ;>,41 facilil3tOfJ, 7

medicIne a ltema t;,.." 31-2, 106, 162 h.btoryof, 14

medItation, 32, 37-8, -10, 89, 156 Mex;co, 17, 70, 75, 100, 1l7, 154,

157-62, 167- 9 , 224

Netherland., 15, 182, 243 Norway, 182

obeslty,5l , l14, IS9 _ alw m'8"'Y, b>riatric

o.g.n donation, ]]3-14, 120-7 t rafficking. 122-4

pat len" international 1, 8, 52-61 , 117-46,

198-200, 2OJ--5, 208, 2-10,

,,'-'" t ranmatio.w, Ill, 142, IH, N S, ;>52

patient mobUlty, 1, 3, 67,94, 131- 2. 1l6-8, 140-4, 146, 179, 1S6, 189, 224,240-52

Phtllppines, 120, 185, 213

regu lation , 95 , 102, 108-9, 1l2-6, 142-6, 184, 188, lU, ll2, 252

ho.pltal. 9 1. 214-1 9 lack of, 109; medicaltouri""

f""lIitalOi>,212 organ .. 120 .. 11_regu].,,;on, 91 , III, 221 .tate, 33, 80

re"'rt, 21 _1, 59, 83, 9 1, 94, 154 lik1tyle, l6-t1 .. a.Ide, 16, 18, 91. 9 4 spa, 14_15,2 1

retreat, 16, 19. 1 1, 36-7, -IO-J. 87. 156

Singapore, 157, 160, 162. 188, 21l, 214

Spain, 88, 90, 92, 103, lOS, 160, 162. 229, 241

m'8e'Y ba rlatrlc. 151. 154-fl. 163, 167- 70,

174,176-8 cordia<:, 160, lb!. 172-3, 210-11 co<n~'1c.14 , l~ 83-96, 151, 154,

156-7, 160-3. 167, 169, 170, 224 gender "'~"ign"""'t, 156, 163, 211 ophthalmoLoglr, ISI orthop.>ediC, 53, lSI, 1S6, 157, 161.

163-5.172-3 surrogacy

comme"'ilI1, 98-108 S\\"il7.erhnd. 18. 21 , 21, fl , 160, 162. Z29

25 8 Inda

Thailand, 3, 40, 0 , ~S, 88-91 , 101, IS4-62, 174, 186, 189, 210-11. 213-14,218

lours.9i. ISS-7S, U6 'irtual, 226, 231

Tuni.ia, 9J-.t, 221 Turl .,., 104, 110 , iS9--02. 224,

m

UK, 26, 49-53, 83, 85, 90-3, 99, 10S--6. lOll, U8, HiO, 11;2, 182, 1SS--6, 209, 21 7-20,23 1-4

US, 33, 49, SI-3, S7_9, 69, 87, 90, 93, 101-8, Ill, 11!J-Z4, 128, 13-4, 1l7, 141,154,151- 76, 185, 190-1, 193. 209--11.213-14

USA,4I , 90,9l, 9 7 _al", US

well"... .. 35, 54, 8-1, 151, 160 ph )"ica~ 14 p'ychologic;t\. 18 ~1In<:S' I"",., ..... 5, 30-2, 3S--O, 33--H, ,,~