Diagnosing Canadians’ Medical Tourism

A more hidden type of healthcare

Medical tourism (sometimes referred to as “MT”) can be best understood as travel for medical treatment beyond one’s community. This is not unheard of in countless communities worldwide, with gaps in local healthcare infrastructure. However, as an international phenomenon, MT bears greater socioeconomic implications as patients are incentivized to cross borders for (often privately funded) treatment. In the process, a global economy has steadily emerged to provide treatment and secondary expenditures for international patients (such as accommodations, multilingual services, recreational activities, etc.).

A mounting global MT industry targeting prospective Canadian patients has been a topic of interest in the media over the years but has seldom garnered extensive quantitative studies. The CBC has observed package deals combining medical treatment with overseas tourism as early as 2004. In recent years, reports of Canadians travelling to Lithuania and Mexico when facing inaccessibility to surgeries and Lyme disease treatment back home have made headlines. The Fraser Institute has carried out some of the only quantitative research spanning years regarding Canadians’ outbound treatment. These studies estimated that in 2014, more than 52,000 Canadian patients sought “non-emergency medical treatment” overseas, dropping to an estimated 45,619 in 2015 and rising to an estimated 63,459 in 2016.

These circumstances raise two important questions: if such little quantitative information exists regarding Canadians’ MT, how can conclusions be drawn regarding MT as it relates to Canadians, and what conclusions might they be? In the absence of robust statistics, Canadians’ MT can instead be evaluated qualitatively by reflecting on some of the incentives of MT, positing failures of domestic healthcare provision as key inspiration for Canadian patients to seek medical attention overseas.

Recognition of the industry

Existing research suggests that the size of the MT industry cannot be underestimated. If seeking alternatives to domestic healthcare options, Canadian patients— alongside millions of other patients worldwide— have many options on offer, and collectively, their spending power is significant. Patients Without Borders has estimated the market size of the global MT industry at $63-88 billion USD in 2023, with somewhere between 21 and 22 million patients crossing borders for treatment that same year.

While the private sector has benefitted from the rise in MT, governments around the world have also demonstrated an interest in promoting MT to prospective patients overseas. A 2014 analysis highlighted how the Hungarian Ministry of Health financed a symposium on MT in London; all the while, the government of Thailand invested in its infrastructure to render the country an attractive destination for foreign patients. For Canadian patients, outbound MT has undergone considerable formal legitimation domestically and overseas. Some policies related to MT have been drafted at the provincial level regarding out-of-province coverage. For example, if treatment is deemed medically necessary but is unavailable in Canada, Newfoundland and Labrador’s Medical Care Plan (MCP) “will provide coverage for medically necessary physician services” (with prior approval).

Together, these circumstances speak to the emergence of a quasi-formalized international healthcare network where gaps in domestic public healthcare provision are resolved through MT by way of drafting policies in some jurisdictions (such as those in Canada) covering interventions deemed “medically necessary.” Conversely, if interventions are considered elective, patients can anticipate paying out of pocket. However, the necessity of every intervention is not always agreed upon by patients and their healthcare providers.

Medical necessity and healthcare provision

To clarify, MT exists for medical interventions deemed essential and non-essential, with some procedures, such as cosmetic surgeries, often deemed non-essential. However, every patient’s medical issues are addressed within a healthcare system’s framework, meaning that interventions and care can be constrained by structural challenges to that system (such as shortages in resources, medical professionals, etc.).

In recent times, patients and healthcare professionals alike have routinely criticized healthcare accessibility across Canada, particularly the declining accessibility to primary care providers and unpredictable wait times for surgeries. In this spirit, Jeremy Snyder, professor of health sciences at Simon Fraser University, has suggested that Canadian patients may opt for MT if they seek treatment that is too expensive, has too long of wait times, or is unavailable or illegal in Canada. Challenges such as these may, therefore, incentivize patients to seek interventions abroad deemed “non-emergency medical treatment” by domestic healthcare systems but may otherwise be considered essential by patients and their loved ones for access to timely and effective care.

Existing knowledge of MT additionally reveals its relationship with recent migration patterns. It has been suggested in the British example that some migrant communities may opt for treatment in their country of origin for reasons of affordability, perceptions of care and better familiarity with that country’s healthcare system. Thus, the use of MT among the Canadian public can similarly be considered through the lens of migration; further studies on this matter may show public knowledge gaps on domestic healthcare provision, multicultural perspectives on care, and other systemic challenges for migrant patients as further factors in the choice of MT among some Canadians.

Some criticism has been leveraged against the MT industry for the risks patients may encounter. In a webpage dedicated to MT, the Canadian government cautions its citizens to be mindful of some risks they may face when seeking treatment abroad, namely stemming from language barriers, different standards for medical professional certification, and even the possibility of having organs transplanted that were harvested nonconsensually. Medical professionals in Australia and Ireland have raised their voices regarding patients receiving poor medical interventions overseas, only to need further treatment when they return home. Canadians’ medical tourism, like that of other nationalities, evidently comes with possible further health complications. While there are many competent medical professionals in the MT industry offering sound treatment to patients worldwide, addressing systemic challenges to healthcare provision in Canada may reduce the likelihood that patients needing medical attention will risk less reputable and safe treatment overseas.

Consumerist responses to systemic challenges?

Conclusions on Canadians’ medical tourism can be drawn from statistical data, but given the relative deficit in such information as it relates specifically to Canadians, researchers can further study this phenomenon by analyzing media testimonies, public health policies, realities of healthcare provision in Canada and statistics and scholarly research on MT from comparative and global perspectives. Such an approach demonstrates a sizeable industry with some legitimation from governments worldwide, including public policy being introduced in Canada to clarify which interventions receive public funding. However, because MT effectively serves to fill gaps in healthcare provision (which has recently attracted a great deal of criticism in Canada), Canadians may be further incentivized to seek medical attention overseas despite risks they may incur.

Addressing primary care availability and time efficiency for surgeries, along with increasing public knowledge of navigating healthcare in Canada, may be crucial first steps in improving Canadians’ relationship with the public healthcare system. Given the size of the global MT industry and dissatisfaction with healthcare provision in Canada, more extensive studies must be undertaken to uncover to what extent Canadian patients are currently seeking treatment overseas and what factors they cite as influential in their decisions. Such studies may speak to other flaws in healthcare accessibility in Canada, but they may also verify concerns raised by patients and medical professionals regarding the MT industry.