esp for tourism

Medical tourism carries some risks that locally-provided medical care does not. Some countries, such as India, Malaysia, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g. Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress, mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nation’s diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be "rare" in the West.^[30]

The quality of post-operative care can also vary dramatically, depending on the hospital and country, and may be different from US or European standards. However, JCI and Trent fulfill the role of accreditation by assessing the standards in the healthcare in the countries like India, China and Thailand. Also, traveling long distances soon after surgery can increase the risk of complications. Long flights and decreased mobility associated with window seats can predispose one towards developing deep vein thrombosis and potentially a pulmonary embolism.^[31] Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing.^[32] To minimise these problems, medical tourism patients often combine their medical trips with vacation time set aside for rest and recovery in the destination country.

Also, health facilities treating medical tourists may lack an adequate complaints policy to deal appropriately and fairly with complaints made by dissatisfied patients.^[33]

Differences in healthcare provider standards around the world have been recognised by the World Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists hospitals and government around the world in setting patient safety policy and practices that can become particularly relevant when providing medical tourism services.^[34]

Finally, after returning home, a patient will have limited contact with his or her surgeon. This means that it will be difficult to deal with any complications that may arise later such as a delayed infection.

However, balancing potential risks is the fact that in some foreign hospitals most or all nurses are registered nurses, as opposed to the nurses aides or other less qualified personnel which are commonly used in American hospitals. Understaffing and the use of overworked and fatigued nursing staff, which is common in American hospitals, may not be as prevalent in some foreign hospitals.

Receiving medical care abroad may subject medical tourists to unfamiliar legal issues.^[35] The limited nature of litigation in various countries is one reason for the lower cost of care overseas. While some countries currently presenting themselves as attractive medical tourism destinations provide some form of legal remedies for medical malpractice, these legal avenues may be unappealing to the medical tourist. Should problems arise, patients might not be covered by adequate personal insurance or might be unable to seek compensation via malpractice lawsuits. Hospitals and/or doctors in some countries may be unable to pay the financial damages awarded by a court to a patient who has sued them, owing to the hospital and/or the doctor not possessing appropriate insurance cover and/or medical indemnity.^[36]

There can be major ethical issues around medical tourism.^[35] For example, the illegal purchase of organs and tissues for transplantation had been alleged in countries such as India^[37][38] and China^[39] prior to 2007. The Declaration of Istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".^[40]

Medical tourism may raise broader ethical issues for the countries in which it is promoted. For example in India, some argue that a "policy of 'medical tourism for the classes and health missions for the masses' will lead to a deepening of the inequities" already embedded in the health care system.^[41] In Thailand, in 2008 it was stated that, "Doctors in Thailand have become so busy with foreigners that Thai patients are having trouble getting care".^[42] Medical tourism centred on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. However, when pioneering advanced technologies, such as providing 'unproven' therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation.^[43][44]

The English language sub-sector is a significant revenue contributor - Millns estimates that in 2008 there were 380,000 foreign students studying in 370 centres, worth £1.2 billion in export earnings. The destinations in which these English language centres and schools are located have historically been promoted as a ‘gateway to Britain, a showcase for Britain and a projection of Britain abroad’

The following brief examples highlight how destinations and attractions are innovatively capitalising on the worldwide demand for English language courses and the associated impacts. The City of Brighton and Hove’s 2008/2018 visitor economy strategy [12] explicitly states that one of its key tourism strengths is that the city ‘continues to be successful in attracting English language students and recently saw the opening of one of Europe’s largest and most modern English Language training facilities in the New England Quarter’.

Similarly, the 35,000 language school students studying English as a foreign language each year make an important contribution to the Hastings economy with some estimates suggesting that the students’ expenditure represents around 25% of the £75 million in total income derived from all tourism activity in Hastings. It is also useful to note that the local council is advocating an extension of the season during which language schools operate in Hastings to more evenly distribute the influx of students.

The Tower of London provides another interesting example of the way in which visitor attractions can innovatively package their offer to the overseas English language education market. Tower history for students from abroad is promoted through workshops. Designed within English as Foreign Language (EFL) guidelines, the workshops are led by costumed presenters and explore many of the stories that make the Tower a unique World Heritage Site.

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