Characterizing barriers and facilitators of metabolic bariatric surgery tourism: a systematic review.

BACKGROUND: Metabolic bariatric surgery tourism continues to rise and has become a growing concern for bariatric surgeons globally. With varying degrees of regulation, counselling and success, those that develop complications may have to deal with a multitude of challenges often distant from their country of operation. The aim of this study was to characterize the barriers and facilitators influencing individuals to undergo metabolic bariatric surgery tourism, in order to better understand the implications to the National Health Service and other healthcare systems. METHODS: A systematic literature search, restricted to the English language, was performed to identify relevant studies. All studies were included until December 2022, the last search date. Study quality was assessed with the validated mixed-methods appraisal tool. A Braun and Clarke thematic analysis was undertaken to identify themes and subthemes. RESULTS: A total of five studies met the inclusion criteria. Identified themes included: availability, accessibility, cost, eligibility, reputation, and stigma; the available evidence was of varying quality. CONCLUSION: This work identifies a series of subthemes influencing the decision to undertake metabolic bariatric surgery tourism. The results highlight the limited literature available in understanding the complex motivational insights; the scale of the problem in the current healthcare system; cost and long-term outcomes. A National Emergency Bariatric Surgery audit would allow generation of more robust data to explore further the issues of clinical relationships and networks and to guide policy making.

Challenges with medical tourism.

PURPOSE OF REVIEW: With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months. RECENT FINDINGS: There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years. SUMMARY: Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.

Retinal injury from a laser skin resurfacing device during medical tourism: a public health concern.

BACKGROUND: Laser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequently, there is an incentive to go abroad, where prices are more affordable. However, practitioners in destination countries may lack rigorous training on laser safety, regulatory oversight, or licensing, especially on devices used for "cosmetic" procedures. In certain cases, this can lead to tragic outcomes, especially when underqualified practitioners operate medical-grade laser devices. CASE PRESENTATION: A 29-year-old woman suffered a retinal burn from a handheld Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulse device used to perform skin resurfacing treatment at a medical spa in Vietnam. The patient was not adequately informed about the potential risk to her vision and was not provided with any eye protection. A momentary, unintended laser exposure to the patient's right eye led to irreversible vision loss due to a macular burn. This incident caused immediate pain, followed by the sudden appearance of floaters, along with a retinal and vitreous hemorrhage. Despite treatment with off-label bevacizumab for the development of a choroidal neovascular membrane, vision remained at the level of counting fingers because of the presence of the macular scar. CONCLUSION: When utilizing laser-based devices, it is crucial to employ safety measures, such as the wearing of safety goggles or the use of eye shields to protect ocular tissues from potential damage. The growing availability of cosmetic laser devices presents a substantial public health risk, because numerous operators lack adequate training in essential safety standards, or they neglect to follow them. Furthermore, patients seeking services abroad are subject to the regulatory practices of the destination country, which may not always enforce the requisite safety standards. Further research is needed to determine regional and global incidence of laser-related injuries to help direct educational and regulatory efforts.

Cross-border healthcare-seeking and utilization behaviours among ethnic minorities: exploring the nexus of the perceived better option and public health concerns.

BACKGROUND: Many ethnic minorities in Hong Kong seek medical tourism after encountering inequalities in access to local healthcare because of language barriers and cultural-religious differences. The present study explored the ethnic minorities' lived experiences of medical tourism and issues arising from cross-border health-seeking relevant to this specific population. METHODS: Qualitative in-depth interviews with 25 ethnic minority informants from five South Asian countries in 2019. RESULTS: The 19 informants out of the 25 have sought assistance from their international networks for home remedies, medical advice and treatments of traditional/Western medicines, for they are more costly or unavailable in Hong Kong and for issues related to racial discrimination, language barriers, transnationalism engagement, cultural insensitivity, and dissatisfaction with healthcare services in Hong Kong. DISCUSSION: Medical tourism can relieve the host country's caring responsibilities from healthcare services, so the government might no longer be hard-pressed to fix the failing healthcare system. Consequently, it could cause public health concerns, such as having patients bear the risks of exposure to new pathogens, the extra cost from postoperative complications, gaps in medical documentation and continuum of care, etc. It also triggers global inequities in health care, exacerbating unequal distribution of resources among the affordable and non-affordable groups. CONCLUSION: Ethnic minorities in Hong Kong sought cross-border healthcare because of structural and cultural-religious issues. The surge of medical tourism from rich and developed countries to poor and developing countries may infringe upon the rights of residents in destination countries. To mitigate such negative impacts, policymakers of host countries should improve hospital infrastructure, as well as train and recruit more culturally sensitive healthcare workers to promote universal health coverage. Healthcare professionals should also strive to enhance their cultural competence to foster effective intercultural communication for ethnic minority groups.

A comprehensive perspective on local drivers in community-based health tourism industry development: a qualitative study of Mazandaran Province, Iran.

BACKGROUND: Health tourism is an important component that may influence the direction of development in a region. Mazandarn, Iran, is recognized as a highly sustainable market in the region because of its abundant natural resources, temperate temperature, and strategic geographical location. Therefore, considering the importance of health tourism and its existing potential in Mazandaran, Iran, this study was conducted with the aim of exploring a comprehensive perspective on local drivers in community-based health tourism industry development and factors affecting the attraction of health tourism. METHODS: We conducted this study in Mazandarn, Iran, using a qualitative approach. Participants included a sample of Iranian people, aged 34-54 years, with previous history of health tourism or expert in it. Participants were selected from three different categories of the community: academic professionals in health tourism, managers in health tourism, and health tourists. Data were obtained via semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was used to converge and compare themes through participant data. The interviews kept going until data saturation was achieved. RESULTS: Based on our findings, we distilled local drivers in community-based health tourism industry development into five main categories and 30 subcategories: (Sharifabadi AM, Ardakani FA. A model for health tourism development using fuzzy TOPSIS and interpretive structural modeling in Yazd province. J Health Adm (JHA). 2014;17:55.) infrastructure and resources; (Hemmati F, Dabbaghi F, Mahmoudi G. Investigating the impact of Information Technology on the status of Health Tourism in Mashhad, Iran. Revista Publicando. 2018;5(15):54-65.) tourist attractions; (Sarabi Asiabar A, Rezapour A, Raei B, Tahernezhad A, Alipour V, Behzadifar M. Economic, Cultural, and Political Requirements for Medical Tourism Development in Iran: Insights from a Fuzzy Analytical Hierarchy Process Method. Med J Islamic Repub Iran. 2022;35:199.) socio-cultural contexts; (Mosadeghrad AM, Sadeghi M. Medical tourism: Reasons for choosing Iran. Payesh (Health Monitor). 2021;20(2):145-66.) economic-financial factors; and (Manna R, Cavallone M, Ciasullo MV, Palumbo R. Beyond the rhetoric of health tourism: shedding light on the reality of health tourism in Italy. Curr Issues Tourism. 2020;23(14):1805-19.) political-communicative factors. The findings of the study showed that, from the participants' point of view, although there are several strategies, such as the development of public service and tourism infrastructure, increasing tourist attractions, and formulating appropriate policies and procedures for the development of health tourism, they are also faced with many challenges, especially political, economic, and cultural challenges. CONCLUSION: This study showed that improving infrastructure and resources, promoting tourist attractions, informing socio-cultural contexts, improving economic and financial capacity, and developing political and communicative contexts might increase the attraction of health tourists. The suggested components are not contextually driven, although empirical outcomes may differ based on the level of service offerings in health tourism locations.

Social egg freezing and reproductive rights justification: A perspective from China.

Divergences and controversies are inevitable in the discussion of freedoms and rights, especially in the matter of reproduction. The Chinese first social egg freezing lawsuit raises the question: is the freedom to freeze eggs for social reasons justified because it is an instance of reproductive rights? This paper accepts social egg freezing as desirable reproductive freedom, but following Harel's approach and considering two theories of rights, the choice and interest theories of rights, we argue that social egg freezing is not a reproductive right because one cannot justify a right or an instance of rights via merely describing the function of those instances that have been justified as right, that is, the choice theory lacks justifying normativity. Since reserving fertility and a suspension from reproduction do not serve reproductive ends per se, the sufficient reason for demanding social egg freezing as a right should be found in other ends rather than in right-to-reproduce, that is, the interest theory denies the demand as a right-to-reproduce. Permitting it on any grounds without guaranteeing adequate and accessible resources, especially in light of cross-border reproductive care, raises serious questions about reproductive equality and violates the idea of reproductive rights. Therefore, any ground for social egg freezing should be weighed against whether more pressing reproductive needs, specifically those that are justified as rights, have been met. It would be social progress to shoulder these burdens for the vulnerable and then allow social egg freezing-if right-to-reproduce were not the only privilege of the few.

Medical tourism among Indonesians: a scoping review.

BACKGROUND: International medical travel or medical tourism is not a new phenomenon in many countries, including among Indonesians. Indonesia is reported as a major source of patients from the lower, middle, to upper classes for its neighbouring countries. This scoping review aims to synthesise evidence on supporting factors for Indonesians taking medical tourism and what needs to be improved in Indonesia's health system. METHODS: We conducted a scoping review guided by a framework provided by Arksey and O'Malley. We systematically searched existing literature from 5 databases, including MEDLINE, PubMed, Scopus, ProQuest, and Wiley. Data were extracted based on study details, study design, characteristics of participants and results. Analysis followed the three-stage procedure outlined by Thomas and Harden: (1) coding the text line by line, interpreting the data and identifying concepts or themes; (2) developing descriptive themes by grouping similar concepts in theme and subtheme and (3) generating analytical themes by reviewing preliminary themes and discussing the addition or revision of themes. RESULTS: A total of 25 articles were included in this review. The review highlights a broad range of facilitators for medical tourism among Indonesians: (i) availability of health services, medical specialities, and person-centred care, (ii) region adjacency, transport, and health agency, (iii) affordability of medical treatment, (iv) religious and socio-cultural factors, and (v) reasons patients reported distrust in Indonesian doctors. CONCLUSION: The findings indicate improvements in the Indonesian health system are necessary if the increasing rates of international medical tourism by Indonesian people are to change. Addressing the factors identified in this scoping review through avenues including policy may increase people's satisfaction and trust towards health care and treatment in Indonesia, thereby reducing the number of Indonesian people taking medical tourism.

The transformation of Jordan's healthcare system in an area of conflict.

BACKGROUND: The Jordanian healthcare system has evolved over the past decades expanding its services, technological, and educational resources. A comprehensive view of this system is lacking. The objective of this report is to describe the structure of the Jordanian healthcare system, the challenges facing it, and the current and recommended health policies. MATERIALS AND METHODS: This study reviewed the current status of the Jordanian healthcare system. The following parameters were analyzed: health indicators, infrastructure, human resources, insurance system, pharmaceutical expense, health education system, and medical tourism. Data were collected from various relevant official institutions and related published literature. RESULTS: Jordan has a young population with a median age of 23.8 years. Life expectancy is 78.8 years for females and 77.0 years for males. The Jordanian healthcare system is divided into three major categories: (1) Governmental Insurance (i.e., the Ministry of Health (MOH), the Royal Medical Services (RMS) and semi-governmental insurance); (2) Private Insurance; and (3) Refugee Insurance, including the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR). The Governmental Insurance covers 64.30% of the total population. Health expenditure is 6.37% of the gross domestic product (GDP). Pharmaceutical expenses make up 26.6% of the total national healthcare budget. Human resource assessment shows a high ratio of medical staff per 10.000 inhabitants, especially concerning physicians (31.7), dentists (7.9), and pharmacists (15.1). However, the ratio of nursing staff per 10.000 inhabitants is considered low (37.5). The Hospital bed/1000 population ratio is also relatively low (1.4). Healthcare accreditation is implemented through the Joint Commission International (JCI) accreditation which was achieved by 7 hospitals and by the National Health Care Accreditation Certificate (HCAC) achieved by 17 hospitals and 42 primary healthcare centers. Postgraduate medical education covers almost all medical and surgical fields. Medical tourism is currently well-established. CONCLUSIONS: Assessment of the Jordanian healthcare system shows high ratios of physicians, dentists, and pharmacists but a low ratio of nursing staff per 10.000 inhabitants. The hospital bed/1000 population ratio is also relatively low. Pharmaceutical expenses are significantly high and medical tourism is well-developed.

The analysis of the medical tourism expansion policy in Taiwan: a policy analysis using Kingdon's multiple streams.

BACKGROUND: Since 2006, Taiwan has actively pursued the development of its medical tourism industry. In 2013, the government sought to bolster this sector by integrating medical tourism into the Free Economic Pilot Zones. Despite narrowly missing the mark, the initiative failed to materialize into law. This qualitative study endeavors to discern the pertinent factors influencing the agenda-setting process for incorporating medical tourism into the Free Economic Pilot Zones in Taiwan. METHODS: A comprehensive examination of policies concerning the legitimation of medical tourism within the Free Economic Pilot Zones was undertaken through semi-structured interviews and a thorough review of policy documents. Key informants were strategically selected using purposive and snowball sampling techniques. Thematic analysis was applied to scrutinize the amassed data and organize it within the framework of Kingdon's multiple streams. RESULTS: In the problem stream, increasing financial strains and cost containment pressures under the National Health Insurance program have long driven health care providers to seek further opportunities in medical tourism. The existing barriers to expanding medical tourism in Taiwan included diplomatic tensions (specifically cross-strait relations), public concerns about commercialization of medical care and reduced their access to care, and legal and language barriers. Within the policy stream, factors such as franchise fees to support national health insurance, limited number of demonstration medical tourism sites and services allowed, the allowance of foreign medical personnel, regulations governing domestic physicians, the importance of demonstration, regulation, and accreditation, as well as restrictions on investment from China, were emphasized. The politics stream highlights factors such as governmental support, opposition from opposing parties, public concerns and critics from academia and non-governmental organizations, and skepticism from medical faculties. CONCLUSION: Acknowledging the recognized challenges in enacting the medical tourism provision of the Free Economic Pilot Zones Special Act and emphasizing the political will of leadership, a viable policy solution remained elusive. Although a window of opportunity existed for the passage of the bill, it waned as public concerns sidelined the issue from the national agenda. The Taiwan case underscores the necessity for meticulous consideration of issues, proposed solutions, and political dynamics to achieve successful policy enactment.

The cost of cosmetic surgery tourism complications to the NHS: A retrospective analysis.

INTRODUCTION: Medical tourism refers to the process of patients travelling outside of their native country to undergo elective surgical procedures and is a rapidly expanding healthcare phenomenon [1-3]. Whilst a multitude of established Private Healthcare Providers (PHPs) offer cosmetic surgical procedures within the United Kingdom (UK), a growing number of patients are opting to travel outside of the UK to undergo cosmetic surgery. AIM: To assess the number of patients presenting to the Canniesburn Plastic Surgery Unit, with cosmetic surgery tourism complications, from outside of the UK, and the associated costs to NHS Scotland over a five-year period. METHODS: A retrospective case review of a prospectively maintained trauma database, which records all acute referrals, was undertaken analysing patients referred from January 1st 2019 to December 31st 2023 inclusive. RESULTS: 81 patients presented over five years with complications of cosmetic surgery tourism. The most common presenting complaints were wound dehiscence (49.4%) or wound infection (24.7%). The total cost to NHS Scotland was £755,559.68 with an average of £9327.90 per patient. CONCLUSION: This is the largest single centre cohort of cosmetic surgery tourism complications reported within the NHS to date; with rates on the rise, demand grows for increased patient information regarding healthcare tourism risks, a national consensus on the extent of NHS management and urgent international collaboration with policymakers is required to address this issue across borders.

Cosmetic Medical Tourists' Use of Online Support Communities: Sharing Information, Reciprocity, and Enduring Relationships.

Cosmetic procedures are amongst the most popular procedures sought after by medical tourists. Cosmetic medical tourists utilise numerous sources of information when planning their trips including, where available, discussing their decision with previous medical tourists. Current research on online support communities has investigated the interactions of patients with various health conditions with online support; however, limited research exists on cosmetic medical tourists' participation in online support communities. Here we report findings from our qualitative interview study of Australian cosmetic medical tourists. We found that many of our participants experienced stigma regarding their intention to receive cosmetic procedures and to travel overseas from within their local social networks. Participating in online communities (Facebook groups) enabled them to access information and support from other cosmetic medical tourists. Through using public posting and messaging functionality of the communities, they performed two distinct roles in the groups that parallel the temporal transitions of their journeys: they were information and support seekers pre-surgery and information and support providers post-surgery. The reciprocity they practiced in the provider role occurred due to their desire to 'pay forward' the support they had received from others pre-surgery. This role was performed as a collective, community-based reciprocity rather than a direct mutual exchange. Some participants also transitioned their online relationships into enduing offline friendships demonstrating how online interactions may become enmeshed with broader social networks.

Cerebral vasospasm due to Fusarium solani meningitis: A complication from medical tourism. Case report and literature review.

OBJECTIVES: Medical tourism is expanding globally, with patients seeking cosmetic procedures abroad. To date, little information is known regarding the risks and outcomes of cosmetic tourism, especially potential stroke complications. Here, we present a case of fungal meningitis in the setting of medical tourism leading to ischemic strokes and vasospasm. MATERIAL AND METHODS: We describe an immunocompetent 29-year-old female patient who initially presented with intractable headaches and an abnormal cerebrospinal fluid (CSF) profile who was eventually diagnosed with Fusarium solani meningitis as a part of a common source outbreak in Matamoros, Mexico. These patients were part of a cohort who underwent cosmetic procedures requiring spinal anesthesia. This report also highlights the unusual clinical course leading to poor outcomes in such conditions. RESULTS: The patient initially presented with headaches, papilledema, elevated opening pressure on the spinal tap, abnormal CSF studies, and eventually developed ischemic strokes and hydrocephalus. CSF showed positive beta D-Glucan with repeated negative CSF fungal cultures. A cerebral angiogram revealed extensive basilar artery vasospasm that led to ischemic strokes. Continued clinical worsening and lack of response to antifungal treatment prompted further imaging that revealed significant non-obstructive hydrocephalus subsequently complicated by spontaneous intracranial hemorrhage. CSF PCR for Fusarium solani species was positive days after her passing. CONCLUSION: This novel case highlights fungal meningitis caused by Fusarium solani complicated by bilateral ischemic strokes stemming from basilar artery vasospasm. Complications from medical tourism impact not only individual patients but also the health systems of both countries. Professional and regulatory entities for cosmetic surgeries must highlight and educate patients on the risks and complications of cosmetic surgeries happening abroad. Physicians should be aware of ongoing outbreaks and possible complications of these procedures.

Domestic and International Cosmetic Tourism Complications Presenting to a US Tertiary Hospital.

BACKGROUND: Cosmetic surgery tourism has become a significant global industry. Often patients who develop postoperative complications present for care in their US home state. OBJECTIVES: In this study we evaluated patients who either traveled abroad or to other states within the United States for cosmetic surgeries and later came with complications for treatment at the authors' center. We sought to compare rates of complications between patients who underwent cosmetic surgery internationally and domestically. METHODS: In this retrospective cross-sectional study we reviewed patients who presented from June 2014 to June 2022 with concerns related to cosmetic surgeries performed in another state or abroad. Binary logistic regressions were performed to assess differences in outcomes between domestic and international cases, including complications, interventions, and admissions. RESULTS: One-hundred twenty-three patients (97.6% female, mean age 34.0 ± 8.7 years, range 16-62 years) sought 159 emergency department consultations. The most common procedures included abdominoplasty (n = 72) and liposuction (n = 56). Complications included wound dehiscence (n = 39), infection (n = 38), and seroma (n = 34). Over one-half of patients required intervention. Twenty-nine patients (23.6%) required hospital admission. On multivariate regression analyses, incidence of seroma (P = .025) and oral (P = .036) and intravenous antibiotic prescriptions (P = .045) was significantly greater among the international cohort than the domestic, and all other complication variables were nonsignificant. There were no other significant differences in operative interventions or hospital admissions between international and domestic cohorts. CONCLUSIONS: Compared to domestic tourism cases, international tourism cases were associated with significantly higher rates of seroma formation and antibiotic use. There were no significant differences otherwise in overall complications, including infections, operative interventions, or hospital admissions.

Perception, Practice and Cost Burden of Medical Tourism Among Physicians in Public Tertiary Health Facilities in Oyo State, South-West, Nigeria.

BACKGROUND: Physicians are key to the clinical decision-making of their clients. Their perception and practice of medical tourism could influence their clients' uptake of the same. This study assessed the perceptions about medical tourism among physicians practising in public tertiary health facilities in Oyo state. We then assessed its practice and cost burden among physicians who had ever engaged in medical tourism. METHODOLOGY: This cross-sectional study conducted in 2019 involved 360 physicians working in two public tertiary health facilities in Oyo State, selected via a two-stage simple random sampling technique. Quantitative data was collected using a semi-structured pre-tested self-administered tool. Data collected was analysed using STATA 17.0 with statistical significance inferred at p<0.05. FINDINGS: The physicians' mean score on knowledge of medical tourism was 4.0±0.8 of 5 marks obtainable. Organ transplant was the most commonly known reason for engaging in medical tourism. Destination country hospital facilities and equipment ranked highest and cost considerations ranked least of perceived factors promoting it. Twenty-four (6.7%) of the physicians studied ever engaged in medical tourism, while 258 (71.7%) intend to if the need arose. The most popular destination country was India. The mean direct cost of engaging in medical tourism was $3,351±$4,357. The mean indirect cost was $2,389±$774, while the mean total cost was $5,739.6±$4,841.8. The majority of the 24 physicians (83.3%) who engaged in medical tourism suffered catastrophic health spending from it. CONCLUSION: High burden of medical tourism on the physicians. Funds spent on medical tourism by them could be used to strengthen the delivery of health services, such as ensuring children are fully immunised.

CONTEXTE: Les médecins jouent un rôle clé dans la prise de décision clinique de leurs patients. Leur perception et leur pratique du tourisme médical pourraient influencer l'adoption de cette pratique par leurs patients. Cette étude a évalué les perceptions concernant le tourisme médical parmi les médecins exerçant dans des établissements de santé tertiaires publics de l'État d'Oyo. Nous avons ensuite évalué sa pratique et son coût parmi les médecins ayant déjà eu recours au tourisme médical. MÉTHODOLOGIE: Cette étude transversale menée en 2019 a impliqué 360 médecins travaillant dans deux établissements de santé tertiaires publics de l'État d'Oyo, sélectionnés par une technique d'échantillonnage aléatoire simple en deux étapes. Des données quantitatives ont été recueillies à l'aide d'un outil semi-structuré pré-testé et auto-administré. Les données collectées ont été analysées à l'aide de STATA 17.0, avec une signification statistique déduite à p<0,05. RÉSULTATS: Le score moyen des médecins en termes de connaissance du tourisme médical était de 4,0±0,8 sur 5 points possibles. La greffe d'organes était la raison la plus souvent citée pour recourir au tourisme médical. Les infrastructures et équipements hospitaliers du pays de destination étaient les facteurs les plus influents, tandis que les considérations de coût étaient les moins perçues. Vingt-quatre (6,7 %) des médecins étudiés avaient déjà eu recours au tourisme médical, tandis que 258 (71,7 %) avaient l'intention de le faire en cas de besoin. Le pays de destination le plus populaire était l'Inde. Le coût direct moyen du recours au tourisme médical était de 3 351 $±4 357 $. Le coût indirect moyen était de 2 389 $±774 $, tandis que le coût total moyen était de 5 739,6 $±4 841,8$. La majorité des 24 médecins (83,3 %) ayant eu recours au tourisme médical ont subi des dépenses de santé catastrophiques à cause de cela. CONCLUSION: Le fardeau du tourisme médical sur les médecins est élevé. Les fonds dépensés pour le tourisme médical pourraient être utilisés pour renforcer la prestation des services de santé, comme assurer que les enfants soient entièrement vaccinés. MOTS CLÉS: Tourisme médical, Connaissance, Pratique, Fardeau des coûts, Services de santé, Dépenses de santé catastrophiques, Facteurs déterminants du tourisme médical, Touristes médicaux.

Physicians' Perception on the Relevance of Healthcare Marketing in a Tertiary Hospital, South-West, Nigeria.

BACKGROUND: Developing nations like Nigeria lose an appreciable percentage of their revenue through medical tourism. The majority of the elite class is not even aware that some of the Medical care sourced in the western climes can readily be accessed locally in some of the healthcare facilities around, amounting to a load of missed opportunities some of which would have been avoided through effective healthcare marketing. This study assessed the perception of healthcare providers on healthcare marketing in Obafemi Awolowo University Teaching Hospital, Ile Ife, Osun State, Nigeria. METHODOLOGY: This is a cross-sectional study. Data collection was by simple random sampling with the aid of a self-administered questionnaire among 190 medical doctors working at Obafemi Awolowo University Teaching Hospital, Ile-Ife. The quantitative data were entered and analyzed using IBM SPSS Statistics version 22. Univariate and bivariate modes of analysis were employed to determine associations between socio-demographic characteristics and the perception of healthcare providers on healthcare marketing. The level of significance was defined at a 95%, confidence interval (p<0.005). RESULTS: The majority of the respondents (79.6%) had good knowledge about services rendered in the facility and a good perception (86.9%) about healthcare marketing with significant association with their specialties as more of the surgically related specialties (93%) recommended healthcare marketing. Among the respondents, (85.6%) agreed that public hospitals have to provide information about the services they offer; (93.4%) agreed that patients have the right to receive information about the services offered, and (63.5%) did not agree that marketing in healthcare is unethical. More than sixty percent of the respondents (62.3%) agreed that healthcare marketing will reduce medical tourism and improve service quality (74.3%). Majority (85%) of the respondents recommended that their healthcare facility should invest in healthcare marketing. CONCLUSION: The study revealed that a high proportion of healthcare providers have a good perception of healthcare marketing and will support their facility's investment in it as this will improve the quality services and increase patients patronage within the health sector.

CONTEXTE: Les nations en développement comme le Nigéria perdent une part appréciable de leurs revenus à cause du tourisme médical. La majorité de la classe élite n'est même pas consciente que certains des soins médicaux recherchés en Occident peuvent être facilement accessibles localement dans certaines installations de santé, ce qui entraîne des occasions manquées qui auraient pu être évitées par un marketing efficace des soins de santé. Cette étude a évalué la perception des prestataires de soins de santé sur le marketing des soins de santé à l'hôpital universitaire Obafemi Awolowo, Ile Ife, État d'Osun, Nigéria. MÉTHODOLOGIE: Il s'agit d'une étude transversale. La collecte de données a été réalisée par échantillonnage aléatoire simple à l'aide d'un questionnaire auto-administré auprès de 190 médecins travaillant à l'hôpital universitaire Obafemi Awolowo, Ile-Ife. Les données quantitatives ont été saisies et analysées à l'aide du logiciel IBM SPSS Statistics version 22. Des modes d'analyse univariée et bivariée ont été employés pour déterminer les associations entre les caractéristiques sociodémographiques et la perception des prestataires de soins de santé sur le marketing des soins de santé. Le niveau de signification a été défini à un intervalle de confiance de 95 % (p<0,005). RÉSULTATS: La majorité des répondants (79,6 %) avaient une bonne connaissance des services rendus dans l'établissement et une bonne perception (86,9 %) du marketing des soins de santé, avec une association significative avec leurs spécialités, car plus de spécialités chirurgicales (93%) recommandaient le marketing des soins de santé. Parmi les répondants, 85,6 % étaient d'accord pour dire que les hôpitaux publics doivent fournir des informations sur les services qu'ils offrent ; 93,4 % étaient d'accord pour dire que les patients ont le droit de recevoir des informations sur les services offerts, et 63,5 % n'étaient pas d'accord pour dire que le marketing dans le domaine de la santé est contraire à l'éthique. Plus de soixante pour cent des répondants (62,3 %) étaient d'accord pour dire que le marketing des soins de santé réduirait le tourisme médical et améliorerait la qualité des services (74,3 %). La majorité (85 %) des répondants ont recommandé que leur établissement de soins de santé investisse dans le marketing des soins de santé. CONCLUSION: L'étude a révélé qu'une forte proportion de prestataires de soins de santé ont une bonne perception du marketing dans le secteur de la santé et soutiendraient l'investissement de leur établissement dans ce domaine, car cela améliorerait la qualité des services et augmenterait la fréquentation des patients dans le secteur de la santé. MOTS-CLÉS: Marketing, Marketing des soins de santé, Médecins, Hôpitaux.

Preparing your patient to travel the globe.

ABSTRACT: Many patients who travel internationally seek medical travel advice from their primary care provider, who may feel unprepared to provide this advice. This article describes online travel medicine resources and a structured approach to a basic pretravel assessment, office evaluation, and destination-specific consultation on travel health and safety.

Mycobacterium abscessus Meningitis Associated with Stem Cell Treatment During Medical Tourism.

Mycobacterium abscessus infections have been reported as adverse events related to medical tourism. We report M. abscessus meningitis in a patient who traveled from Colorado, USA, to Mexico to receive intrathecal stem cell injections as treatment for multiple sclerosis. We also review the management of this challenging central nervous system infection.

The Regulation of Mitochondrial Replacement Techniques Around the World.

Mitochondrial replacement techniques (MRTs, also referred to as mitochondrial replacement therapies) have given hope to many women who wish to have genetically related children but have mitochondrial DNA mutations in their eggs. MRTs have also spurred deep ethical disagreements and led to different regulatory approaches worldwide. In this review, we discuss the current regulation of MRTs across several countries. After discussing the basics of the science, we describe the current law and policy directions in seven countries: the United Kingdom, the United States, Canada, Australia, Germany, Israel, and Singapore. We also discuss the emerging phenomenon of medical tourism (also called medical travel) for MRTs to places like Greece, Spain, Mexico, and Ukraine. We then pull out some key findings regarding similarities and differences in regulatory approaches around the world.

Traveling Across States for Prohibited Treatments: Medical Aid in Dying and Looming Battles Over Abortion.

This JGIM Perspective discusses new and emerging challenges with accessing controversial medical therapies like medical aid in dying and abortion. While some states permit these therapies for only their residents, other states prohibit these therapies for their own residents. We summarize recent developments and growing challenges for clinicians treating "medical tourism" patients from other jurisdictions.

Identifying discrepancies between clinical practice and evidence-based guideline in recurrent pregnancy loss care, a tool for clinical guideline implementation.

BACKGROUND: Practice variation in recurrent pregnancy loss (RPL) care is common. International guidelines vary in their recommendations for the management of RPL couples, which could lead to an increase of cross border reproductive care. Currently, the Dutch RPL guideline is being adapted from the European Society for Human Reproduction and Embryology (ESHRE) guideline. We aim to identify discrepancies between RPL guidelines and RPL practice. These discrepancies could be considered in the development of a new guideline and implementation strategies to promote adherence to new recommendations. METHODS: A nationwide survey on the management of RPL patients was conducted across all 107 hospital-based obstetrics and gynaecology practices in the Netherlands. The survey was sent via the Dutch Society for Obstetricians and Gynaecologists to all affiliated clinicians. The questionnaire consisted of 36 questions divided in four sections: clinician's demographics, RPL definition, investigations and therapy. The data were compared to the recommendations given by the Dutch national guideline and the most recent guideline of the ESHRE. RESULTS: All hospital-based practices (100%; n = 107) filled in the online questionnaire. The majority of respondents defined RPL similarly, as two or more pregnancy losses (87.4%), not obligatory consecutive (93.1%). More than half of respondents routinely perform thrombophilia screening ( 58%), although not advised by the ESHRE, while thyroid function (57%), thyroid auto-immunity (27%) and ß2-glycoprotein antibodies (42%) in the context of antiphospholipid syndrome (APS) are recommended but investigated less often. Regarding parental karyotyping, 20% of respondents stated they always perform parental karyotyping, without prior risk assessment. because of RPL. Treatment for hereditary thrombophilia was frequently (43.8% (n = 137)) prescribed although not recommended. And finally, a considerable part (12-16%) of respondents prescribe medication in case of unexplained RPL. CONCLUSION: While many clinicians perform investigations recommended by the ESHRE, there is a considerable variation of RPL practice in the Netherlands. We identified discrepancies between RPL guidelines and RPL practice, providing possibilities to focus on multifaceted implementation strategies, such as educational intervention, local consensus processes and auditing and feedback. This will improve the quality of care provided to RPL patients and may diminish the necessity felt by patients to turn to multiple opinions or cross border reproductive care.