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.

The impact of country image and patient cosmopolitanism on medical tourism.

The purpose of this research is to examine the impact affective/cognitive country image, cosmopolitanism, and satisfaction with insurance have on patient willingness to go abroad for surgery. Patients are presented a scenario where they select having knee replacement surgery domestically, having to pay all co-pays and deductibles, or abroad (Mexico, India, Israel) for free surgery at a JCI certified hospital. Results indicate cosmopolitanism impacts patient perception of medical tourism whilst affective and cognitive country image exhibit varying levels of significance. This study contributes to the literature by assessing factors that impact patient likelihood to travel abroad for surgery.

The role and importance of perceived risk in medical tourism. Applying the theory of planned behaviour.

The main aim of the study was to investigate the role and importance of perceived risk in medical tourism (MT). The research demonstrates that the country of origin and an assessment of the respondents' own health condition significantly moderates the impact of their attitudes on behavioral intention. The research shows a strong correlation between the risk perceived by the respondents and their attitudes towards MT services. This relationship is significantly moderated by risk awareness, aversion to risk and gender. Additionally, an important factor in the model is the level of satisfaction with medical services in their own country. The survey using a fully structured questionnaire was conducted among young consumers from Jordan, Poland and Turkey. To verify the hypotheses, a multiple regression model with interactions was used.

Route of chronic kidney patients foreigners in the search for health care in a border area.

OBJECTIVES: to describe the journey of foreigners with chronic kidney diseases searching for treatment in the Brazilian Unified Health System in a border area. METHODS: this is a qualitative research conducted with thirteen foreign participants. Data were collected by interviews and analyzed based on the theoretical-methodological framework of the therapeutic itinerary. RESULTS: empirical evidence showed seven thematic categories, indicating poor illness perception; poor family support throughout treatment; social aspects such as work, income, and housing as sources of distress; search for alternative treatments; interrupted search for healthcare abroad due to financial problems; journey to healthcare-seeking in Brazil eased by family members and social networks. FINAL CONSIDERATIONS: the asymmetries within the Paraguayan and Brazilian health systems spur the search for cross-border integration actions. Identifying another country's assistance aspects may help in planning more welcoming policies in border regions.

Factors that infertile couples from mainland China may take into consideration for cross-border reproductive care - A cross-sectional questionnaire study.

OBJECTIVE: Cross-border reproductive care (CBRC) has become popular in the world, including mainland China. We designed a questionnaire and aimed to determine the main factors that infertile couples from mainland China may consider for CBRC. MATERIALS AND METHODS: In this cross-sectional questionnaire-based study, we retrospectively analyzed the data from questionnaires collected at the Reproductive Center of Beijing BaoDao Obstetrics and Gynecology Hospital from January 2018 to June 2018. The questionnaire contained 38 items that belonged to six different categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and overseas medical services). The item scores for each factor were calculated and then weighted using principal component analysis. RESULTS: A total of 297 infertile couples were identified. Most of the infertile women were aged 31-35 years, were married 1-3 years, and had a bachelor's degree. In the weighted factor analysis, "clean outpatient clinic and medical equipment" had the highest weight in the dimension of environment and equipment. The item with the highest weight in the dimension of service quality was "wait time for examination". In the dimension of patient safety, "health education on medication and surgery by counselors" had the highest weight. The item with the highest weight in the dimension of medical quality was "fee charged for ART treatment". The items with the three highest weights in the dimension of information acquisition channel were "other (seminar, exhibition, dissertation …)", "introduction from friends and relatives", and "telephone inquiry". In the dimension of overseas medical services, the two items with the highest weights were "cultural similarities" and "language similarities". CONCLUSION: For CBRC, infertile couples from mainland China may take following significant factors into consideration: a high success rate and inexpensive treatment, cultural and linguistic familiarity, high-quality service and short wait time.

Gestational age limits for abortion and cross-border reproductive care in Europe: a mixed-methods study.

OBJECTIVES: Little is known about the experiences of women who travel within Europe for abortion care from countries with relatively liberal laws. This paper aims to assess the primary reasons for travel among a sample of women who travelled from European countries with relatively liberal abortion laws to obtain abortion care mainly in the UK and the Netherlands. DESIGN: Multi-country, 5-year mixed methods study on barriers to legal abortion and travel for abortion. SETTING: UK, the Netherlands and Spain. POPULATION OR SAMPLE: We present quantitative data from 204 surveys, and qualitative data from 30 in-depth interviews with pregnant people who travelled to the UK, the Netherlands and Spain from countries where abortion is legal on broad grounds within specific gestational age (GA) limits. METHODS: Mixed-methods. MAIN OUTCOME MEASURES: GA when presenting at abortion clinic, primary reason for abortion-related travel. RESULTS: Study participants overwhelmingly reported travelling for abortion because they had exceeded GA limits in their country of residence. Participants also reported numerous delays and barriers to receiving care. CONCLUSIONS: Our findings highlight the need for policies that support access to abortion throughout pregnancy and illustrate that early access to it is necessary but not sufficient to meet people's reproductive health needs. FUNDING: This study is funded by the European Research Council (ERC). TWEETABLE ABSTRACT: This study shows that GA limits drive women from EU countries where abortion is legal to seek abortions abroad.

Modulatory effects of ayahuasca on personality structure in a traditional framework.

Ayahuasca is a psychoactive plant brew containing dimethyltryptamine (DMT) and monoamine oxidase inhibitors (MAOIs). It originates from the Amazon basin, where it is used primarily for ceremonial purposes. Ayahuasca tourists are now entering certain communities seeking alternative physical or psychological healing, as well as spiritual growth. RATIONALE: Recent evidence has shown that the similar acting psychedelic compound, psilocybin, facilitated long-term increases in trait openness following a single administration. OBJECTIVES: This paper assesses the impact of ayahuasca on personality in a traditional framework catering for ayahuasca tourists. METHOD: Within a mixed design, we examined the effect of ayahuasca on participants' personality (measured by the NEO Personality Inventory 3 questionnaire) across time (pre- to post-ayahuasca administration, and 6-month follow-up), relative to a comparison group (who did not ingest ayahuasca). RESULTS: The results demonstrated significant increases in agreeableness pre- and post-ayahuasca administration and significant reductions in neuroticism in 24 participants, relative to the comparison group. Both of these changes were sustained at 6-month follow-up, and trait level increases were also observed in openness at this stage. Additionally, greater perceived mystical experience (measured using the Mystical Experience Questionnaire 30) was associated with increased reductions in neuroticism. CONCLUSIONS: These findings, which indicate a positive mediating effect of ayahuasca on personality, support the growing literature suggesting potential therapeutic avenues for serotonergic psychedelics.

Perspectives of Nunavut patients and families on their cancer and end of life care experiences.

The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people's experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.

Exploring Internal Benefits of Medical Tourism Facilitators' Satisfaction: Customer Orientation, Job Satisfaction, and Work Performance.

EXECUTIVE SUMMARY: This study examined the impact of employee satisfaction with management and coworkers on their performance as medical tourism facilitators. The proposed hypotheses were tested with structural equation modeling based on data collected from major hospitals in South Korea. Results supported assumptions that satisfaction with management is positively correlated with customer orientation and job satisfaction of medical tourism facilitators, as well as with the assumption that satisfaction with coworkers has a direct impact on customer orientation. This study has practical implications as organizations develop effective internal marketing (i.e., communication) strategies to improve the performance of medical tourism facilitators.

Perceived cultural differences in healthcare for foreign patients visiting South Korea: tool development and measurement.

BACKGROUND: We developed a 41-item tool measuring cultural differences in healthcare as perceived by foreign patients visiting South Korea. METHODS: The tool was tested on 256 foreign patients who visited three tertiary hospitals in Seoul, South Korea. Content validity was explored by two physicians and eight nurses working in an international healthcare department. Structural validity was tested via exploratory factor analysis and by testing two hypotheses: (1) there are perceived cultural differences between the South Korean healthcare and those of foreign patients' home countries (one-sample t-test); and, (2) Perceived cultural differences vary among language groups (analysis of variance). We also calculated Cronbach's alpha. RESULTS: The content validity index of the tool was 0.97. Exploratory factor analysis identified seven significant factors: hospital care and services, food, the healthcare system, communication, the healthcare facility, religion, and cultural values. The overall Cronbach's alpha for the tool was 0.96, indicating very high internal consistency. We found that foreign patients visiting South Korean hospitals perceived that the healthcare culture differed significantly from that of their home country. The perceived cultural differences varied significantly by language group. CONCLUSIONS: Nurses can use our new tool to understand the cultural differences of foreign patients and provide them with culturally competent nursing care.

Birth Tourism Among Chinese Women.

PURPOSE: To explore the reasons why some Chinese women travel to the United States on a tourist visa specifically to give birth, also known as birth tourism. STUDY DESIGN: Qualitative, exploratory design. METHODS: Using convenience and snowball sampling, Chinese women were recruited from the waiting rooms of obstetricians known to care for birth tourists. Participants completed demographic data and provided answers to questions about their reasons for traveling to give birth and their birth experience while in the United States. Qualitative content analysis methods were used to extract themes from participant narratives. RESULTS: Twelve married, college-educated women, aged between 26 and 39 years, self-identifying as birth tourists from China participated in this study. Content analysis revealed two themes: (1) positive perceptions of childbirth in the United States; and (2) securing a future for their child. CLINICAL IMPLICATIONS: Study findings suggest Chinese birth tourists come to the United States for a better childbirth experience, and to secure future opportunities for their children. Nurses should be aware of the current political climate on immigration and birth tourism in order to promote a safe and judgment-free environment when providing care to this unique population of women.

Women on the move: A search for preferred birth services.

BACKGROUND: Women and midwives travel long distances, or abroad, to receive or provide birth services. Travel for birth services is not represented in the existing literature, despite the wide scale research available on medical travel. AIM: We explored the perspectives of women who were seeking better services outside their places of residence and midwives who travel to provide these services. METHOD: We followed a qualitative descriptive approach. We conducted 13 qualitative interviews with women from various European countries, four travelling midwives and one activist. Principles of thematic analysis were used. FINDINGS: Deciding whether to travel is the result of a long-term process, influenced by various push and pull factors. Travelling women and midwives share values; they trust the capacity of women to give birth; they value respect and equality in communication; they search for trusting relationships and friendly environments without unnecessary treatments. Trust and distrust on interpersonal and institutional levels influence women's decisions and frame narratives about their experiences. CONCLUSION: To a great extent, travelling women and midwives share the values embedded in the midwifery model of care. Women and midwives are willing to take matters into their own hands to achieve their expected birth experiences.

[Second opinion abroad; motives and experiences of patients with incurable cancer]. / Second opinion in het buitenland.

OBJECTIVE: To explore motives and experiences of patients with incurable cancer who are looking across the border for second opinions or treatments or are considering to do so. DESIGN: Qualitative, semi-structured interview study. METHOD: A total of 24 patients with incurable cancer from two Dutch hospitals were interviewed by phone. All interviews were coded independently by two researchers and then analysed inductively, without any pre-specified theoretical framework. RESULTS: Patients were looking for second opinions or treatments because they found it very difficult to accept a sudden diagnosis of incurable disease. They experienced little guidance during this transition. Patients felt they were not offered any treatment options because of imperative protocols. Many patients were in great need of some form of hope. There were often high expectations - unrealistic or not - of the possibilities abroad. Oncologists' reactions to patients' choices were very diverse. While disapproving reactions were unable to influence patients' choices, well-substantiated arguments were sometimes successful in influencing patients' choices. CONCLUSION: More guidance seems advisable for some patients to help them deal with a diagnosis of incurable disease. Dutch oncologists might be able to offer alternative forms of hope to these patients, who have a great need for this. If physicians speak with patients about what a treatment abroad may or may not be able to provide, this might benefit patients.

[Post-operative infections after cosmetic tourism].

Cosmetic tourism is defined as patient mobility across borders, typically constituted by patients seeking cosmetic surgery at lower costs abroad. The most common procedures are abdominoplasty, fat grafting and breast augmentation. Very little is known about the complication rates after cosmetic tourism, and there is a paucity of evidence in all aspects of cosmetic tourism. In this review, we focus on post-operative complications i.e. post-operative infections, in particular with rare microorganisms such as mycobacteria.

Understanding medical travel from a source country perspective: a cross sectional study of the experiences of medical travelers from the Maldives.

BACKGROUND: The resolution adopted in 2006 by the World Health Organization on international trade and health urges Member States to understand the implications of international trade and trade agreements for health and to address any challenges arising through policies and regulations. The government of Maldives is an importer of health services (with outgoing medical travelers), through offering a comprehensive universal health care package for its people that includes subsidized treatment abroad for services unavailable in the country. By the end of the first year of the scheme approximately US$11.6 m had been spent by the government of Maldives to treat patients abroad. In this study, affordability, continuity and quality of this care were assessed from the perspective of the medical traveler to provide recommendations for safer and more cost effective medical travel policy. RESULTS: Despite universal health care, a substantial proportion of Maldivian travelers have not accessed the government subsidy, and a third reported not having sufficient funds for the treatment episode abroad. Among the five most visited hospitals in this study, none were JCI accredited at the time of the study period and only three from India had undergone the National Accreditation Board for Hospitals (NABH) in India. Satisfaction with treatment received was high amongst travelers but concern for the continuity of care was very high, and more than a third of the patients had experienced complications arising from the treatment overseas. CONCLUSION: Source countries can use their bargaining power in the trade of health services to offer a more comprehensive package for medical travelers. Source countries with largely public funded health systems need to ensure that medical travel is truly affordable and universal, with measures for quality control such as the use of accredited foreign hospitals to make it safer and to impose measures that ensure the continuity of care for travelers.

Charlie Gard and the weight of parental rights to seek experimental treatment.

The case of Charlie Gard, an infant with a genetic illness whose parents sought experimental treatment in the USA, brought important debates about the moral status of parents and children to the public eye. After setting out the facts of the case, this article considers some of these debates through the lens of parental rights. Parental rights are most commonly based on the promotion of a child's welfare; however, in Charlie's case, promotion of Charlie's welfare cannot explain every fact of the case. Indeed, some seem most logically to extend from intrinsic parental rights, that is, parental rights that exist independent of welfare promotion. I observe that a strong claim for intrinsic parental rights can be built on arguments for genetic propriety and children's limited personhood. Critique of these arguments suggests the scope of parental rights remains limited: property rights entail proper use; non-personhood includes only a small cohort of very young or seriously intellectually disabled children and the uniqueness of parental genetic connection is limited. Moreover, there are cogent arguments about parents' competence to make judgements, and public interest arguments against allowing access to experimental treatment. Nevertheless, while arguments based on propriety may raise concerns about the attitude involved in envisioning children as property, I conclude that these arguments do appear to offer a prima facie case for a parental right to seek experimental treatment in certain limited circumstances.

Dutch citizens of Turkish origin who utilize healthcare services in Turkey: a qualitative study on motives and contextual factors.

BACKGROUND: Dutch residents of Turkish origin frequently utilize healthcare in Turkey. METHODS: To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals. RESULTS: Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands. CONCLUSIONS: These mismatches in expectations of what constitutes "good care" led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients.