Medical tourism
Overview
 
Medical tourism is a term initially coined by travel agencies
Travel agency
A travel agency is a retail business that sells travel related products and services to customers on behalf of suppliers such as airlines, car rentals, cruise lines, hotels, railways, sightseeing tours and package holidays that combine several products...

 and the mass media
Mass media
Mass media refers collectively to all media technologies which are intended to reach a large audience via mass communication. Broadcast media transmit their information electronically and comprise of television, film and radio, movies, CDs, DVDs and some other gadgets like cameras or video consoles...

 to describe the rapidly-growing practice of travelling across international borders to obtain health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

. It also refers pejoratively to the practice of healthcare providers travelling internationally to deliver healthcare.

Services typically sought by travelers include elective procedures as well as complex specialized surgeries
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 such as joint replacement
Joint replacement
Replacement arthroplasty [from Greek arthron, joint, limb, articulate, + -plassein, to form, mould, forge, feign, make an image of], or joint replacement surgery, is a procedure of orthopedic surgery in which the arthritic or dysfunctional joint surface is replaced with an orthopaedic prosthesis...

 (knee
Knee replacement
Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis...

/hip
Hip replacement
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe...

), cardiac surgery
Cardiac surgery
Cardiovascular surgery is surgery on the heart or great vessels performed by cardiac surgeons. Frequently, it is done to treat complications of ischemic heart disease , correct congenital heart disease, or treat valvular heart disease from various causes including endocarditis, rheumatic heart...

, dental surgery
Dental surgery
Dental surgery is any of a number of medical procedures that involve artificially modifying dentition, in other words surgery of the teeth and jaw bones.-Types:Some of the more common are:...

, and cosmetic surgeries.
Encyclopedia
Medical tourism is a term initially coined by travel agencies
Travel agency
A travel agency is a retail business that sells travel related products and services to customers on behalf of suppliers such as airlines, car rentals, cruise lines, hotels, railways, sightseeing tours and package holidays that combine several products...

 and the mass media
Mass media
Mass media refers collectively to all media technologies which are intended to reach a large audience via mass communication. Broadcast media transmit their information electronically and comprise of television, film and radio, movies, CDs, DVDs and some other gadgets like cameras or video consoles...

 to describe the rapidly-growing practice of travelling across international borders to obtain health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...

. It also refers pejoratively to the practice of healthcare providers travelling internationally to deliver healthcare.

Services typically sought by travelers include elective procedures as well as complex specialized surgeries
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 such as joint replacement
Joint replacement
Replacement arthroplasty [from Greek arthron, joint, limb, articulate, + -plassein, to form, mould, forge, feign, make an image of], or joint replacement surgery, is a procedure of orthopedic surgery in which the arthritic or dysfunctional joint surface is replaced with an orthopaedic prosthesis...

 (knee
Knee replacement
Knee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis...

/hip
Hip replacement
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe...

), cardiac surgery
Cardiac surgery
Cardiovascular surgery is surgery on the heart or great vessels performed by cardiac surgeons. Frequently, it is done to treat complications of ischemic heart disease , correct congenital heart disease, or treat valvular heart disease from various causes including endocarditis, rheumatic heart...

, dental surgery
Dental surgery
Dental surgery is any of a number of medical procedures that involve artificially modifying dentition, in other words surgery of the teeth and jaw bones.-Types:Some of the more common are:...

, and cosmetic surgeries. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available.

Over 50 countries have identified medical tourism as a national industry. However, accreditation
Accreditation
Accreditation is a process in which certification of competency, authority, or credibility is presented.Organizations that issue credentials or certify third parties against official standards are themselves formally accredited by accreditation bodies ; hence they are sometimes known as "accredited...

 and other measures of quality vary widely across the globe, and some destinations may become hazardous or even dangerous for medical tourists.

In the context of global health, the term "medical tourism" is pejorative because during such trips health care providers often practice outside of their areas of expertise or hold different (i.e., lower) standards of care. Greater numbers than ever before of student volunteers, health professions trainees, and researchers from resource-rich countries are working temporarily and anticipating future work in resource-starved areas. This emphasizes the importance of understanding this other definition.

History

The first recorded instance of medical tourism dates back thousands of years to when Greek
Greeks
The Greeks, also known as the Hellenes , are a nation and ethnic group native to Greece, Cyprus and neighboring regions. They also form a significant diaspora, with Greek communities established around the world....

 pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf
Saronic Gulf
The Saronic Gulf or Gulf of Aegina in Greece forms part of the Aegean Sea and defines the eastern side of the isthmus of Corinth. It is the eastern terminus of the Corinth Canal, which cuts across the isthmus.-Geography:The gulf includes the islands of; Aegina, Salamis, and Poros along with...

 called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism.

Spa town
Spa town
A spa town is a town situated around a mineral spa . Patrons resorted to spas to "take the waters" for their purported health benefits. The word comes from the Belgian town Spa. In continental Europe a spa was known as a ville d'eau...

s and sanitarium
Sanatorium
A sanatorium is a medical facility for long-term illness, most typically associated with treatment of tuberculosis before antibiotics...

s may be considered an early form of medical tourism. In eighteenth century England, for example, patients visited spa
Spa town
A spa town is a town situated around a mineral spa . Patrons resorted to spas to "take the waters" for their purported health benefits. The word comes from the Belgian town Spa. In continental Europe a spa was known as a ville d'eau...

s because they were places with supposedly health-giving mineral water
Mineral water
Mineral water is water containing minerals or other dissolved substances that alter its taste or give it therapeutic value, generally obtained from a naturally occurring mineral spring or source. Dissolved substances in the water may include various salts and sulfur compounds...

s, treating diseases from gout
Gout
Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...

 to liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...

 disorders and bronchitis
Bronchitis
Acute bronchitis is an inflammation of the large bronchi in the lungs that is usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms include cough, sputum production, and shortness of breath and wheezing related to the obstruction of the inflamed airways...

.

Description

Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad.

Many surgery procedures performed in medical tourism destinations cost a fraction of the price they do in the First World
First World
The concept of the First World first originated during the Cold War, where it was used to describe countries that were aligned with the United States. These countries were democratic and capitalistic. After the fall of the Soviet Union and the end of the Cold War, the term "First World" took on a...

. For example a liver transplant that cost $300,000 USD in America cost about $91,000 USD in Taiwan. A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. Using Canada as an example, an estimated 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks. Canada has set waiting-time benchmarks, e. g. 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures.

Medical tourists come from a variety of locations including Europe, the Middle East, Japan, the United States, and Canada. Factors that drive demand for medical services abroad in First World countries include: large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.

In First World countries like the United States medical tourism has large growth prospects and potentially destabilizing implications. A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that a million and a half would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.

An authority at the Harvard Business School recently stated that "medical tourism is promoted much more heavily in the United Kingdom than in the United States".

Additionally, some patients in some First World countries are finding that insurance either does not cover orthopedic surgery (such as knee/hip replacement) or limits the choice of the facility, surgeon, or prosthetics to be used. Medical tourism for knee/hip replacements has emerged as one of the more widely accepted procedures because of the lower cost and minimal difficulties associated with the traveling to/from the surgery. Colombia provides a knee replacement for about $5,000 USD, including all associated fees, such as FDA-approved prosthetics and hospital stay-over expenses. However, many clinics quote prices that are not all-inclusive and include only the surgeon fees associated with the procedure.

According to an article by the University of Delaware publication, UDaily:
Popular medical travel worldwide destinations include: Argentina
Argentina
Argentina , officially the Argentine Republic , is the second largest country in South America by land area, after Brazil. It is constituted as a federation of 23 provinces and an autonomous city, Buenos Aires...

, Brunei
Brunei
Brunei , officially the State of Brunei Darussalam or the Nation of Brunei, the Abode of Peace , is a sovereign state located on the north coast of the island of Borneo, in Southeast Asia...

, Cuba
Cuba
The Republic of Cuba is an island nation in the Caribbean. The nation of Cuba consists of the main island of Cuba, the Isla de la Juventud, and several archipelagos. Havana is the largest city in Cuba and the country's capital. Santiago de Cuba is the second largest city...

, Colombia
Colombia
Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...

, Costa Rica
Costa Rica
Costa Rica , officially the Republic of Costa Rica is a multilingual, multiethnic and multicultural country in Central America, bordered by Nicaragua to the north, Panama to the southeast, the Pacific Ocean to the west and the Caribbean Sea to the east....

, Hong Kong
Hong Kong
Hong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...

, Hungary
Hungary
Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...

, India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

, Jordan
Jordan
Jordan , officially the Hashemite Kingdom of Jordan , Al-Mamlaka al-Urduniyya al-Hashemiyya) is a kingdom on the East Bank of the River Jordan. The country borders Saudi Arabia to the east and south-east, Iraq to the north-east, Syria to the north and the West Bank and Israel to the west, sharing...

, Lithuania
Lithuania
Lithuania , officially the Republic of Lithuania is a country in Northern Europe, the biggest of the three Baltic states. It is situated along the southeastern shore of the Baltic Sea, whereby to the west lie Sweden and Denmark...

, Malaysia, The Philippines, Singapore
Singapore
Singapore , officially the Republic of Singapore, is a Southeast Asian city-state off the southern tip of the Malay Peninsula, north of the equator. An island country made up of 63 islands, it is separated from Malaysia by the Straits of Johor to its north and from Indonesia's Riau Islands by the...

, South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

, Thailand
Thailand
Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...

, and recently, Saudi Arabia
Saudi Arabia
The Kingdom of Saudi Arabia , commonly known in British English as Saudi Arabia and in Arabic as as-Sa‘ūdiyyah , is the largest state in Western Asia by land area, constituting the bulk of the Arabian Peninsula, and the second-largest in the Arab World...

, UAE
United Arab Emirates
The United Arab Emirates, abbreviated as the UAE, or shortened to "the Emirates", is a state situated in the southeast of the Arabian Peninsula in Western Asia on the Persian Gulf, bordering Oman, and Saudi Arabia, and sharing sea borders with Iraq, Kuwait, Bahrain, Qatar, and Iran.The UAE is a...

, South Korea
South Korea
The Republic of Korea , , is a sovereign state in East Asia, located on the southern portion of the Korean Peninsula. It is neighbored by the People's Republic of China to the west, Japan to the east, North Korea to the north, and the East China Sea and Republic of China to the south...

, Tunisia
Tunisia
Tunisia , officially the Tunisian RepublicThe long name of Tunisia in other languages used in the country is: , is the northernmost country in Africa. It is a Maghreb country and is bordered by Algeria to the west, Libya to the southeast, and the Mediterranean Sea to the north and east. Its area...

, Ukraine
Ukraine
Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...

, and New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...

.

Popular cosmetic surgery travel destinations include: Argentina
Argentina
Argentina , officially the Argentine Republic , is the second largest country in South America by land area, after Brazil. It is constituted as a federation of 23 provinces and an autonomous city, Buenos Aires...

, Bolivia
Bolivia
Bolivia officially known as Plurinational State of Bolivia , is a landlocked country in central South America. It is the poorest country in South America...

, Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...

, Colombia
Colombia
Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...

, Costa Rica
Costa Rica
Costa Rica , officially the Republic of Costa Rica is a multilingual, multiethnic and multicultural country in Central America, bordered by Nicaragua to the north, Panama to the southeast, the Pacific Ocean to the west and the Caribbean Sea to the east....

, Cuba
Cuba
The Republic of Cuba is an island nation in the Caribbean. The nation of Cuba consists of the main island of Cuba, the Isla de la Juventud, and several archipelagos. Havana is the largest city in Cuba and the country's capital. Santiago de Cuba is the second largest city...

, Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...

, Turkey
Turkey
Turkey , known officially as the Republic of Turkey , is a Eurasian country located in Western Asia and in East Thrace in Southeastern Europe...

,and Ukraine
Ukraine
Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...

. In South America, countries such as Argentina, Bolivia, Brazil and Colombia lead on plastic surgery medical skills relying on their experienced plastic surgeons. In Bolivia and Colombia, plastic surgery has also become quite common. According to the "Sociedad Boliviana de Cirugia Plastica y Reconstructiva", more than 70% of middle and upper class women in the country have had some form of plastic surgery. Colombia also provides advanced care in cardiovascular and transplant surgery.

In Europe Belgium
Belgium
Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...

, Poland
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...

, Slovakia
Slovakia
The Slovak Republic is a landlocked state in Central Europe. It has a population of over five million and an area of about . Slovakia is bordered by the Czech Republic and Austria to the west, Poland to the north, Ukraine to the east and Hungary to the south...

, and Ukraine
Ukraine
Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...

 are also breaking into the business.
South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

 is taking the term "medical tourism" very literally by promoting their "medical safaris".

A specialized subset of medical tourism is reproductive tourism and reproductive outsourcing, which is the practice of traveling abroad to undergo in-vitro fertilization, surrogate pregnancy and other assisted reproductive technology
Assisted reproductive technology
Assisted reproductive technology is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments. Some forms of ART are also used in fertile couples for genetic reasons...

 treatments including freezing embryos for retro-production.

However, perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.

Health tourism provider
Health tourism provider
A health tourism provider or medical tourism provider is an organisation or a company which seeks to bring together a prospective patient with a service provider, usually a hospital or a clinic. If the patient is crossing international borders to obtain medical care, then that individual would...

s have developed as intermediaries to unite potential medical tourists with provider hospitals and other organisations. Companies are beginning to offer global health care options that will enable North American and European patients to access world health care at a fraction of the cost of domestic care. Companies that focus on medical value travel typically provide nurse case managers to assist patients with pre- and post-travel medical issues. They also help provide resources for follow-up care upon the patient's return.

Process

The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider
Health tourism provider
A health tourism provider or medical tourism provider is an organisation or a company which seeks to bring together a prospective patient with a service provider, usually a hospital or a clinic. If the patient is crossing international borders to obtain medical care, then that individual would...

. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified medical doctors or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.

International healthcare accreditation

International healthcare accreditation is the process of certifying a level of quality for healthcare providers and programs across multiple countries. International healthcare accreditation organizations certify a wide range of healthcare programs such as hospitals, primary care centers, medical transport, and ambulatory care services.

The oldest international accrediting body is Accreditation Canada, formerly known as the Canadian Council on Health Services Accreditation, which accredited the Bermuda Hospital Board as soon as 1968. Since then, it has accredited hospitals and health service organizations in ten other countries.

In the United States, the accreditation group Joint Commission International (JCI) has been inspecting and accrediting health care facilities and hospitals outside of the United States since 1999. Many international hospitals today see obtaining international accreditation as a way to attract American patients.

Joint Commission International is a relative of the Joint Commission in the United States. Both are US-style independent private sector not-for-profit organizations that develop nationally and internationally recognized procedures and standards to help improve patient care and safety. They work with hospitals to help them meet Joint Commission standards for patient care and then accredit those hospitals meeting the standards.

QHA Trent Accreditation
QHA Trent Accreditation
QHA Trent Accreditation is a United Kingdom-based independent holistic accreditation scheme for hospitals and clinics that functions worldwide. It represents an option for healthcare providers to international accreditation schemes such as Joint Commission International from the USA...

, based in the UK, is an active independent holistic accreditation scheme.

The different international healthcare accreditation schemes vary in quality, size, cost, intent and the skill and intensity of their marketing. They also vary in terms of cost to hospitals and healthcare institutions making use of them. A forecast by Deloitte Consulting regarding medical tourism published in August 2008 noted the value of accreditation in ensuring quality of healthcare and specifically mentioned JCI, ISQUA and Trent.

Increasingly, some hospitals are looking towards dual international accreditation, perhaps having both JCI to cover potential US clientele, QHA Trent for potential British and European clientele, and Accreditation Canada. As a result of competition between clinics for American medical tourists, there have been initiatives to rank hospitals based on patient-reported metrics.

Other organizations providing contributions to quality practices include:
  • The United Kingdom Accreditation Forum
    United Kingdom Accreditation Forum
    Founded in June 1998 by a group of leading healthcare accreditation organisations, the United Kingdom Accreditation Forum is a London-based network of healthcare accreditation organisations formed with the intention of sharing experience regarding good practice in accreditation, as well as sharing...

     (UKAF) is an established network of accreditation organisations with the intention of sharing experience good practice and new ideas around the methodology for accreditation programmes, covering issues such as developing healthcare quality standards, implementation of standards within healthcare organisations, assessment by peer review and exploration of the peer review techniques to include the recruitment, training, monitoring and evaluation of peer reviewers and the mechanisms for awards of accredited status to organisations.

Organizations and Associations

The goal of such associations is often to raise awareness of medical tourism in the hopes of expanding the industry and in doing so generate profit.

The Medical Tourism Association
Medical Tourism Association
Medical Tourism Association is the first membership based international non-profit trade association for the medical tourism and global healthcare industry. The MTA consists of top international hospitals, healthcare providers, insurance companies, medical travel facilitators, and other affiliated...

 (MTA) is the first 501(c) non-profit trade association for the medical tourism industry. It is made up of international hospitals, healthcare providers, medical travel facilitators, insurance companies, and other affiliates.

HealthCare Tourism International (HTI) is a 501(c) non-profit tax-exempt organization that is complementary to the Joint Commission International accreditation group. Health care organizations can apply for self-certification or accreditation on the HTI website.

Risks

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 nations 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.

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 in a cramped airline cabin are a known risk factor for developing blood clots in the legs such as venous thrombosis or pulmonary embolus economy class syndrome. Other vacation activities can be problematic as well — for example, scars may become darker and more noticeable if they sunburn while healing. 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.

Differences in healthcare provider standards around the world have been recognised by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

, 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.

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.

Legal issues

Receiving medical care abroad may subject medical tourists to unfamiliar legal issues. 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
Medical malpractice
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and...

, 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
Malpractice
In law, malpractice is a type of negligence in, which the professional under a duty to act, fails to follow generally accepted professional standards, and that breach of duty is the proximate cause of injury to a plaintiff who suffers harm...

 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.

Ethical issues

There can be major ethical issues around medical tourism. For example, the illegal purchase of organs and tissues for transplantation had been alleged in countries such as India and China prior to 2007. The Declaration of Istanbul
Declaration of Istanbul
The Declaration of Istanbul was created at the Istanbul Summit on Organ Trafficking and Transplant Tourism held from 30 April to 1 May 2008 in Istanbul, Turkey...

 distinguishes between ethically problematic "transplant tourism" and "travel for transplantation".

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. 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". Medical tourism centred on new technologies, such as stem cell treatments
Stem cell treatments
Stem cell treatments are a type of intervention strategy that introduces new cells into damaged tissue in order to treat disease or injury. Many medical researchers believe that stem cell treatments have the potential to change the face of human disease and alleviate suffering...

, 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.

Employer-sponsored health care in the US

Some US employers have begun exploring medical travel programs as a way to cut employee health care costs. Such proposals have raised stormy debates between employers and trade union
Trade union
A trade union, trades union or labor union is an organization of workers that have banded together to achieve common goals such as better working conditions. The trade union, through its leadership, bargains with the employer on behalf of union members and negotiates labour contracts with...

s representing workers, with one union stating that it deplored the "shocking new approach" of offering employees overseas treatment in return for a share of the company's savings. The unions also raise the issues of legal liability
Legal liability
Legal liability is the legal bound obligation to pay debts.* In law a person is said to be legally liable when they are financially and legally responsible for something. Legal liability concerns both civil law and criminal law. See Strict liability. Under English law, with the passing of the Theft...

 should something go wrong, and potential job losses in the US health care industry if treatment is outsourced
Outsourcing
Outsourcing is the process of contracting a business function to someone else.-Overview:The term outsourcing is used inconsistently but usually involves the contracting out of a business function - commonly one previously performed in-house - to an external provider...

.

Employers may offer incentives such as paying for air travel and waiving out-of-pocket expenses for care outside of the US. For example, in January 2008, Hannaford Bros., a supermarket chain based in Maine, began paying the entire medical bill for employees to travel to Singapore for hip and knee replacements, including travel for the patient and companion. Medical travel packages can integrate with all types of health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...

, including limited benefit plans, preferred provider organization
Preferred provider organization
In health insurance in the United States, a preferred provider organization is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced...

s and high deductible health plan
High Deductible Health Plan
A high-deductible health plan is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. Being covered by an HDHP is also a requirement for having a health savings account. Some HDHP plans also offer additional "wellness" benefits, provided before a...

s.

In 2000 Blue Shield of California began the United States' first cross border health plan. Patients in California could travel to one of the three certified hospitals in Mexico for treatment under California Blue Shield. In 2007, a subsidiary of BlueCross BlueShield of South Carolina, Companion Global Healthcare, teamed up with hospitals in Thailand, Singapore, Turkey, Ireland, Costa Rica and India. A 2008 article in Fast Company
Fast Company (magazine)
Fast Company is a full-color business magazine that releases 10 issues per year and reports on topics including innovation, digital media, technology, change management, leadership, design, and social responsibility...

discusses the globalization of healthcare and describes how various players in the US healthcare market have begun to explore it.

Dental

Dental tourism involves individuals seeking dental care
Dental care
Dental care is the maintenance of healthy teeth. Forms include:* Oral hygiene, the practice of keeping the mouth and teeth clean in order to prevent cavities , gum disease, and other dental disorders....

 outside of their local healthcare systems.

Fertility

Fertility tourism is the practice of traveling to another country for fertility treatments. The main reasons for fertility tourism are legal regulation of the sought procedure in the home country, or lower price. In-vitro fertilization, donor insemination and surrogacy
Surrogacy
Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person. This woman may be the child's genetic mother , or she may carry the pregnancy to delivery after having an embryo, to which she has no genetic relationship whatsoever, transferred to her uterus...

 are major procedures involved.

Israel

Israel
Israel
The State of Israel is a parliamentary republic located in the Middle East, along the eastern shore of the Mediterranean Sea...

 is emerging as a popular destination for medical tourists. In 2006, 15,000 foreigners travelled to the country for medical procedures, bringing in $40 million of revenue.

Medical tourists choose Israel for several reasons. Some come from European nations such as Romania
Romania
Romania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...

 where certain procedures are not available.

Other medical tourists come to Israel to visit the Dead Sea
Dead Sea
The Dead Sea , also called the Salt Sea, is a salt lake bordering Jordan to the east and Israel and the West Bank to the west. Its surface and shores are below sea level, the lowest elevation on the Earth's surface. The Dead Sea is deep, the deepest hypersaline lake in the world...

, a world-famous therapeutic resort. The Israel Ministry of Tourism and several professional medical services providers have set out to generate awareness of Israel's medical capabilities.

Jordan

Jordan
Jordan
Jordan , officially the Hashemite Kingdom of Jordan , Al-Mamlaka al-Urduniyya al-Hashemiyya) is a kingdom on the East Bank of the River Jordan. The country borders Saudi Arabia to the east and south-east, Iraq to the north-east, Syria to the north and the West Bank and Israel to the west, sharing...

 is an emerging medical tourism destination, with related revenues exceeding one billion dollars in 2007. More than 250,000 patients from other countries sought treatment in Jordan that year. This included an estimated 45,000 Iraqis and approximately 25,000 patients each from Palestine and Sudan. An estimated 1,800 US citizens, 1,200 UK citizens, and 400 Canadians also sought treatment in Jordan that year. Treatment costs can be as low as 25 percent of costs in the US. The kingdom was rated as number one in the region and fifth in the world as a medical tourism hub in a study by the World Bank.

United Arab Emirates

Hospitals in Dubai
Dubai
Dubai is a city and emirate in the United Arab Emirates . The emirate is located south of the Persian Gulf on the Arabian Peninsula and has the largest population with the second-largest land territory by area of all the emirates, after Abu Dhabi...

 and other emirates
Emirates of the United Arab Emirates
The United Arab Emirates is composed of 7 emirates :-References:...

 have expressed an intent to develop in medical tourism. Some have American-sourced international healthcare accreditation, while others are looking towards the UK, Australia and Canada for accreditation services. For example, QHA Trent has now accredited several hospitals in the UAE.

South Africa

South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

 is the first country in Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...

 to emerge as a medical tourism destination. It offers world-class medical facilities and affordable medical and dental care.

The Americas

Countries in the Americas that are treating foreign patients include Argentina
Argentina
Argentina , officially the Argentine Republic , is the second largest country in South America by land area, after Brazil. It is constituted as a federation of 23 provinces and an autonomous city, Buenos Aires...

, Bolivia
Bolivia
Bolivia officially known as Plurinational State of Bolivia , is a landlocked country in central South America. It is the poorest country in South America...

, Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...

, Colombia
Colombia
Colombia, officially the Republic of Colombia , is a unitary constitutional republic comprising thirty-two departments. The country is located in northwestern South America, bordered to the east by Venezuela and Brazil; to the south by Ecuador and Peru; to the north by the Caribbean Sea; to the...

, Costa Rica
Costa Rica
Costa Rica , officially the Republic of Costa Rica is a multilingual, multiethnic and multicultural country in Central America, bordered by Nicaragua to the north, Panama to the southeast, the Pacific Ocean to the west and the Caribbean Sea to the east....

, Cuba
Cuba
The Republic of Cuba is an island nation in the Caribbean. The nation of Cuba consists of the main island of Cuba, the Isla de la Juventud, and several archipelagos. Havana is the largest city in Cuba and the country's capital. Santiago de Cuba is the second largest city...

, Dominican Republic
Dominican Republic
The Dominican Republic is a nation on the island of La Hispaniola, part of the Greater Antilles archipelago in the Caribbean region. The western third of the island is occupied by the nation of Haiti, making Hispaniola one of two Caribbean islands that are shared by two countries...

, Guatemala
Guatemala
Guatemala is a country in Central America bordered by Mexico to the north and west, the Pacific Ocean to the southwest, Belize to the northeast, the Caribbean to the east, and Honduras and El Salvador to the southeast...

, Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...

, Panama
Panama
Panama , officially the Republic of Panama , is the southernmost country of Central America. Situated on the isthmus connecting North and South America, it is bordered by Costa Rica to the northwest, Colombia to the southeast, the Caribbean Sea to the north and the Pacific Ocean to the south. The...

, Peru
Peru
Peru , officially the Republic of Peru , is a country in western South America. It is bordered on the north by Ecuador and Colombia, on the east by Brazil, on the southeast by Bolivia, on the south by Chile, and on the west by the Pacific Ocean....

 and Uruguay
Uruguay
Uruguay ,officially the Oriental Republic of Uruguay,sometimes the Eastern Republic of Uruguay; ) is a country in the southeastern part of South America. It is home to some 3.5 million people, of whom 1.8 million live in the capital Montevideo and its metropolitan area...

.

Brazil

Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...

 has long been known as a destination for cosmetic surgery. For non-cosmetic procedures, Brazil is only now entering the global market. However, Albert Einstein Jewish Hospital in São Paulo was the first JCI-accredited facility outside of the US, and more than a dozen Brazilian medical facilities have since been similarly accredited. Brazil requires visas for US citizens based on a reciprocal arrangement since Brazilians are required to obtain a visa to visit the US. Unlike in the U.S and other countries where medical procedures are simply done in an office, Plastic surgery in Brazil is done in specific plastic surgery only hospitals

Canada

Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

 has entered the medical tourism field. In comparison to US health costs, medical tourism patients can save 30 to 60 percent on health costs in Canada.

Costa Rica

Costa Rica's popularity in the medical tourism industry has been growing steadily over the years. Currently there are 3 Joint Commission International accredited (JCI) Hospitals all of which are currently located in San Jose, Costa Rica. Recently announced by JCI accredited Clinica Biblica, is a $40 million dollar hospital in Guanacaste designed to target the influx of medical tourism arriving in the Liberia International airport every year. This will make for a total of over six major private hospitals and 22 public hospitals. When the World Health Organization (WHO) ranked the world’s health systems in the year 2000, Costa Rica was ranked as no. 36, which was higher than the U.S., and together with Dominica it dominated the list amongst the Central American countries.

Costa Rica offers these levels of care ranging from Intermediate Life Saving capabilities, Complex Life Saving Treatment Capabilities, Advanced Life Savings Treatment Capabilities, and Life Style Treatment Services (Full range of dental work and cosmetic surgery).

Costa Rica's proximity to the U.S. helps attract over 20,000 U.S. patients a year. The Deloitte Center for Health Solutions, in their 2009 report "Medical Tourism Consumers in Search of Value" reported cost savings average of between 30-70% of US prices.

Cuba

Cuba has been a popular medical tourism destination for more than 40 years. Thousands of patients travel to Cuba, particularly from Latin America and Europe, attracted by the "fine reputation of Cuban doctors, the low prices and nearby beaches on which to recuperate." In 2006, Cuba attracted nearly 20,000 medical tourists.

Medical treatments included joint replacement, cancer treatment, eye surgery, cosmetic surgery and addictions rehabilitation. Costs are about 60 to 80 percent less than US costs.

Cuba has hospitals for Cuban residents and others that focus on serving foreigners and diplomats. In the 2007 American documentary film, Sicko
Sicko
Sicko is a 2007 documentary film by American filmmaker Michael Moore. The film investigates health care in the United States, focusing on its health insurance and the pharmaceutical industry. The movie compares the for-profit, non-universal U.S...

, which criticizes the US healthcare system, producer Michael Moore
Michael Moore
Michael Francis Moore is an American filmmaker, author, social critic and activist. He is the director and producer of Fahrenheit 9/11, which is the highest-grossing documentary of all time. His films Bowling for Columbine and Sicko also place in the top ten highest-grossing documentaries...

 leads a group of uninsured American patients to Cuba to obtain more affordable medical treatment. Sicko has greatly increased foreigners' interest in Cuban healthcare. A recent Miami Herald story focused on the high quality of health care that Canadian and American medical tourism patients receive in Cuba.

The Cuban government has developed Cuban medical tourism to generate income for the country. Residents of Canada, the UK and most other countries can travel to Cuba without any difficulty, although a tourist visa is generally required. For Americans, however, because of the US trade policy towards Cuba, travelers must either obtain US government approval, or, more frequently, travel to Cuba from Canada, Mexico, the Bahamas, Jamaica or the Dominican Republic. Cuban immigration authorities do not stamp the passports of US visitors so that Americans can keep their travels a private matter.

To date no Cuban facility has achieved JCI Accreditation.

Mexico

Americans, particularly those living near the Mexican border, now routinely cross to Mexico for medical care. Popular specialties include dentistry and plastic surgery. Mexican dentists often charge one-fifth to one-fourth of US prices, while other procedures typically cost a third what they would in the US.

In Texas, legislators explored the possibility of allowing health maintenance organizations to operate on both sides of the border. However, physicians in south Texas lobbied against the changes, arguing that local doctors could not compete with the lower costs in Mexico". US doctors point out that the Mexican legal system makes it almost impossible to sue Mexican doctors for malpractice.

However, many who travel to Mexico for care report that they are satisfied. According to a report commissioned by Families U.S.A., a Washington advocacy group for health-care issues, "About 90 percent [feel] the care they had received in Mexico had been good or excellent. About 80 percent rated the care they had received in the United States as good or excellent".

Indeed "some U.S. dentists ... have conceded to the competition and begun a 'reverse migration' opening offices in Mexico to take advantage of lower costs". More American insurers are providing coverage for travelers, as the out-of-pocket costs to them are much lower. "With healthcare costs in the United States continuing to rise, many employers in Southern California are turning to insurance plans that send their workers to Mexico for routine care, plans that are growing by nearly 3,000 people a year."

Tijuana has proven to be a convenient center for 'medical tourism'. Due to its strategic geographic location, patients from California and much of the west coast have turned to Tijuana for elective procedures as well as for others such as chemotherapy, among others. According to the San Diego Union Tribune, about 1 million Californians go to Mexico for healthcare, and most of these patients go to Tijuana. Many of these patients seek weight loss, and plastic surgery, in addition to alternative cancer treatments. According to the Secretary of Tourism of Baja California, in 2009, close to 8 million people went to Tijuana for some type of healthcare.

In addition to dental and plastic surgery, Mexican hospitals are popular for bariatric surgery for weight loss, considered an elective procedure that is not covered by some US insurers. A popular bariatric procedure, lap band surgery, which was approved by the FDA in the US in 2001, has been performed for longer by Mexican surgeons.

Some clinics may also offer alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

 therapies that have been proven ineffective and are banned in the United States. The Mexican government has shut down some of these in recent times, in response to controversial cases like that of Coretta Scott King
Coretta Scott King
Coretta Scott King was an American author, activist, and civil rights leader. The widow of Martin Luther King, Jr., Coretta Scott King helped lead the African-American Civil Rights Movement in the 1960s.Mrs...

.

Panama

In Panama
Panama
Panama , officially the Republic of Panama , is the southernmost country of Central America. Situated on the isthmus connecting North and South America, it is bordered by Costa Rica to the northwest, Colombia to the southeast, the Caribbean Sea to the north and the Pacific Ocean to the south. The...

, health and medical tourism is growing rapidly. Factors drawing medical tourists include Panama's tourist appeal, position as a hub for international travel, and use of the American dollar as the official currency. Many of Panama’s doctors are bilingual, board certified, and accustomed to working with the same medical equipment and technology used in the United States and Europe. On most procedures, Panama offers savings of more than 50% compared to the US and Europe. No Panamanian hospitals currently have international healthcare accreditation, whether through US, British, Australian or Canadian sources.

United States

A McKinsey and Co. report from 2008 found that a plurality of an estimated 60,000 to 85,000 medical tourists were traveling to the United States for the purpose of receiving in-patient medical care; the same McKinsey study estimated that 750,000 American medical tourists traveled from the United States to other countries in 2007 (up from 500,000 in 2006). The availability of advanced medical technology and sophisticated training of physicians are cited as driving motivators for growth in foreigners traveling to the U.S. for medical care, whereas the low costs for hospital stays and major/complex procedures at Western-accredited medical facilities abroad are cited as major motivators for American travelers. Also, it has been noted that the decline in value of the U.S. dollar is offering additional incentive for foreign travel to the U.S., although cost differences between the US and many locations in Asia far outweigh any currency fluctuations.

Several major medical centers and teaching hospitals offer international patient centers that cater to patients from foreign countries who seek medical treatment in the U.S. Many of these organizations offer service coordinators to assist international patients with arrangements for medical care, accommodations, finances and transportation including air ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....

 services.

Many locations in the US that offer medical care comparable in price to foreign medical facilities are not Joint Commission Accredited.

Uruguay

Uruguay
Uruguay
Uruguay ,officially the Oriental Republic of Uruguay,sometimes the Eastern Republic of Uruguay; ) is a country in the southeastern part of South America. It is home to some 3.5 million people, of whom 1.8 million live in the capital Montevideo and its metropolitan area...

 recently entered the medical tourism market. A private medical tourism initiative, Uruhealth, has been created with support from the Ministries of Tourism and Public Health. The initiative involves the infrastructure, human resources and experience of two healthcare companies: MP Personalized Medicine (Montevideo) and SEMM-Mautone Hospital (Punta del Este).

China

China is fast emerging as a desirable destination for individuals seeking medical care in a wide range of medical specialties, including cardiology, neurology, orthopedics and others. A number of private and government hospitals in major cities have established international departments. Many leading hospitals provide treatments integrating Traditional Chinese Medicine with Western medical technology and techniques. China is home to leading stem cell research and treatment hospitals that offer Westerners who want to take advantage of stem cell treatments that are still considered experimental or have yet to be approved in their home country.

Hong Kong

As of 2006, Hong Kong
Hong Kong
Hong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...

 had 12 private hospitals and 39 public hospitals, providing 3,124 and 27,755 beds respectively. A wide range of health care services are offered. All 12 of Hong Kong's private hospitals have been surveyed and accredited by the UK's Trent Accreditation Scheme since early 2001. This has been a major factor in the ascent of standards in Hong Kong's private hospitals. The Trent scheme works closely with the hospitals it assesses to generate standards appropriate to the locality (with respect to culture, geography, public health, primary care interfaces etc.), and always uses combinations of UK-sourced and Hong Kong-sourced surveyors. Some of Hong Kong's private hospitals have now gone on to obtain dual international accreditation, with both Trent and JCI (and have therefore attained a standard surpassing some of the best hospitals in Thailand and Singapore). Others are looking towards dual international accreditation with Trent and the Australian group. Hong Kong public hospitals have yet to commit to external accreditation.

India

India’s medical tourism sector is expected to experience an annual growth rate of 30% Advantages for medical tourists include reduced costs, the availability of latest medical technologies and a growing compliance on international quality standards, as well as the fact that foreigners are not likely to face a language barrier in India. The Indian government is taking steps to address infrastructure issues that hinder the country's growth in medical tourism.

The most popular treatments sought in India by medical tourists are alternative medicine, bone-marrow transplant, cardiac bypass surgery, eye surgery and orthopedic surgery. India is known in particular for heart surgery, hip resurfacing
Hip resurfacing
Hip resurfacing has been developed as a surgical alternative to total hip replacement . The procedure consists of placing a cobalt-chrome metal cap, which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup is placed in the acetabulum , replacing the...

 and other areas of advanced medicine.

South Korea

Listed on CNN.com as one of the “hot destinations” for medical tourism, South Korea is quickly establishing itself in the field of medical tourism.

However, The Korea Times
The Korea Times
The Korea Times is the oldest of three English-language newspapers published daily in South Korea, along with The Korea Herald and The JoongAng Daily. It is part of the same newspaper group as Hankook Ilbo, a major Korean language daily...

reported in a series of articles that Korean hospitals have adopted a discriminatory pricing policy, charging foreigners two to three times more than the full-fee for locals.

The paper revealed that the price disparity in medical fees for foreign patients is extremely high, considering that the difference between the lowest and highest fees for the most-sought-after procedures exceeds more than 10 times on average.

It claims the government is overlooking soaring medical fees on foreign patients, who are unprotected from malpractice, discriminatory charging, overpricing and patient privacy rights under the Korean Medical Law.

In 2008, Korea had 27,480 foreign-based patients and the Korean health ministry expects that number to increase to 140,000 by 2015. Due to legislation passed in May 2009, state-licensed clinics and hospitals are now allowed to directly seek out foreign patients through various promotional activities. In 2009, South Korea had a total number of 60,000 medical tourists. In 2010, the number had risen to 80,000. The South Korean Ministry of Health has set the target for 2015 to up to 300,000 medical tourists.

Korean hospitals and clinics provide a variety of medical services for medical tourists including comprehensive health screening, cancer treatment, organ transplantation, joint/rheumatism care, spinal treatment, ophthalmology, dental care, infertility treatment, otorhinolaryngology, and Korean traditional medicine. Currently, the most popular treatments for medical tourists are cosmetic procedures such as eyelid surgery, nose jobs, facelifts, and skin lightening.

Over 30 South Korean hospitals and clinics are member providers under the Council for Korea Medicine Overseas Promotion (CKMOP). Among these facilities are the “Big Four” – Seoul National University Hospital
Seoul National University Hospital
Seoul National University Hospital is Korea's top hospital. This hospital is a general and teaching hospital of Seoul National University's School of Medicine. Its headquarters are located in Yeon-gun, Jong-ro in Seoul...

, Samsung Medical Center
Samsung Medical Center
Samsung Medical Center which is located in Irwon-Dong of Gangnam-Gu, Seoul Korea is a tertiary hospital. SMC is composed of Samsung Seoul Hospital, Kangbook Samsung Hospital, Samsung Changwon hospital, and Samsung Life Sciences Research Center...

, Asan Medical Center
Asan Medical Center
Asan Medical Center is the parent of seven hospitals which are part of the Asan Foundation established in 1977 and which has non-profit operations in areas including healthcare, social work, scholarship, and R&D support....

, and Yonsei Severance Hospital.

Malaysia

Malaysia is well on its way to develop itself as a medical tourism hub and is the most visited medical tourism destination by UK patients, attracting 8.5% of all UK medical tourists. The country has excellent hospitals, English is widely spoken, and many staff have been trained to a high level in the UK or in the US. There is a highly active Association for Private Hospitals of Malaysia working to develop medical tourism. However, while Malaysia has a national accreditation healthcare scheme (MSQH) and many Malaysia's hospitals are currently firmly on the way to achieve international healthcare accreditation.

Malaysian hospitals such Gleneagles Hospital Kuala Lumpur http://www.gimc.com.my, International Specialist Eye Centre, Penang Adventist Hospital are JCI accredited. The Ministry of Health has launched a medical tourism page.

New Zealand

New Zealand is a relatively new destination to medical travel. It has all the hallmarks of a very successful destination especially for North American based patients. This includes being a first world, developed economy with a sophisticated and comprehensive medical system. It is first and foremost English speaking with a rich heritage of producing world class doctors and medical research.

Many of its private hospitals are internationally accredited, state of the art and offer an integrated package of care.

The cost of the surgical care in New Zealand is significantly cheaper. On average it is considered that New Zealand’s surgical costs are around 15 to 20% the cost of the same surgical procedure in the USA. One patient who had his prosthetic hip replaced in New Zealand said the total cost including travel, lodging and the surgery at a private hospital was $20,000, as opposed to the $80,000 - $140,000 he was told the operation would have cost at home.

Added to this the personalized level of medical care, the world renown natural beauty and tranquility, the fact that New Zealand is one of the safest places in the world and only 12 hours direct flight from the west coast of North America, then New Zealand as a medical travel destination looks set to develop.

Pakistan

Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...

 has mentioned its keenness on working towards medical tourism and has considered it as a key element in its recent tourism policy. Despite suffering several blowbacks, due to insecurity and instability in the region, medical tourism in Pakistan has been arranging potential trips for many medical health and care procedures. A number of modern hospital facilities exist in Islamabad
Islamabad
Islamabad is the capital of Pakistan and the tenth largest city in the country. Located within the Islamabad Capital Territory , the population of the city has grown from 100,000 in 1951 to 1.7 million in 2011...

, Karachi
Karachi
Karachi is the largest city, main seaport and the main financial centre of Pakistan, as well as the capital of the province of Sindh. The city has an estimated population of 13 to 15 million, while the total metropolitan area has a population of over 18 million...

 and Lahore
Lahore
Lahore is the capital of the Pakistani province of Punjab and the second largest city in the country. With a rich and fabulous history dating back to over a thousand years ago, Lahore is no doubt Pakistan's cultural capital. One of the most densely populated cities in the world, Lahore remains a...

 which are fully equipped and facilitated. Many doctors and surgeons in Pakistani hospitals tend to be foreign qualified. A number of patients from neighbouring countries have traveled to Pakistan for treatment.

Philippines

The Philippines
Philippines
The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...

 has been growing as a destination for medical tourism. The US Medical Tourism Association magazine reported that this services sub-sector grew 8.0% in 2007.
The number can be expected to grow as American health-care costs rise, or if pending legislation results in an increase in patient wait times for surgical procedures (as has been seen in other countries where care has been nationalized), due to the traditional political, economic and cultural connections between the United States and the Philippines. International accreditation of hospitals has increased, and QHA Trent has now accredited hospitals in the Philippines.

The Philippines is one of a few countries that sends qualified nurses, physicians and dentists to the US, the thousands serving in American medical facilities being a testament to its quality of medical education. Many also work in the UK. According to year 2000 WHO rankings of the world's health systems, the Philippines takes its position on no.60.

Singapore

Singapore has a dozen hospitals and health centers with JCI accreditation. In 1997 (published 2000), the World Health Organization ranked Singapore's health care system sixth best in the world and the highest ranked system in Asia. In 2000, Singapore received 410,000 medical tourists. By 2012, the Singaporean government aims to attract one million international patients annually.

Patients come from neighboring countries, such as Indonesia and Malaysia, and patient numbers from Indochina, South Asia, the Middle East and Greater China are growing. Patients from developed countries such as the United States and the UK are also beginning to choose Singapore as their medical travel destination for relatively affordable health care services in a clean cosmopolitan city.

Singapore recently launched the region’s first cardiology clinic catering especially for the needs of women. This is in recognition of the fact that cardiovascular disease (heart disease and stroke) is the top killer among women in Singapore and in many other countries in the Asia Pacific. The Women’s Heart Health Clinic is located in the National University Hospital. Its emphasis is on prevention as well as treatment. Women are treated by an all-women team comprising a cardiologist, dietician (heart-healthy diet), occupational therapists (lifestyle management) and physiotherapist (exercise prescription).

Taiwan

The Taiwanese government has declared its determination for the country to become a medical tourism center. In 2007, the Department of Health launched a campaign to promote inbound medical tourism, focusing on integrating the resources of the government and academia to build Taiwan's brand as a medical tourism destination. Costs for procedures remain comparatively low. Taiwan
Taiwan
Taiwan , also known, especially in the past, as Formosa , is the largest island of the same-named island group of East Asia in the western Pacific Ocean and located off the southeastern coast of mainland China. The island forms over 99% of the current territory of the Republic of China following...

 is known for liver transplants, joint replacement surgery, bone marrow transplants, and reconstructive and plastic surgery.

Thailand

Medical tourism has been a growing segment of Thailand
Thailand
Thailand , officially the Kingdom of Thailand , formerly known as Siam , is a country located at the centre of the Indochina peninsula and Southeast Asia. It is bordered to the north by Burma and Laos, to the east by Laos and Cambodia, to the south by the Gulf of Thailand and Malaysia, and to the...

's tourism and health-care sectors. In 2005, one Bangkok hospital took in 150,000 treatment seekers from abroad. In 2006, medical tourism was projected to earn the country 36.4 billion baht.

Treatments for medical tourists in Thailand range from cosmetic, organ transplants, cardiac, and orthopaedic treatments to dental and cardiac surgeries. Treatments also include spa
Spa in Thailand
Introduced in the early 1990s, spas in Thailand are a relatively new phenomenon and one that has only very recently increased in popularity. Not only are spas popular and fashionable with foreign tourists and expatriates, but the local Thais are also enjoying this new alternative therapy, one which...

, physical and mental therapies, as well as procedures that are considered more along the lines of fringe medical practices. One patient who had coronary artery bypass surgery
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...

 at Bumrungrad International hospital in Bangkok said the operation cost him US
United States dollar
The United States dollar , also referred to as the American dollar, is the official currency of the United States of America. It is divided into 100 smaller units called cents or pennies....

$12,000 (8,200 euros), as opposed to the $100,000 (68,000 euros) he estimated the operation would have cost him at home. Bumrungrad treated approximately 55,000 American patients in 2005 alone, a 30% increase from the previous year.

Hospitals in Thailand are a popular destination for other Asians. Bangkok Hospital, which caters to medical tourists, has a Japanese wing, and Phyathai Hospitals Group
Phyathai Hospitals Group
The is a Bangkok-based hospital group in Thailand that has provided health care service for over 30 years.The group consists of Phyathai 1 Hospital, Phyathai 2 Hospital, and Phyathai 3 Hospital...

 has interpreters for over 22 languages, besides the English-speaking medical staff. When Nepal
Nepal
Nepal , officially the Federal Democratic Republic of Nepal, is a landlocked sovereign state located in South Asia. It is located in the Himalayas and bordered to the north by the People's Republic of China, and to the south, east, and west by the Republic of India...

 Prime Minister Girija Prasad Koirala
Girija Prasad Koirala
Girija Prasad Koirala was a Nepalese politician and the President of the Nepali Congress, a major political party. He was Prime Minister of Nepal for four times, serving from 1991 to 1994, 1998 to 1999, 2000 to 2001, and from 2006 to 2008; he was also Acting Head of State from January 2007 to July...

 needed medical care in 2006, he went to Bangkok.

Many Thai physicians hold US or UK professional certification. Bumrungrad International hospital states that many of its doctors and staff are trained in the UK, Europe and the US. Bumrungrad International was accredited most recently in 2005 by the Joint Commission.
Some of the country’s major hospitals have also achieved certification by the International Organization for Standardization
International Organization for Standardization
The International Organization for Standardization , widely known as ISO, is an international standard-setting body composed of representatives from various national standards organizations. Founded on February 23, 1947, the organization promulgates worldwide proprietary, industrial and commercial...

’s ISO 9001:2000. However, ISO 2000 is not an accreditation scheme.

The World Health Organization's 2000 ranking put the Thai healthcare system at number 47, below the USA's ranking at 37 and the United Kingdom's ranking at 18.

Europe

Countries in Europe that have active medical tourism sectors include Turkey
Turkey
Turkey , known officially as the Republic of Turkey , is a Eurasian country located in Western Asia and in East Thrace in Southeastern Europe...

, Romania
Romania
Romania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...

, Cyprus
Cyprus
Cyprus , officially the Republic of Cyprus , is a Eurasian island country, member of the European Union, in the Eastern Mediterranean, east of Greece, south of Turkey, west of Syria and north of Egypt. It is the third largest island in the Mediterranean Sea.The earliest known human activity on the...

, Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

, Hungary
Hungary
Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...

, Estonia
Estonia
Estonia , officially the Republic of Estonia , is a state in the Baltic region of Northern Europe. It is bordered to the north by the Gulf of Finland, to the west by the Baltic Sea, to the south by Latvia , and to the east by Lake Peipsi and the Russian Federation . Across the Baltic Sea lies...

, Lithuania
Lithuania
Lithuania , officially the Republic of Lithuania is a country in Northern Europe, the biggest of the three Baltic states. It is situated along the southeastern shore of the Baltic Sea, whereby to the west lie Sweden and Denmark...

, Malta
Malta
Malta , officially known as the Republic of Malta , is a Southern European country consisting of an archipelago situated in the centre of the Mediterranean, south of Sicily, east of Tunisia and north of Libya, with Gibraltar to the west and Alexandria to the east.Malta covers just over in...

, Poland
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...

, Portugal
Portugal
Portugal , officially the Portuguese Republic is a country situated in southwestern Europe on the Iberian Peninsula. Portugal is the westernmost country of Europe, and is bordered by the Atlantic Ocean to the West and South and by Spain to the North and East. The Atlantic archipelagos of the...

, Czech Republic
Czech Republic
The Czech Republic is a landlocked country in Central Europe. The country is bordered by Poland to the northeast, Slovakia to the east, Austria to the south, and Germany to the west and northwest....

, Slovakia
Slovakia
The Slovak Republic is a landlocked state in Central Europe. It has a population of over five million and an area of about . Slovakia is bordered by the Czech Republic and Austria to the west, Poland to the north, Ukraine to the east and Hungary to the south...

, Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...

, and Ukraine
Ukraine
Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...

.

In 2006 it was ruled that under the conditions of the E112 European health scheme, UK health authorities had to pay the bill if one of their patients could establish urgent medical reasons for seeking quicker treatment in another European union country.

Czech Republic

Czech Republic
Czech Republic
The Czech Republic is a landlocked country in Central Europe. The country is bordered by Poland to the northeast, Slovakia to the east, Austria to the south, and Germany to the west and northwest....

 has built its medical tourism on spas and medical care equalling the world standards (for example Ostrava University Hospital).

Cyprus

Cyprus
Cyprus
Cyprus , officially the Republic of Cyprus , is a Eurasian island country, member of the European Union, in the Eastern Mediterranean, east of Greece, south of Turkey, west of Syria and north of Egypt. It is the third largest island in the Mediterranean Sea.The earliest known human activity on the...

 is actively developing its medical tourism industry. Currently very few hospitals have independent accreditation.

Estonia

Estonia
Estonia
Estonia , officially the Republic of Estonia , is a state in the Baltic region of Northern Europe. It is bordered to the north by the Gulf of Finland, to the west by the Baltic Sea, to the south by Latvia , and to the east by Lake Peipsi and the Russian Federation . Across the Baltic Sea lies...

 is particularly popular among Scandinavians for medical tourism. The medical tourism industry achieves world standards and has to comply with EU regulation since it joined the EU in 2004. Estonia is known for its good medical care and scored particularly high in the Health Consumer Powerhouse report, produced on behalf of the European Union.

France

British NHS patients have been offered treatment in France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...

 to reduce waiting lists for hip, knee and cataract surgery since 2002. France is a popular tourist destination but also ranked the world's leading health care system. This ranking reflects the expertise offered by doctors and surgeons to patients cared for in France. The French National Authority for Health (HAS) issues high-level quality requirements for French health care, with which clinics and hospitals must comply in order to be accredited.

Germany

Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

 is a destination for patients seeking advanced medical technology, high standards, safety, and quick treatment.
All German citizens have health coverage, resulting in a high hospital density, with twice as many hospitals per capita as the United States. The high hospital density results in shorter waitlists for treatment.
Costs for medical treatment compete well with other developed European countries and are commonly 50% of those in the USA.

Germany is an attractive destination for patients from the Middle East since traveling to the USA has become more difficult for them since the September 11 attacks. US citizens sometimes travel to Germany to seek treatments such as artificial cervical disc replacement that are not US Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

 (FDA) approved.

Hungary

Because of an advantageous geographical location thermal water can be found with good quality and in great quantities on over 80% of Hungary
Hungary
Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...

's territory. Approximately 1,500 thermal springs can be found in Hungary. There are approximately 450 public baths in Hungary.

The Romans
Ancient Rome
Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....

 heralded the first age of spa in Hungary, the remains of their bath complexes are still to be seen in Óbuda
Óbuda
Óbuda was a historical city in Hungary. United with Buda and Pest in 1873 it now forms part of District III-Óbuda-Békásmegyer of Budapest. The name means Old Buda in Hungarian...

, to this day. The spa culture was revived during the Turkish Invasion who used the thermal springs of Buda
Buda
For detailed information see: History of Buda CastleBuda is the western part of the Hungarian capital Budapest on the west bank of the Danube. The name Buda takes its name from the name of Bleda the Hun ruler, whose name is also Buda in Hungarian.Buda comprises about one-third of Budapest's...

 for the construction of a number of bathhouses, some of which are still functioning (Király Baths
Király Baths
Király Bath or Király fürdő is a thermal bath that was first built in Hungary in the second half of the sixteenth century, during the time of Ottoman rule....

, Rudas Baths
Rudas Baths
Rudas Bath or Rudas fürdő is a thermal and medicinal bath in Budapest, Hungary. It was first built in 1550, during the time of Ottoman rule. To date, it retains many of the key elements of a Turkish bath, exemplified by its Turkish dome and octagonal pool. It is located at Döbrentei tér 9 on the...

).

In the 19th century the advancement in deep drilling and medical science provided the springboard for a further leap in bathing culture. Grand spas such as Gellért Baths
Gellért Baths
Gellért Thermal Baths and Swimming Pool, also called Gellért fürdő or Gellért Baths, are a bath complex in Budapest, Hungary, built between 1912 and 1918 in the Art Nouveau style. They were damaged during World War II, but then rebuilt. References to healing waters in this location are found from...

, Lukács Baths, Margaret Island
Margaret Island
Margaret Island is a long island, 500 metres wide, in the middle of the Danube in central Budapest, Hungary. It belongs administratively to the 13th district. The island is mostly covered by landscape parks, and is a popular recreational area. Its medieval ruins are reminders of its importance...

, and Széchenyi Medicinal Bath
Széchenyi Medicinal Bath
The Széchenyi Medicinal Bath in Budapest is the largest medicinal bath in Europe. Its water is supplied by two thermal springs, their temperature is and , respectively....

 are a reflection of this resurgence in popularity.

Lithuania

Lithuania
Lithuania
Lithuania , officially the Republic of Lithuania is a country in Northern Europe, the biggest of the three Baltic states. It is situated along the southeastern shore of the Baltic Sea, whereby to the west lie Sweden and Denmark...

 is one of several countries actively promoting medical tourism. Treatments involve cosmetic surgery, eye surgery, and other services.

Poland

Since 2004, when Poland
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...

 joined the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...

, it has become another locale for people seeking cheaper medical treatments. The quality of care in Poland must comply with EU standards.
The best hospitals and clinics in Poland are concentrated in the Polish Association of Medical Tourism (PAMT). The Association is responsible for the development of this sector of the economy in Poland.

Romania

Romania
Romania
Romania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...

 is a member state of the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...

. Medical tourism services in Romania
Romania
Romania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...

 varied but cover a large scope. The quality of services is implemented by both national and EU bodies of accreditation. Medical tourism in Romania is quality driven as outlined in the Medical Tourism Magazine, issue 18.

The private healthcare system in Romania is amongst the most dynamic in the country in terms of investments and growth. Market reports state that growth can still be expected in the private system in the years to come.

There are facilitators in Romania helping traveling patients access services, both medical and touristic services.

Turkey

Turkey
Turkey
Turkey , known officially as the Republic of Turkey , is a Eurasian country located in Western Asia and in East Thrace in Southeastern Europe...

 attracts medical tourists from Europe and the Balkans, the United States, Eurasia and the Middle East, hosting about 40,000 annually,

The Turkish private healthcare system is striving to become a strategic global health service provider manufacturing center. Web site www.healthinturkey.org http://www.healthinturkey.org has been established by the DEİK-Foreign Economic Relations Board of Turkey Healthcare Committee and the Accredited Hospitals Association of Turkey. The site contains information on prices and hospital statistics, information about the healthcare, pharmaceutical and insurance environments as well as an international patient guide.

Over 34 hospitals and medical institutions have achieved Joint Commission International accreditation.

United Kingdom

The United Kingdom is one of the most active of medical tourism destinations, especially London. http://www.imtj.com/articles/2009/the-forgotten-medical-tourism-destination-30026/?locale=en,http://www.imtj.com/news/?EntryId82=285641 Nevertheless, as at the present time very few UK private hospitals have gone through independent international accreditation (they only have the mandatory registration with the UK's watchdog, the Care Quality Commission), so they have not as yet measured themselves against the best clinics and hospitals elsewhere in the world.

External links

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