Sometimes medical tourism is driven by patients seeking lower costs. Sometimes it’s the desire to access better quality treatment or a better outcome. But when treatment laws and regulations differ from region to region or country to country, patients cross borders to seek the treatment they want or need. IMTJ Editor-in-Chief Keith Pollard reviews recent examples spanning the US, EU and India.
In June, we witnessed the biggest change in abortion laws in the United States in fifty years. In 1973, the Roe v. Wade case was a legal milestone, protecting women’s abortion rights across the United States. The case ruled that a woman’s right to terminate a pregnancy was protected by the US Constitution and, at the time, prevented two states, Texas and Georgia, from restricting those rights. However, the United States Supreme Court has now put an end to this constitutional right. More than half of the 50 US states will now introduce laws that restrict access to abortion services.
Changes to US law will spur domestic medical travel from one US state to another, and possibly to countries outside of the US. This could lead to the closure of abortion clinics in some US states and create an influx of patients for those elsewhere.
IVF – regulations drive medical travel
The cross-border assisted reproduction market is heavily influenced by the variation in regulations from country to country. Within the EU, there is no standard approach to determining who can access IVF treatment and what clinics can offer. The European Society of Human Reproduction and Embryology (ESHRE) maintains an interactive map that illustrates the variability in legislation and regulation on ART and IUI. The IVI Assisted Reproduction Group provides a helpful summary of the various rules and regulations:
- Sperm donation is allowed in 20 of the 27 EU states.
- Egg donation is only allowed in 17 states.
- Donor anonymity varies from state to state. In countries such as Switzerland, Germany, Malta, Finland and the United Kingdom, a child may know the identity of the donor when he reaches a certain age.
- There are restrictions in some countries that allow treatment only for heterosexual couples. The rights of single women and lesbian couples also vary.
- There may be age limits for women’s access to treatment.
Inevitably, the difference in regulations between countries encourages infertile couples to travel to a destination where the treatment they want is authorized.
EU Medical Travel Legislation
Rather than restricting medical travel, in 2011 the European Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare aimed to establish rules aimed at facilitating access to healthcare quality and safe cross-border services in the EU, to ensure patient mobility in accordance with the principles established by the European Court of Justice and to promote cooperation between Member States in the field of healthcare. However, more than ten years later, the impact of this major legislation has probably been less than hoped, although some attempts have been made to assess the impact on different Member States (See: Impact of the 2011 Directive /24/EU on the application of patients’ rights in cross-border healthcare: a comparative analysis).
Drug and treatment approval attracts medical travelers
Another example of legislation motivating medical travel is where treatment approaches and new drug developments can be accelerated in one country over another. “Drug tourism” is often driven by lower drug costs in some countries. For example, there is the flow of US citizens crossing the border into Mexico to obtain medications, especially for long-term conditions, which are available at greatly reduced prices. However, the pursuit of the “elixir of life” or a life-saving medicine continues to drive medical travel where a “miracle cure” is claimed to be available at a destination. A prime example is stem cell therapy, which is often claimed to repair damage resulting from a disease or life-threatening condition. This clearly presents some dangers when patients seek unproven treatments or when the standard of care may be questionable.
Some countries have been proactive in encouraging medical travel by establishing clear processes to support medical travel. India’s medical visa program is a prime example. A Home Ministry report to the Indian Parliament in February 2022 said that 825,000 medical visas for India had been issued to foreigners, mostly African countries, between 2019 and 2021. More recently, Prime Minister Modi has announced the introduction of a special category of AYUSH visa to promote inbound medical tourism for the treatment of traditional medicine, as part of the “Heal in India” campaign.
So… it’s not just about cutting costs and improving quality
Medical tourism is complicated. It is not a single market. It is made up of a multitude of market niches, each of which is made up of disparate patients with varying needs, who may be considering medical travel for a variety of reasons. A change in healthcare regulations and legislation in one country can often present an opportunity for another.