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Johanna Hanefeld and Richard Smith

A novelty of globalization, over previous centuries of internationalization of trade across borders, has been the increasing focus on services, in addition to primary and manufactured goods, which has been facilitated by advances in transport and telecommunications. While there are many services which impact upon health, over the past two decades there has been a considerable rise in trade in services directly related to healthcare and health systems; largely as a direct result of the development of the General Agreement on Trade in Services (GATS) by the World Trade Organization in the mid-1990s. This trade takes a number of different forms, including the cross-border provision of medical services, foreign direct investment in health services, movement of health workers across borders and, perhaps most prominently, ‘medical tourism’, where patients move to access services abroad and which is examined in greater detail in this Handbook. While the overall volume of trade in health-related services is not fully known, and data poses difficulties across the different types of travel, available data sources suggest that although health-related services represent only a small proportion of the overall trade in services, this is a significant growth area. This chapter reviews the different types of trade in health services as defined under the GATS agreement and discusses the relationship between these different modes.

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Johanna Hanefeld and Richard Smith

Medical tourism is often associated with patients travelling for treatment to an exotic destination where they pay out-of-pocket for their treatment, received mainly in the private sector. Yet the term medical travel or tourism covers a range of different types of travel including where patients travel as part of government schemes purchasing medical services abroad, where patients return to their home country to receive treatment – often called diaspora patients, or cross-border areas which operate schemes allowing patients from different countries to access services. It also extends to where patients travel because they are unable to access a type of treatment at home or when a treatment is not accessible to them. This type of treatment, where there is less patient choice, is sometimes referred to as medical migration. In this chapter, the authors review different types of financing mechanisms used by patients travelling for treatment, and they explore how different types of financing mechanisms link to specific types of travel and industry models.

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Johanna Hanefeld and Daniel Horsfall

Despite a growth in literature focusing on many different aspects of medical tourism or travel (Connell, 2013), empirical evidence is still limited. While studies have addressed the system-level effects on origin and destination countries, health services and population, few have focused on who travels and why. Studies on bariatric tourists to date have focused on complications and ethical issues relating to patients who travel for bariatric treatment but not on motivation and experience. Like cosmetic surgery, bariatric surgery is often perceived to be non-essential, but links to patients intending to improve themselves and their looks, taking action on an aspect of their life with which they are dissatisfied (Holliday et al., 2014). This chapter addresses the gap in the literature, by focusing on thirteen in-depth interviews with UK patients who travelled abroad to access bariatric treatment. It examines their motivation to travel, how they decided on the procedure and provider of treatment, the experiences of actual treatments received, and any complications or follow-up treatment required once they returned to the UK.

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Edited by Neil Lunt, Daniel Horsfall and Johanna Hanefeld

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Neil Lunt, Daniel Horsfall and Johanna Hanefeld

Travel for health benefits pre-dates the rise of modern medicine and existence of passports, harking back to porous borders and less institutionalized medicine. Alongside change in travel technology, scientific and surgical developments encouraged growing patient mobility during the twentieth century. In recent decades wealthy people from less developed areas of the world travelled to developed nations to access better facilities and highly trained clinicians, drawn by innovation and reputation. In what is predominantly a private sector there has been dramatic commodification of health and medical treatments. This chapter traces the shaping of contemporary medical tourism, including the strategic role of governments in supporting and promoting national interests, and demands for regulation.

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Edited by Neil Lunt, Daniel Horsfall and Johanna Hanefeld

The growth of international travel for purposes of medical treatment has been accompanied by increased academic research and analysis. This Handbook explores the emergence of medical travel and patient mobility and the implications for patients and health systems. Bringing together leading scholars and analysts from across the globe, this unprecedented Handbook examines the regional and national experiences of medical tourism, including coverage of the Americas, Europe, Africa, the Middle East, and Asia. The chapters explore topics on issues of risk, law and ethics; and include treatment-focused discussions which highlight patient decision-making, patient experience and treatment outcomes for cosmetic, transplantation, dentil, fertility and bariatric treatment.