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John Connell

International medical mobility is multifaceted but, since the 1990s, medical tourism has grown rapidly in the wake of the Asian financial crisis, to become a growing and distinctive niche in the tourism industry. About thirty countries are key destinations, especially in south-east Asia, for various procedures from cosmetic surgery to check-ups. Numerous countries are anxious to participate. Much international medical travel is over short distances across nearby borders, resulting in the emergence of distinctive border regions. Patient-travellers are often from the diaspora, or from culturally similar regions. Costs and quality and word of mouth influence choice of destination. Urban bias in medical tourism and uneven development have raised ethical questions in contexts where privatization and destination branding are significant. Transnational hospital chains characterize part of the industry and local needs are marginalized. The political economy of health care is no longer tied to locality.

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John Connell

Medical tourism has never been effectively defined. It is usually conceived as relatively recent travel from the global ‘north’ to the ‘south’, but is much more complex and scarcely new. Definitions take varying note of intent, procedures (that usually exclude wellness and sometimes dentistry) and the role of actual tourism. Refugee movements, formal transfers across adjacent borders, return of diasporic patients, movements of the desperately ill, and the search for ‘last resort’ cures, raise moral, cultural and political issues and challenge easy definition. Balancing medical care, intent, need, duration, gravity and tourism is difficult, and emphasises the extraordinary social, geographical and medical diversity of medical tourism. International medical travel, or transnational healthcare, provide more all-embracing definitions for cross-border movements for medical care, with medical tourism more appropriate for circumstances where tourism plays a substantial role, but medical tourism is likely to remain the primary term since it meets industry’s populist needs.

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Preface

Environments, Economies and Contemporary Change

John Connell

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Introduction

Environments, Economies and Contemporary Change

John Connell

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Islands and political economies

Environments, Economies and Contemporary Change

John Connell

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The historic core: agriculture and fisheries

Environments, Economies and Contemporary Change

John Connell

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Towards modern economies?

Environments, Economies and Contemporary Change

John Connell

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Urban futures?

Environments, Economies and Contemporary Change

John Connell

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Leaving the islands: international migration

Environments, Economies and Contemporary Change

John Connell

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Environmental change

Environments, Economies and Contemporary Change

John Connell