OUTPATIENTS

Monocle Washington correspondent Issenberg (The Victory Lab: The Secret Science of Winning Campaigns, 2012, etc.) describes the rise of medical tourism, which draws patients from around the world to such unexpected places as Hungary, the acknowledged dental capital of Europe, and Thailand, whose government touts it as the “Medical Hub of Asia.”

Once, going abroad for health care was reserved for the wealthy. Now, tens of thousands of patients who feel they cannot get needed care where they live are traveling to distant places. “Emiratis fly to South Korea for organ transplants,” writes the author. “Canadians travel to Costa Rica for check-ups. Yeminis with heart disease often end up in India.” Patients travel to the United States seeking access to care; they leave the U.S. in search of lower costs. The $90,000 heart bypass available to insured Americans at home costs $20,000 in Singapore. Many countries offer special health-travel promotional packages, with some clinicians sending chauffeured cars to collect patients at airports. Turkey’s 2014 economic modernization plan calls for expanded medical tourism. With a focus on Eastern Europe, the author traces the globalization-driven growth of the search for better health care, offering many stories of practitioners who provide dental implants, joint replacements, and other procedures. He details the growth of national health systems since the 1880s, takes into account the health travel–related effects of the fall of the Soviet Union and the rise of the European Union, and finds that the revenues of foreign patients bolster the budgets of hospitals. At the same time, local patients often lack the means to pay for care or linger on waiting lists. In Issenberg’s view, the scarcity of care for locals is caused not by health tourism but by local government policy.

Policymakers will benefit from the author’s densely detailed but accessible, on-the-ground reporting of an increasingly commonplace phenomenon with serious implications for the future of health care.