Children's Medical Tourism: Developing an inclusive base for international study

Children's medical tourism - where parents take children across international borders for treatment - is increasingly seen in medical practice, but raises many questions and has been little studied. Parents may be motivated to take their children to another country for different reasons:

i) Treatment may be unavailable except by travelling to the destination country. This may be because the treatment is difficult to access or is too costly in their resident country; is innovative and has no proven efficacy, or; is bogus or unsupported by science.

ii) The destination is desirable for cultural reasons, either because the way paediatric medicine operates is preferred in the destination country, or because the cultural setting affects the types of treatments offered and/or their delivery.

These motivations may overlap: for example female genital cutting may be sought for cultural reasons, but also illegal or otherwise inaccessible in a resident country, while not proscribed in a destination country.

The growth of children's medical tourism is likely to have been facilitated by the growth of international trade in services which can be readily accessed through e-commerce and ready access to cheap international travel. The impacts on children and families, and healthcare systems here and abroad are not understood. Global health has huge inequalities and the barrier presented by international borders varies enormously between locations and the origin of those seeking to cross them.

The global market in healthcare has few checks and balances to ensure it works in the interests of children. The correct way for governments, healthcare systems and the global community to respond to the globalisation of children's medical treatment is unclear.

Little research has been done to help us understand when and where children's medical tourism takes place, to describe the background or motivations of parents, and to describe the consequent impact on children.

Children's medical tourism presents a range of putative problems that require researchers across the world to work together, for example:

-There are severe global inequalities in children's access to healthcare. It is not clear if children's medical tourism a solution to this problem, or worsens the situation;

-Some types of medical tourism may serve cultural needs. it is unclear how global standard setting can be balanced with appropriate cultural sensitivity;

-Parents who access the children's medical tourism market may be poorly supported in making healthcare choices. It is unclear what information parents need to make informed choices, and what information institutions are providing;

-Medical treatment and recovery is often stressful and child medical tourism involves parents and children travelling long distances from their networks of social support. Strategies to support children and families are unclear;

-Almost every jurisdiction globally has ratified the UN Convention on the Rights of the Child 1989, but little research has examined how the obligations of the convention should be applied to children's medical tourism;

-Many countries are developing medical tourism industries, but there is no consistent standard or regulation of this market including for childrens' treatment;

-There are difficulties in both proving liability and gaining recompense across borders for negligent treatment. Negligent treatment of children may not manifest for many years, presenting a special challenge; -Medical tourism has been implicated in the transfer of unusual illnesses between different areas;

Researching children's medical tourism presents methodological challenges. While reasons for child medical tourism may be diverse, some motivations for seeking treatment across borders may be associated with difficult to reach populations. Relationships must be established to engage these communities in order to undertake inclusive research.