This study examined Australian television and print news and current affairs coverage of medical tourism: its type and format, content – the countries, types of procedures and news actors featured – and the extent to which the appeals, credibility and risks of medical tourism were mentioned. This section considers what messages about medical tourism and its LMIC destination countries were presented in the coverage.
The media portrayal of medical tourism reflects several trends identified in earlier research concerning the Australian domestic coverage of both LMICs and their health status [8
]. First, the topics represented among the 131 media items analysed were concentrated around a total of just ten major medical foci (Tables and ): a range of surgical interventions, reproductive and regenerative procedures, and the threat of novel infections brought into the country by returning medical tourists. This set of concerns is similarly narrow to those previously noted in an investigation of the Australian media’s reporting of international humanitarian issues [4
]. Geographic attention in both television and newspaper items was largely on Asian nations, due to their proximity and consequent significance as a cluster of inexpensive destinations with which Australians already have some familiarity as both ‘backyards’ and ‘playgrounds’ [36
]. The newspaper data evidenced somewhat more extensive geographic and medical emphases. Yet this broader focus did not extend to risk considerations, which remained largely limited to individual patients’ personal or legal interests. This latter observation reflects the findings of a Canadian qualitative study of medical tourists, who spoke about the ethical dimensions of their particular decision to travel for treatment in terms of what they perceived as aspects of domestic health provision that had forced them abroad: namely, the waiting times and systemic limitations which, in turn, justified their ‘queue-jumping’ [37
Second, the restricted medical, geographic and risk concerns evident in the Australian media coverage of medical tourism were reinforced by its emphasis on identified individuals who had undergone surgery. That patients featured so prominently among news actors in both television and newspaper coverage is consistent with the use of sources in health and medical news: those affected by a health problem provide an appealing and ‘authentic’ contrast to the media presentation of statistics or research [30
]. Yoking such ‘newsworthy’ but otherwise abstract material to an individual narrative personalises the story, in line with the centrality of ‘human interest’ to general news and current affairs [38
]; the items in these datasets invariably used medical tourists’ experiences as ‘hooks’ for a wider discussion of the phenomenon. Although not all patient news actors had happy experiences to relate, every story that presented medical tourism in a positive light included at least one delighted patient. Third, the high proportion of Australians among all those interviewed mirrors the inclination toward domestic sources in LMIC news more broadly [8
]. There was far less media attention given to those who make certain types of medical tourism possible, such as surrogate mothers and organ donors.
Finally the extent to which the media content sought to establish a sense of personal relevance for audience members, a characteristic that has previously been noted in the Australian coverage of LMIC health [8
], partially explains the patterns of appeals, credibility and risks in the presentation of medical tourism. Among the television items, the attraction of ‘access to services’ appeared most frequently as a result of the number of stories about stem-cell and reproductive therapies not legally available to patients in Australia, with ‘access to ‘medical breakthrough” not much further down the list (referred to in 21.2% of stories). The focus on these procedures, too, made ‘ethical dilemmas’ (53%) the largest single category of risk evident in the television coverage. Subsequently in both television and newspaper datasets the common appeals of low cost, being able to ‘feel good’, the opportunity to travel and the lack of waiting time were consistent with the large amount of coverage related to cosmetic surgery, which was presented as a matter of ‘lifestyle choice’ for those willing and able to pay. Among the newspaper items nearly half mentioned the risk of complications (47.7%), as a result of the interest in certain, more complex (transplant and orthopaedic) surgeries. Portraying medical tourism as an extension of the bargain-hunters’ holiday that Australian travellers in Asia have long enjoyed, on which the greatest satisfaction is derived in purchasing desirable goods at the lowest possible price, promotes a kind of medical ‘shop-til-you-drop’ approach, with unrestricted access to procedures that are not necessarily required or recommended – and ultimately, a commodification of health-care [24
Given the various dimensions of uncertainty surrounding medical tourism, we might assume that potential medical tourists approach this healthcare option with heightened perceptions of its associated risks [35
]. Yet in its presentation of medical tourism, Australian news and current affairs coverage of the practice more often referenced some aspect of the actions of other medical tourists (the numbers who take part, and their personal experiences) than any reliable medical consideration. Mentions of a health facility’s international accreditation (referred to in 12.1% and 4.6% of television and newspaper stories, respectively), medical practitioners’ biography or education (10.6% and 12.3%) and ease of contacting a health-care provider following a procedure (6% and 4.6%) ranked fairly low down the list of such factors in both television and newspaper items. There is little opportunity for individuals to verify this key information and, at any rate, few medical tourists would have the requisite knowledge to properly assess a hospital’s reputation or a doctor’s skills for themselves – despite the confident assertion by many patient news actors that they had ‘done their research’ online before committing to travel. An interview study with Canadian medical tourism facilitators found that most of their ‘referrals’ came via word-of-mouth or websites [39
] – and crucial sources of relevant online information are offered by commercial interests [40
]. Investigations into the presentation of appeal and risk on medical tourism websites have previously noted that testimonials, a common technique in general advertising and used liberally in this Australian media dataset, are of limited value to would-be medical tourists since they provide no insight into the individual-level differences that might influence medical outcomes [35
Such a presentation is troubling since the notion of ‘choice’ and the associated power of the healthcare consumer are central to the medical tourism phenomenon [16
] and feature prominently in its Australian television and newspaper coverage. The mention of diverse and contrasting appeals and risks across the media dataset would appear to reinforce a belief that audiences, as an exercise of their freedom to choose, can make up their own minds. This approach is also understandable in editorial terms, with ‘balance’ a significant tenet of journalistic practice. However, presenting information from sources of varying legitimacy as though they were equally valid might properly be considered a form of bias [41
] and may leave audience members confused as to their best course of action. The television items examined here appeared largely on commercial networks, which are under sustained pressure to produce widely-engaging content at the lowest cost [42
]. In this context feature stories, which comprised the bulk of this coverage (Table ) and that reported medical tourism as a minority practice in Australian social life, make both economic and ratings sense [8
]. That the print items were mostly published in metropolitan newspapers reflects the mainly urban distribution of Australia’s population. It also suggests that this coverage does not merely give an account of the current domestic reality of medical tourism but is also aspirational, demonstrating to a wide and relatively affluent audience why and how they might participate in the practice.
Since our findings showed that both television and newspaper portrayals placed greater emphasis on the appeals than the risks or factors lending credibility to medical tourism, it was perhaps unsurprising that the ethical interest expressed in this coverage was also largely at the level of the individual Australian patient, their experiences and feelings about the process. Canadian research into medical tourists’ own understanding of their health-related travel has demonstrated a disjunction between the system-level ethical concerns of academic literature on the practice and the personal ones expressed by medical tourists; indeed, many of those interviewed were puzzled by questions about any possible larger ethical implications [37
]. Yet as mentioned above medical tourism has huge, potential medical and political consequences for both source and destination countries. While it doubtless benefits some patients from high-income nations and the large corporate medical outfits that have increasingly arisen to serve this market [24
], the advantages for local populations – including ‘direct’ providers like surrogate mothers and organ donors – are less certain [16
]. In our data one, lengthy television current affairs story and three shorter follow-up pieces examined the gap in quality between the private healthcare offered to medical tourists in India and the public services available to that country’s citizens, but these were the only media items to engage with the possible effects of medical tourism for health in LMICs. Four stories – one on an overseas knee reconstruction and three about cosmetic surgery – mentioned some health-system outcomes, but only insofar as they related to subsequent burdens for Australian healthcare.
Presenting medical tourism as simply another option available to the wealthy may inhibit appropriate policy development in source countries as, for example, growing numbers of medical tourists diminish the incentives for governments to expand their domestic health workforces [43
]. Although in recent years private organisations such as the US-based Joint Commission International (JCI) have accredited health-care facilities in numerous LMICs [44
], medical tourism otherwise remains largely unregulated: Australia and Canada, for instance, have no national health and safety guidelines on patient or practitioner involvement in the practice [45
]. Likewise efforts in destination countries have, to date, been piecemeal: India now has a special medical tourist visa but has otherwise left sectoral regulation to its private medical providers [46
]. Many medical-tourism destinations have less strict medical liability provisions than source countries, restricting patient options for legal recourse and compensation; some medical tourism facilitators include insurance in their prices and patients may take out their own policies [10
]. In the absence of official, medical directives and within the prevailing framework of medical tourism as a customer’s prerogative, the presentation to Australian media audiences of any hazards arising from the practice was a combination of anecdotal, patient evidence and a healthy dose of ‘buyer beware’.
Equally instructive in examining the content of any media corpus is the matter of what it does not
contain. Cosmetic surgery was, until recent times, reasonably uncommon and presented to media audiences as mainly the province of professionally vain female celebrities, whose medical outcomes were sometimes the occasion for a mixture of bemusement and horror [47
]. This cultural dynamic has clearly shifted. Across the television and newspaper items investigated here, cosmetic surgery was the dominant medical focus, yet never once were the – again, mainly female – patients censured for vanity. Instead their decision to do ‘something that I’ve always dreamed about’ and fix ‘a few imperfections’ was portrayed sympathetically, and as largely another manifestation of consumer choice – in this case an economically rational one, since the decision to go overseas was so often presented as being motivated by the lower prices charged for such procedures elsewhere. It is also interesting to consider how medical tourism would be presented in the domestic media if the phenomenon looked similar to its LMIC manifestation: namely, small but growing numbers of wealthy overseas patients travelling to Australia for health-care. A recent scoping study, prepared for the Australian government, on inbound medical tourism gives some idea of the perceived benefits from this practice. Again, they are presented in highly rational, mostly economic, terms: attracting foreign currency, reducing the medical professional ‘brain drain’ of health workers and providing extra resources for investment into the local health system [48
]. The study points out that Australian education is already marketed to international student ‘customers’ in the same way that medical services now might be.
The context for most of the world’s travel for medical care is quite banal: it would appear to take place largely between LMICs themselves, over short distances, across borders and within regions, although there is a lack of valid data on the size and direction of such patient flows [14
]. However, media coverage of the practice for Australian audience presented it as being primarily about long-distance journeys for non-essential, often cosmetic, procedures. The picture offered in this television and newspaper data of LMICs themselves was similarly distorted: no longer simply passive recipients of external financial and technical assistance these nations were now sources of benefit to Australians, in the form of low-cost, convenient and even enjoyable combinations of health-care and travel. In this, the Australian media’s presentation of medical tourism departs from how LMICs are usually covered in mainstream news and current affairs. Rather than attracting attention because of the health problems felt to be ‘typical’ of such locations – communicable disease, injury and child health, with no emphasis on emerging problems such as chronic disease [8
] – instead it is LMICs’ credentialled experts and advanced facilities that are touted to local audiences. The ambivalence and complexity of LMIC destinations courting medical tourists in national self-interest while, to varying degrees, failing to adequately meet the health-care needs of their own citizens [23
] is a poor fit with the simpler Australian media narrative of individual choice and personal gain. Medical tourism is likely to continue growing, with increased foreign investment in private health-care in LMICs, improved access to technology in these countries, continued ‘word of mouth’ about the practice, the intensification of its marketing and persistent cost differentials between source and destination countries [13
]. In addition, many American insurers are moving toward sending patients requiring complex medical procedures offshore in their attempts to reduce the financial burden of employee healthcare [19
]. This growth is significant because, although medical tourism has consequences for both social justice and health equity, what it will mean in the longer term for public health is far from settled.
There are several limitations to the current study. Although there was careful and comprehensive quantification of the content categories discussed, this coding could not account for the quality, importance or strength of each of these elements within the television or newspaper items surveyed. Further, this research could not account for any effects on potential medical tourists’ decision-making of the media content examined. Future studies into the media coverage of medical tourism could usefully address each of these areas by continuing qualitative research with past or potential medical tourists [15
] in order to better understand how elements of appeal, credibility and risk played a part in their choice; and undertaking comparative analysis of similar media datasets from other destination and source countries.