Historical reflections on medical travel.

The terms ‘medical tourism’ and ‘health tourism’ cover many phenomena. Individuals able to afford the costs have frequently traveled great distances to consult with healers considered especially competent in their field. A reputation for expertise has, for the past century, been linked to technological capacity and those who can do so may prefer to travel to places such as the Mayo Clinic rather than relying on technology and expertise available locally. In Canada, there is something like a tradition that provincial Premiers with serious illnesses travel to the United States for their medical care. This is always controversial since Premiers are supposedly responsible for the quality of provincial health-care systems; if they don’t trust these institutions why should the rest of us? But despite occasional bursts of outrage, most Canadians understand the desire to obtain the best possible medical care even if it means traveling outside the country. What is unusual about the newest sort of ‘health tourism’ discussed in several papers in this issue is that technology and excellence are only some of the attracting features. Relatively low costs, desire to avoid waiting lists, access to procedures or facilities unavailable and possibly illegal at home, are often determining factors in individual decisions to travel for health care. One factor that is less than central is place. It just happens that the Mayo Clinic is in Rochester Minnesota, or the Cleveland Clinic is in Cleveland Ohio, or that the institutions discussed in these pages are located where they are. Location of course is not irrelevant. Not every locale can bring together the expertise, technology, capital, easy access and relative lack of political violence that turns a city into a medical destination. But there is nothing about these places that is intrinsically healthy or good for you. In many ways, ‘tourism’ is a catchy misnomer that simply means traveling long distances for medical care not dissimilar to what is available at home. While this phenomenon has relevance for medical care and global health and for the ways social scientists study them, such practices can best be seen as yet another example of the expanding global economy, another form of ‘offshoring’ goods and services, whose consequences have yet to be fully understood. It in no way diminishes the significance of this phenomenon to note that its application to health care is too recent for historians to have much in the way of a contribution to make to its discussion.