Patients with Passports: Medical Tourism, Law, and Ethics by I Glenn Cohen (review)

I. Glenn Cohen’s Patients with Passports: Medical Tourism, Law, and Ethics offers a thorough examination of the growing practice of medical tourism, the legal regulations governing it, and the many ethical issues it raises for policy-makers, health care providers, and prospective medical tourists. Demonstrating mastery of the relevant literatures in the social sciences, law, ethics, and political philosophy, Cohen provides a comprehensive overview of the current practice of medical tourism, and offers well-argued, sensible policy advice to guide its reform. Cohen’s book is a significant achievement of interdisciplinary scholarship and is essential reading for scholars and policy-makers.

Medical tourists, Cohen claims, are people who travel to a foreign country for the primary purpose of getting health care. While the popular image of medical tourism in the U.S. context involves patients from high-income countries such as the U.S. traveling to low-income countries such as Mexico, India, or Thailand to access less costly health care or services that are illegal in their home country, Cohen notes that a good deal of medical tourism does not fit this image. Medical tourism also occurs between high-income countries—e.g., Canadian patients seeking care in the U.S.; between low- and middle-income countries—e.g., Cuba is a major destination for patients from many Caribbean and Central American countries; and from low-and middle-income to high-income countries as wealthy patients in the former seek what they presume to be better care in the latter. Although Cohen’s book touches on the legal and ethical issues raised by all of these different flows of medical tourists, the focus of his analysis largely concerns high-income patients—i.e., patients from high-income countries or high-income patients from low- and middle-income countries—seeking care in low-income countries.

Cohen’s book is divided into two parts: (1) medical tourism for services that are legal in the patient’s home country—e.g., hip replacements or cosmetic surgeries; and (2) medical tourism for services that are illegal in the patient’s home country—e.g., transplant tourism and tourism for [End Page e-1] assisted suicide. I discuss each part in turn before offering some critical remarks.

Regarding medical tourism for services legal in the patient’s home country, Cohen first focuses on medical tourists paying out-of-pocket for health care. These patients may be uninsured or underinsured and so see medical tourism as an affordable way to get care. Cohen explains first that these patients face a lack of information regarding the quality of care that many foreign hospitals and clinics offer—e.g., information regarding clinical outcomes and the risk of disease transmission—which makes informed decision-making difficult. Cohen also explores the question of the regulations home countries and international bodies should put in place to address this lack of information. Is it sufficient to require hospitals and clinics to disclose materially relevant information to prospective patients, for example, by making third-party accreditation conditional on such disclosure? Or, should home governments take steps to restrict patient choice, for example, by making patients who seek medical care from certain foreign providers ineligible for government provided health care such as Medicare or Medicaid? Cohen, quite sensibly, opts for a middle position, one that does not involve restricting patients’ choices but also goes beyond simply mandating the disclosure of information. Cohen suggests that regulators implement a “channeling regime,” a set of regulations that nudge or incentivize patients to make good choices. For example, regulators could create a list of “approved” and “unapproved” providers and services.

Medical tourists paying out of pocket also face the problem of legal liability. Focusing on U.S. medical tourists, Cohen explains that they face a substantial reduction in the likelihood and amount of financial recovery for medical malpractice compared to U.S. patients who do not travel abroad. Here too Cohen recommends that U.S. regulators introduce a channeling regime rather than simply providing...