Medical tourism and cross-border care

Background Paper

Published 07/05/2013

This paper presents an overview of medical tourism and cross-border care, and outlines the major ethical and policy issues these activities present.

The author was commissioned by the Nuffield Council on Bioethics to write this paper in order to inform the Council’s discussions about possible future work on this topic. The paper is intended to provide an overview of key clinical, ethical, social, legal and policy issues, but is not intended to offer any conclusions or recommendations regarding future policy and practice. Any views expressed in the paper are the author’s own and not those of the Nuffield Council on Bioethics.


Dr Dominique McMahon, Munk School of Global Affairs, University of Toronto


Medical tourism and cross-border care are defined as the movement of patients across national boundaries for the expressed purpose of seeking out medical care. While these terms and others are, at times, used interchangeably, they are often distinguishable. Medical tourism here refers to medical care sought by individuals and accessed through their own volition, even without or against the recommendation of their local health care provider. Care is typically paid out of pocket, and is in some cases combined with additional leisure or culture-related activities. Cross-border care instead refers to care that is facilitated or referred by a local health provider or institution, often by pre-established arrangements or agreements. Cross-border care is typically sought in countries within the same region, and is often reimbursable or paid directly by the responsible party. This would include, for example, patients accessing care within EU countries through their rights as EU citizens, agreements to outsource public UK orthopaedic patients to France, Germany and Belgium, or cross-border insurance contracts between the US and Mexico.