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Medical travel special issue in JEMS



New special issue available!

Neil Lunt and Meghann Ormond have co-edited a special issue of the Journal of Ethnic and Migration Studies (JEMS) on transnational medical travel that came out online first on 11 May 2019. See below for links to papers and abstracts.


Contributions were first presented as papers at the 2016 Academic Conference on International Medical Travel and Cross-Border Healthcare in Madrid, Spain.


Contributors

- Chee Heng Leng (Universiti Sains Malaysia, Malaysia)

- Daniel Horsfall (University of York , UK)

- Mounir Jarraya (University of Sfax, Tunisia)

- Neil Lunt (University of York, UK)

- Alice M. Nah (University of York , UK)

- Meghann Ormond (Wageningen University & Research, The Netherlands)

- Betty Rouland (Institut de recherche sur le Maghreb contemporain de Tunis (IRMC), Tunisia)

- Arturo Vargas Bustamante (UCLA, US)

- Andrea Whittaker (Monash University, Australia) Contents

1/ Ormond, M. and Lunt, N. 2019. “Transnational medical travel: Patient mobility, shifting health system entitlements and attachments.” https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597465 (Open access)

2/ Lunt, N. 2019. “UK Somali populations as medical nomads.” https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597466

3/ Horsfall, D. 2019. “Medical tourism from the UK to Poland: How the market masks migration.” https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597470

4/ Vargas Bustamante, A. 2019. “US-Mexico Cross-Border Health Visitors: How Mexican border cities in the state of Baja California address unmet healthcare needs from US residents.” https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597473

5/ Rouland, B. and Mounir, J. 2019. “From medical tourism to regionalism from the bottom up: Emerging transnational spaces of care between Libya and Tunisia.” https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597475

6/ Chee, H.L. and Whittaker, A. 2019. “Moralities in international medical travel: Moral discourses among Indonesian patients and locally-based agents in Malaysia.” https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597476

7/ Ormond, M. and Nah, A.M. 2019. “Risk entrepreneurship and the construction of healthcare deservingness for ‘desirable’, ‘acceptable’ and ‘disposable’ migrants in Malaysia.” https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597477 (Open access)


Abstracts

1/ Ormond, M. and Lunt, N. 2019. “Transnational medical travel: Patient mobility, shifting health system entitlements and attachments.” Journal of Ethnic and Migration Studies. https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597465

Keywords:

Health care, place attachment, transnationalism, migrant health, medical tourism, disenfranchisement

Abstract:

Transnational medical travel -- the temporary movement by patients across national borders in order to address medical concerns abroad that are unable to be sufficiently met within their countries of residence -- is an important therapeutic coping strategy used by growing proportions of peoples with a diverse range of mobility profiles and intensities of global moorings. Studying this phenomenon provides useful insight into the rapidly globalising era of health governance, where an ever-wider array of state and non-state actors are transcending the increasingly restrictive national containerisations of health care and engaging in cross-border action to effectively address contemporary health challenges at both individual and collective levels. In our introduction to this special issue on transnational medical travel, we draw on both ‘medical tourism’ and migrant health scholarship to acknowledge the diversity of motivations among migrant and non-migrant patients alike and the complex nature of mobile patients’ attachments to the multiple places in which they seek care. We then bring attention to how dynamic structural issues in mobile patients’ countries of residence and destination shape their attachments to places and health systems over time, examining the linkages between vitality of the political and social systems in these places to which they are differently attached and their dis/satisfaction and dis/enfranchisement with them.


2/ Lunt, N. 2019. “UK Somali populations as medical nomads.” Journal of Ethnic and Migration Studies. https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597466

Keywords:

Medical tourism, pilgrim, exile, medical nomad, transnationalism, Somali

Abstract:

Much medical travel scholarship has been driven by a commercial focus whereby private providers pursue a high-value and complex patient market, primarily emanating from the Middle East, North America and Western Europe. This emphasis has led to a framing around ‘medical tourism’, prompting countervailing critiques of the term and the introduction of alternatives including ‘medical pilgrimage’ and ‘medical exile’. Reappraising the dynamics of mobility has led to explanations of medical travel increasingly located in fields of diaspora and transnationalism. The article identifies how diasporas and transnational communities resist straightforward categorization regarding the routes and processes through which they utilise healthcare. In this vein the article introduces the concept of ‘medical nomadism’ and grounds it in the experiences of Somali patients’ travel from the United Kingdom for healthcare overseas. It argues medical nomadism is a distinct medical travel behaviour, pointing to similar behaviours of Cape Verdeans living in Netherlands, and the concept’s utility in interrogating broader health-seeking mobility.


3/ Horsfall, D. 2019. “Medical tourism from the UK to Poland: How the market masks migration.” Journal of Ethnic and Migration Studies. https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597470

Keywords:

Medical tourism; migration; Poland

Abstract:

Much medical travel happens, but it is misleading to label it as ‘medical tourism’. Rather, patterns of travel reflect a range of drivers: from longstanding cultural, economic and political ties to the country providing treatment, to word-of-mouth networks. Poland provides a particularly interesting case, as it has been touted as the leading medical tourism destination for UK medical travellers in Europe; marketing by Polish providers is advanced and there is strong government support for the industry. In this paper examining data from the UK’s International Passenger Survey for the past 15 years, we demonstrate that, while travel to Poland has indeed increased dramatically, much of this actually reflects a wider pattern of Polish migrants living in the UK and returning to Poland for medical care rather than increased ‘medical tourism’ consumer activity by Britons in Poland.


4/ Vargas Bustamante, A. 2019. “US-Mexico Cross-Border Health Visitors: How Mexican border cities in the state of Baja California address unmet healthcare needs from US residents.” Journal of Ethnic and Migration Studies. https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597473

Keywords:

Transnational healthcare, US-Mexico border, Healthcare reform, Medical travel

Abstract:

Millions of uninsured and underinsured individuals in the United States (US) face considerable barriers to care access. To address some of them, many cross the southern border with Mexico to utilise lower-cost healthcare. With expanded health insurance coverage in the US after the passage of the Affordable Care Act (ACA), it has been questioned whether better access to care in the US would lead to a reduced demand for cross-border care in Mexico. This paper uses 2010 and 2013 data from international travellers into Baja California (Mexico) to examine how Mexican border cities address the unmet healthcare needs from US residents. I argue that changes in health insurance entitlements under the ACA are unlikely to change the incentives to make use of health services south of the border. The recent repeal of the ACA health insurance mandate could even strengthen these incentives to seek care abroad. This study shows that healthcare supply in Mexico sometimes complements and others substitutes healthcare available to medical travellers in the US, since healthcare rendered in Mexico is rarely covered in the US or it is less expensive and of better quality from the patient perspective. Baja California offers services to both insured and uninsured US residents. Different cities in the Mexican border specialise in particular services for medical travellers. We find that cross-border visitors to Baja California cities are more likely to be of Latino origin and to lack health insurance in the US; however, the share of non-Latino visitors increased in 2013 compared to 2010. Healthcare supply in Baja California for cross-border patients focuses on services that are rarely covered by US health insurance plans, such as dental services or long-term care. We conclude that affordability, cultural familiarity, perceived quality of care in Mexico, and geographic proximity, regardless of insurance coverage in the US, continue to be comparative advantages for healthcare providers in Mexican border cities.


5/ Rouland, B. and Mounir, J. 2019. “From medical tourism to regionalism from the bottom up: Emerging transnational spaces of care between Libya and Tunisia.” Journal of Ethnic and Migration Studies. https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597475

Keywords:

Tunisia; Libya; Medical tourism; Transnational space of care; Hybrid mobilities; Therapeutic circulation.

Abstract:

This paper analyses the emergence of transnational care through the case study of Libyan patients seeking care in the Tunisian city of Sfax as a result of changes triggered by the 2011 Arab uprisings. Deconstructing categories of ‘medical tourist’ and ‘medical traveller’, we examine how the evolving geopolitical context produced specific migratory profiles (diasporic, traveller, cross-border, war-wounded and transnational patients) and spaces (cross-border, (intra)regional and transnational spaces of care) between Libya and Tunisia. Given a lack of data on the topic in North Africa, we developed a study on health mobilities and circulations from a South-South perspective. Based on a survey amongst Libyan patients (n=205) in four private clinics and nine semi-structured interviews with health professionals in Sfax, we identified, how four key geopolitical periods shaped medical travel to this city: (1) initial diasporic exchanges facilitated by bilateral agreements; (2) an emerging medical tourism industry within private health services arising from the UN embargo on Libya; (3) the 2011 political crisis and arrival of war-wounded; and (4) therapeutic circulations and emerging transnational spaces of care resulting from the context of war.


6/ Chee, H.L. and Whittaker, A. 2019. “Moralities in international medical travel: Moral discourses among Indonesian patients and locally-based agents in Malaysia.” Journal of Ethnic and Migration Studies. https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597476

Keywords:

International medical travel, medical tourism, Malaysia, Indonesian patients, moralities

Abstract:

This paper views international medical travel through the lens of medical migrations and contextualises it within regional historical linkages. Drawing from fieldwork with staff, facilitators, and Indonesian patients in two Malaysian private hospitals, it frames international medical travel as a moral endeavour, and aims to uncover the premises that make this endeavour meaningful and desirable. Understanding moralities as a field of embodied predispositions created in the dynamics of social interaction, we argue that a strand of moral logic underlies the practice of medical travel. We call this the morality of need, which dictates that people do whatever they can for themselves and their families’ medical needs, including travelling abroad, as well as ‘help others’ by giving information and accompanying them overseas for their medical needs. This moral logic co-exists in tension with a morality of business that accepts the legitimacy of generating earnings from people’s medical needs. Within this moral framework, international medical travel is seen as a necessary practice for sustaining health and well-being, and extends beyond the family as social and moral support for others facing similar predicaments.


7/ Ormond, M. and Nah, A.M. 2019. “Risk entrepreneurship and the construction of healthcare deservingness for ‘desirable’, ‘acceptable’ and ‘disposable’ migrants in Malaysia.” Journal of Ethnic and Migration Studies. https://www.tandfonline.com/doi/full/10.1080/1369183X.2019.1597477

Keywords:

Health care privatisation; deservingness; risk entrepreneurship; Malaysia, migrants

Abstract:

In recent years, scholars have focused on the concept of healthcare deservingness, observing that healthcare professionals, state authorities and the broader public make moral judgements about which migrants are deserving of health care and which are not. Such literature tends to focus on migrants with irregular status. This article examines how state calculations of healthcare deservingness have also been applied to authorised migrants. Focusing on Malaysia, we examine the ways in which state authorities construct migrants as ‘desirable’, ‘acceptable’ and ‘disposable’, differentiated through calculations of their biological and economic risks and potential contribution to ‘the nation’. To do this, we analyse recent government and commercial policies, plans and practices to reflect on how such biopolitical orderings create the conditions for risk entrepreneurship – where public and private actors capitalise on profit-making opportunities that emerge from the construction of risky subjects and risky scenarios – while reinforcing hierarchies of healthcare deservingness that exacerbate health inequalities by privileging migrants with greater economic capital and legitimising the exclusion of poor migrants.

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