A new mother travels to Tijuana for body contouring surgery and a “mommy makeover” procedure. A middle-aged man travels to Phuket for a lower facelift and abdominal liposuction. A group of teens eagerly plans their all-inclusive plastic surgery package in the Dominican Republic: tummy tucks and tanning on the beaches of Puerto Plata. Google Trend data shows an over 100 percent increase in queries about liposuction in Turkish clinics from 2020 to 2023.
Cheaper, less invasive, and increasingly advertised, cosmetic procedures have become common; approximately a fifth of citizens in developing nations like Brazil and China say they plan to purchase such treatments as anti-wrinkle injections in the next five years. Medical aesthetics, already a US$82 billion industry, is poised to nearly double in size to US$143 billion by 2030.
Democratizing aesthetic surgery for both patrons and providers, the internet age has seen a global rise in uncertified plastic surgeons performing procedures. In Iran, there are only about 400 accredited plastic surgeons for the roughly 2,000 doctors offering cosmetic procedures. In Britain, over two-thirds of people administering anti-wrinkle and filler injections were found to be not medical doctors.
In addition to going to uncertified “professionals” who offer procedures at discounted prices, consumers have begun to take their wallets abroad to receive even cheaper operations overseas. Medical tourism, the act of traveling abroad for healthcare, is nothing new. However, the democratization of plastic surgery, globalization, and the internet age have pushed cosmetic surgery to the forefront of this growing industry–just a few months ago, the “Guadalajara Lady” went viral on TikTok for receiving a facelift at a fraction of the US price. Combined with greater accessibility and heightened awareness, cosmetic procedures have propelled medical tourism to new heights.
First World Service, Third World Prices
Enticing the impatient inpatients of the West, medical costs in Southeast Asian nations like India, Thailand, and Singapore are a fraction of those in the United States. Owing to favorable exchange rates, Westerners can travel to low- and mid-income countries (LMICs) and receive first-world procedures at third-world prices. Even with airfare, hotel, and other incidental expenses included, treatments can cost as little as 10 percent of comparable American care. Brazilian nose jobs average at US$2,000, nearly a fourth of the average cost of US$7,600 in America. A Turkish hair transplant can be a fifth of the price in Britain, explaining the continuous rise in Turkey-bound medical migrants–from 2013 to last year, procedures rose from 300,000 to over 1.5 million.
Of course, this financially and aesthetically motivated travel does not come without risks. Aside from migrating filler and unsatisfactory post-op results, transnational cosmetic procedures in nations with looser regulations or credential requirements can result in infection or even death. Twenty-nine American citizens were reported dead just from 2019 to 2020 as a result of cosmetic surgery in the Dominican Republic; this potential for misfortune hasn’t deterred plastic surgery hopefuls, however. Experts estimated there were 750,000 American medical tourists in 2007; in 2017, this number rose to 1.4 million. The medical tourism industry – and plane tickets overseas – are expected to increase by 25 percent per year by 2025.
In addition to being an economic boon for customers, the Western export of patients to developing markets is highly advantageous for the countries that receive them. Mirroring insurance, banking, and other industries that have followed the trend of outsourcing, medical tourism has become profitable due to globalization. With consumers realizing the ease of hopping onto a plane to undergo procedures, this willingness to travel farther in exchange for a lower medical bill provides destination countries with a lucrative opportunity. Compared to traditional tourism, medical tourism has significantly greater revenue-generating capabilities–medical tourists in Asia are estimated to spend over twice as much as traditional tourists.
Augmenting Bodies and Policies
Exemplifying the for-profit nature of private healthcare, medical tourism has significantly influenced the policies of destination countries striving to reap its benefits. India and Thailand have shaped their policies around it, introducing expedited medical visas to promote migration for cosmetic procedures. Specifically, Thailand has sought to facilitate the influx of foreign patients by negotiating the portability of public insurance between donor countries. Governments have directly subsidized medical tourism by providing public land, corporate tax breaks, and reduced tariffs on medical equipment used by private hospitals that serve medical tourists.
Not only a testament to the power of medical tourism, the ability to shape international relations and synchronize national policies requires a form of soft power known as health diplomacy. A linkage between foreign affairs and global health, health diplomacy is a form of diplomacy that focuses on protecting health across borders and uses health-related issues to promote stability between nations. Furthermore, health diplomacy contributes to soft power and enables nations to secure political and economic gains, prestige, and influence by projecting a commitment to global and internal health.
Health diplomacy’s place as a form of soft power is evident in the People’s Republic of China (PRC)’s use of health initiatives to build alliances with developing nations. Serving as a “first responder” for developing countries during COVID and spearheading global immunization, China’s Belt and Road Initiative and vaccine policy allowed it to simultaneously increase its reputation in the third world while diminishing that of the West. But the export of medical aid has done more than generate goodwill. Spanning multiple decades, the PRC’s cultivation of international relations using health diplomacy has most notably afforded it its 1971 admission to the UN, an achievement that would not have been possible without the affirmative votes of its Third World and ASEAN supporters.
Filling Wrinkles, Lips, and Public Hospital Beds
Rather than a tool for political gambits or a means to optimize international prestige, health diplomacy pertaining to medical tourism relies on destination nations tailoring their policies around customers of the West to best extract profit. For example, Malaysia was able to grow its medical tourism sector at an annual rate of 16.3 percent over 4 years through government-led initiatives such as the establishment of the Malaysia Healthcare Travel Council (MHTC), an organization implemented to facilitate coordination between private hospitals, government agencies, and medical tourists. Self-described as an organization “with the mandate to position Malaysia as THE healthcare travel destination in the world,” the MHTC and other efforts by the Ministry of Health Malaysia have significantly advanced Malaysian medical tourism, generating MYR 1.7 billion in revenue and attracting 1.22 million medical tourists in 2019 alone.
Combined with unfavorable policy changes in donor countries (such as reduced coverage or long wait-time benchmarks for non-urgent procedures), these destination nation initiatives fuel the lucrative flow of medical tourists and greatly influence perceptions of healthcare systems on both sides of patient exchange. But although destination nation governments may reap the benefits, this rise in tourism often comes at the expense of native citizens.
Despite being required to serve impoverished domestic customers as well, legal regulations protecting citizens are often ignored by destination nation hospitals in favor of the lucrative procedures requested by foreigners. Public hospitals in some nations have been opened to privately-financed foreign patients, misappropriating public resources not only in the form of inequitable government investment but also literally in the form of hospital beds. Cuban citizens grapple with deteriorating healthcare facilities battered by US-led embargos, while Havana-bound Americans receive first-class service. The attention directed toward medical tourism raises questions about healthcare equity and the potential misuse of public funds – are nations prioritizing the lucrative business of servicing foreigners while their public healthcare systems for citizens deteriorate? India specifically only allocates 4.9 percent of its GDP on healthcare (compared to the US’s 15.3, France’s 11.1, and Switzerland’s 11.3 percent), yet it is a juggernaut in the medical tourism industry. Shaving jawlines and public resources, the profitability of medical tourism creates a conflict between the economic interests of destination nations and their citizens’ access to equitable healthcare.
While health diplomacy initiatives promoting medical tourism may improve international relations between donor-destination countries, these same treatment pathways for foreigners often become barriers for native citizens. Funds that could have been allocated to public hospitals and other egalitarian forms of care are instead delegated to private hospitals that serve foreigners. Making healthcare more accessible to medical tourists while limiting resources for citizens, medical tourism-promoting policies not only transform the socioeconomic conditions of involved nations but also global health as a whole.
