To the extent that these patients made use of LDC health facilities, that was not the primary goal of their trip so they are not, strictly speaking, medical tourists who have traveled with the purpose of improving their health. They are nevertheless included in this study because they demand the same services as other foreign patients. While there are no disaggregated statistics on the numbers of such incidental medical tourists in the countries under study, some sporadic evidence is available: for example, of the tourists and businessmen who traveled to Thailand in 1977, fi ve million got sick and one half of those received medical care. Foreigners who require incidental medical care in developing countries can be divided into two categories according to the duration of their visit. Long-term stayers include students pursing training or degree courses that require residence of several months or years. Cuba, South Africa, and India attract students from neighboring countries where the educational system is inferior and/or costlier. In the course of their studies, these students are likely to have medical problems that are resolved by the local health-care system.
Another group of long-term stayers are foreign workers. They are migrants or expatriates working in multinational or national enterprises (in countries such as Chile, many expatriates came with the spread of multinationals in the 1980s and 1990s18). Like students, given the duration of their stay, it is expected that they will use the health-care system. Retirees from more developed countries sometimes move to less developed (and warmer) countries where their pensions go further and they can more comfortably live out their old age. For this reason, Americans are drawn to Mexico and Costa Rica. Japanese retirees are known to spend entire winters in beach resorts across Asia where their expenses are lower than at home (this phenomenon is called long-stay tourism, a growing niche).19 Given their age and the duration of their stay, these retirees are likely to become ill and use local medical services.
Foreign residents of LDCs are unlikely to use the national public health system. Instead, they will use private sector services that medical tourists or wealthy citizens use. The second category of incidental medical tourists consists of ordinary tourists who travel for a short period of time to enjoy beaches, jungles, and historical sites. Globally, such tourists made 700 million international trips in 2000, up from 25 million in 1950.20 It is no surprise that some of them got sick while on their trip. They did not plan to buy health-care services, but they were forced to do so. These are usually emergency care services, since routine care or minor health concerns will be shelved until a traveler’s return home. The chances of healthy people becoming ill while traveling is higher than if they stayed at home, given freely fl oating respiratory illnesses in airplane cabins as well as exposure to digestive and other illnesses that may not exist in one’s home environment. Moreover, some types of tourist activities are more likely to result in accidents that require care (for example, mountain climbing, skiing, scuba diving, or hurricane chasing).
Given that international travel is expected to rise in the future (the UNWTO predicts 935 million people will travel in 2010, nearly double the 500 million people who traveled abroad in 1993), incidental medical tourism is also expected to rise.