Cultural Geography Chair Group, Wageningen University, PO Box 47, 6700 AA, The Netherlands.
Soc Sci Med. 2015 Jan;124:305-12. doi: 10.1016/j.socscimed.2014.06.007. Epub 2014 Jun 7.
Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and management of these in the home context.
全球范围内，越来越多的患者作为医疗消费者有意跨境求医。然而，尽管学者们已经开始研究国际医疗旅游（IMT）对接收医疗旅行者的人和地方的影响，但对其对医疗旅行者原籍国背景的影响的研究却很少，且大多是推测性的。虽然支持者称赞 IMT 有潜力使国内卫生系统更能满足有市场意识的医疗消费者的需求，但批评者则认为这是进一步使医疗需求的满足去政治化的一种方式。本文借鉴政治消费者主义、健康倡导和社会运动的研究成果，主张将 IMT 重新定义为，它不是对医疗旅行者原籍国卫生系统内部围绕获取、权利和认可的斗争的一次性声明或外部事件，而是这些斗争中一系列持续参与的重要形式之一。为此，对现有关于 IMT 对国内影响的有限实证研究进行了审查，并对印度尼西亚前往马来西亚的医疗旅游案例进行了研究。案例研究材料取自 2007-08 年和 2012 年对涉及 IMT 的印尼和马来西亚受访者进行的 85 次访谈，受访者包括作为护理接受者、正式和非正式护理提供者、中介、推动者和政策制定者的医疗旅行者。审查和案例研究的证据表明，IMT 可能会通过改变医疗旅行者、他们的家人、社区、正式和非正式中介以及国内外医疗服务提供者的观点、习惯、期望和责任意识，以及他们之间的共谋关系，在微观和宏观层面上对医疗旅行者原籍国的背景产生政治和社会变革。影响受到原籍国政治和社会系统的意识形态基础、医疗旅行者的疾病或治疗的状况以及在原籍国背景下对这些问题的承认和管理的有组织支持的存在的制约。
