Durham Jo, Blondell Sarah J
The University of Queensland, School of Public Health, Herston, Qld, 4006, Australia.
Global Health. 2017 Aug 29;13(1):68. doi: 10.1186/s12992-017-0287-8.
Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient's social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional ways of thinking about public health and the notion of health systems contained within the nation state. Further research is needed to better understand the effects of patient travel, and how to harness the benefits of patient travel without exacerbating existing health inequalities.
患者跨境寻求医疗服务的现象日益普遍。患者从高收入国家前往中等收入国家就医的情况已有充分记录，他们寻求比在本国更便宜或更容易获得的治疗。而对于患者从一个低收入国家前往另一个低收入国家，或者从低收入国家前往高收入国家的情况，人们了解得较少。在本文中，我们进行了一项现实主义综述，以探讨低收入国家的患者为何、在何种背景下以及如何前往经济水平相同或更发达的国家接受计划性医疗服务。基于对文献的初步梳理以及与关键信息提供者的讨论，我们提出了一个关于人们为何、如何、何人以及在何种背景下跨境接受计划性医疗服务的初始理论和一系列命题。然后，我们系统地查找并综合了：（1）来自Scopus、Embase、科学引文索引和Econlit数据库的同行评审研究；（2）使用关键信息提供者和谷歌搜索的非索引报告；（3）纳入文献参考文献列表中的论文，以收集支持或反驳我们初始命题的证据。在回顾文献和提取数据时，我们借鉴了皮埃尔·布迪厄的研究成果，以理解物质和非物质资本与认知过程在跨境就医决策中的相互作用。患者出行主要是由于本国缺乏服务和/或当地服务不可接受，何时出行以及前往何处的决定通常在患者的社交网络内做出。他们能够通过多种资源出行，包括社交网络、经济和文化资本以及惯习。拥有上述因素较多的患者有更多的医疗选择；然而，即使是资源有限的患者也会进行跨境就医。患者流动挑战了传统的公共卫生思维方式以及民族国家内部卫生系统的概念。需要进一步研究以更好地理解患者流动的影响，以及如何在不加剧现有健康不平等的情况下利用患者流动的益处。
