Outpatients: The Astonishing New World of Medical Tourism

Columbia Global Reports

by Sasha Issenberg

Need surgery? You better travel.

Globalization produces a lot of odd results around the world. One of them is that Hungary has become the dentistry capital of thanks to aggressive marketing campaigns and heavy government support, more people go there for dental care than to any other country in Europe. The towns of Mosonmagyaróvár and Sopron boast the highest concentrations of dental clinics in the world.

The story of how Hungary became Europe's dental chair is a case study in the booming practice of medical tourism. It is a rapidly growing business, as patients go in search of lower prices, and some countries have found economic opportunity in turning health care into a global trade. An American with insurance can expect to pay $90,000 for a heart bypass in the U.S., but only $12,000 if he or she travels to Thailand.

The question is whether medical tourism represents the future of health care, which traditionally has been a core responsibility of national governments. Sasha Issenberg's acclaimed books, The Sushi Economy and  The Victory Lab , were early in identifying changes in the way the world works. A brilliant journalist with a keen eye for significant trends, he now turns his talents to medical tourism, and gives us a funny, vivid, wise narrative that will change the way you think about health care.

Genres: Nonfiction, Health

128 pages, Paperback

First published February 9, 2016

About the author

Sasha Issenberg is the author of three previous books, on topics ranging from the global sushi business to medical tourism and the science of political campaigns. He covered the 2008 election as a national political reporter in the Washington bureau of The Boston Globe, the 2012 election for Slate, the 2016 election for Bloomberg Politics and Businessweek, and 2020 for The Recount. He is the Washington correspondent for Monocle, and has also written for New York magazine, The New York Times Magazine, and George, where he served as a contributing editor. He teaches in the political science department at UCLA.

Reviews

[Javier Boncompte G. · Rating 2 out of 5]

I found this book because I had previously read other works from the author and I was impressed by his writing and capacity to immerse into an unfamiliar topic. However, this book fails to deliver what his other books did. It might the that it is too short or that my expectations on such a promising issue as medical tourism were too high. Despite this, it is an exciting book with enjoyable anecdotes and remarkably easy to read.

My main critique is that the author focused too much on Eastern Europe and didn't provide a global perspective of medical tourism. Limiting himself to the interesting cases of Bulgaria, Hungary, and a bit of Thailand. I also missed that the author questioned or contrasted the sayings from those interviewed with experts that could provide a more theoretical or intellectual approach on the matter. As it seems to go too easy on them and lightly takes their conclusion that medical tourism has no pervasive effect in the healthcare of the people of those countries. He doesn't even interviews a patient or opposing politician/NGO.

In short, interesting and easy to read but fails to deliver what it promised.

[Louis · Rating 4 out of 5]

“Eastern Europe was becoming a destination for Middle Eastern knees. The culprits appear to be stress from repeated bending at prayer. Here was a Libyan woman trapped in a Japanese hospital in the Bulgarian capital, all when at her most vulnerable.”

“Medical tourists are engaged in a uniquely modern form of rebellion, asserting an individual’s independence from the persistence of political geography.”

“But what did the presence of a Libyan woman in a Bulgarian hospital bed mean for a Sofia resident with knee problems? And could Libya ever develop a modern health-care system if all the local patients who had a way of financing their care took their problems - and money - elsewhere?”

“In any case, medical tourism does not create new inequalities in so much as it magnifies existing ones.”

“Why should the EU pronounce itself on an issue like how chicken should live, and where they should live - and not on patients and health care?”

“Medical tourism has spurred an entrepreneurial spirit into a sector where during the dark times, they said in a public hospital that the patient has three rights: to wait, to shut up, and to pay.”

“Inevitably, foreign winners produce local losers.”

[Amy · Rating 2 out of 5]

So, I was disappointed by Outpatients. I read this book expected a short but informative read about medical tourism (causes, effects, implications, etcetera), but I got a kind of disjointed story - mostly about dentistry in Hungary - instead. Aside from the back-cover write up, Outpatients didn't have a clear thesis running through the text itself. Also, while some parts were educational, the whole book read like a particularly long, aimless article. Before actually reading Outpatients, I had thought to reccomend it to my mother (she will likely need to engage in medical tourism at some point due a health issue), but now I will not.

[Kelli · Rating 3 out of 5]

As many others mentioned, Issenberg's focus is not entirely on global medical tourism but in particular that of Europe with a specific focus on Hungarian dentists for most of the book. There are short snippets of other countries or medical tourism facts but they are sparse and are thrown here and there.

The book is relatively short so it would have been nice to have expanded to maybe discuss other countries, especially since he brought some examples up numerous times (like that of Bangkok's international hospital). All in all, it was very informative about Hungarian dentists and I learned about that topic in full detail now being more knowledgeable on it.

[Mary · Rating 4 out of 5]

Outpatients is a good introductory book on medical tourism. I found the contents interesting and easy to read, despite some complex details. There are large economic impacts of medical tourism, and I had no idea what was really going on in the world. I'm grateful to the author for revealing this situation to me. What I found disappointing is that the book seemed to focus on just a few places in the world, and I would've liked to read more on the overall global picture. The author was good enough to include additional reading references at the back.

[Karla · Rating 4 out of 5]

Things are different today. This was a different read for me. Interesting. Could have lived without it. Gained some perspective as a result. Not bad. Just not my wheelhouse to speak critically on. Read and decide for yourself.

[Matthew · Rating 4 out of 5]

An interesting look at a disturbing trend and reality. It reveals a symptom of broken systems and mislabeled priorities. The Epilogue is especially worthy.

[James · Rating 5 out of 5]

I was raised on fiction. The phrase medical tourism conjures thoughts of experimental procedures in tropical locations that could either cure you or turn you into a werewolf. The reality of medical tourism is focused on economics rather than spidey sense, but its intricacies are novel in their own right. Issenberg notes that when we are sick, we are at our most vulnerable. This is when it's most important to be at home and surrounded by family and friends. Most people who travel for medical care do so because they cannot afford the care they need at home, or its not available.

When people travel of necessity for healthcare, medical tourism begins to be a cause of tighter global relations rather than a result of it. Issenberg describes healthcare as one of the most entrenched institutions that the EU has been unable to integrate. How can national single-player and privatized healthcare systems coexist in a pan-European system of unrestricted migration? Who should pay for the healthcare of Friedrich Jauch, a Bavarian citizen who spent five decades working across the nearby border with Austria?

As much as I enjoyed the intricacies of Isenberg's musings on healthcare and globalization, I wish that he had chosen a more interesting case study for this book. Dentistry has become a commodity that escapes local customs and culture. How do popular plastic surgery destinations like South Korea adapt to the different notions of beauty of a global clientele? How do countries that specialize in organ transplants justify giving these limited resources to foreigners when they could go to a friend or a neighbor who needs it to save their life? Healthcare has an economic component, but it is also the most personal and human service we have.

[ArrowBreaker · Rating 3 out of 5]

Medical tourism is what peaked my interest in this reading material. I've heard stories about how people will go to South Korea to get plastic surgery because it's cheaper and more widespread there.

But Issenberg only focused on Europe. Particularly, Hungarian dentists.

How to make a book about medical tourism more interesting: economics and dentists. Oooo. I can hardly contain myself.

It offered interesting insight into the problems faced in the healthcare system and the different methods different countries employ them. "Each country's health policies developed according to its peculiar circumstances." I'd say if you're interested in this remotely, check it out at the library.