title: The 'patient's physician one-step removed': the evolving roles of medical tourism facilitators.
abstract: BACKGROUND
  Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly understood.
  
  
  METHODS
  12 facilitators were interviewed from 10 Canadian medical tourism companies.
  
  
  RESULTS
  Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry.
  
  
  CONCLUSIONS
  Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada. jcs12@sfu.ca
authors.forename: Jeremy
authors.initials: J
authors.lastname: Snyder
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.forename: Krystyna
authors.initials: K
authors.lastname: Adams
authors.forename: Paul
authors.initials: P
authors.lastname: Kingsbury
authors.forename: Rory
authors.initials: R
authors.lastname: Johnston
mesh_terms: D000328:Adult; D002170:Canada; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards; D004992:Ethics, Medical; D019981:Health Care Sector / Q000941:ethics*; D006801:Humans; D007407:Interviews as Topic; D008389:Marketing of Health Services / Q000941:ethics* / Q000592:standards*; D057193:Medical Tourism / Q000941:ethics*; D010817:Physician-Patient Relations; D011634:Public Health; D012380:Role; D012926:Social Control, Formal; D014195:Travel