title: "Best care on home ground" versus "elitist healthcare": concerns and competing expectations for medical tourism development in Barbados.
abstract: BACKGROUND
  Many countries have demonstrated interest in expanding their medical tourism sectors because of its potential economic and health system benefits. However, medical tourism poses challenges to the equitable distribution of health resources between international and local patients and private and public medical facilities. Currently, very little is known about how medical tourism is perceived among front line workers and users of health systems in medical tourism 'destinations'. Barbados is one such country currently seeking to expand its medical tourism sector. Barbadian nurses and health care users were consulted about the challenges and benefits posed by ongoing medical tourism development there.
  
  
  METHODS
  Focus groups were held with two stakeholder groups in May, 2013. Nine (n = 9) citizens who use the public health system participated in the first focus group and seven (n = 7) nurses participated in the second. Each focus group ran for 1.5 hours and was digitally recorded. Following transcription, thematic analysis of the digitally coded focus group data was conducted to identify cross-cutting themes and issues.
  
  
  RESULTS
  Three core concerns regarding medical tourism's health equity impacts were raised; its potential to 1) incentivize migration of health workers from public to private facilities, 2) burden Barbados' lone tertiary health care centre, and 3) produce different tiers of quality of care within the same health system. These concerns were informed and tempered by the existing a) health system structure that incorporates both universal public healthcare and a significant private medical sector, b) international mobility among patients and health workers, and c) Barbados' large recreational tourism sector, which served as the main reference in discussions about medical tourism's impacts. Incorporating these concerns and contextual influences, participants' shared their expectations of how medical tourism should locally develop and operate.
  
  
  CONCLUSIONS
  By engaging with local health workers and users, we begin to unpack how potential health equity impacts of medical tourism in an emerging destination are understood by local stakeholders who are not directing sector development. This further outlines how these groups employ knowledge from their home context to ground and reconcile their hopes and concerns for the impacts posed by medical tourism.
authors: Department of Geography, Simon Fraser University, Burnaby, Canada. rrj1@sfu.ca.
authors: Rory
authors: R
authors: Johnston
authors: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada. kaa4@sfu.ca.
authors: Krystyna
authors: K
authors: Adams
authors: Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados. lisarbishop@yahoo.co.uk.
authors: Lisa
authors: L
authors: Bishop
authors: Department of Geography, Simon Fraser University, Burnaby, Canada. crooks@sfu.ca.
authors: Valorie A
authors: VA
authors: Crooks
authors: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada. jc12@sfu.ca.
authors: Jeremy
authors: J
authors: Snyder
mesh_terms: D001460:Barbados; D017144:Focus Groups; D006295:Health Resources / Q000941:ethics* / Q000600:supply & distribution; D054625:Healthcare Disparities / Q000941:ethics*; D006801:Humans; D057193:Medical Tourism; D064689:Nurses, Public Health / Q000941:ethics*; D010342:Patient Acceptance of Health Care; D017149:Private Sector / Q000941:ethics* / Q000706:statistics & numerical data
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