Health and Wellness–Related Travel: A Scoping Study of the Literature in 2010-2018

Travel for Basic Health Care: The Tourism Approach

In addition to the patient-centered research on the use of health care services abroad, there was a large quantity of studies that approached this topic from a tourism perspective. Often, studies in this category did not specify the service users’ exact motivations for travel, whether it was for basic or specialized health care. The total number of articles included in this section was 99. The amount of these studies has grown from around five studies per year in 2010 and 2011 to around 15 per year from 2015 onwards. Considering the publication forums, tourism journals—especially Journal of Travel and Tourism Marketing, Current Issues in Tourism, and Tourism Management—were strongly represented. Also, health and service–related journals as well as journals on business, marketing, and management published notable numbers of studies on this subject.

Terminologically, medical tourism was by far the most common notion, whereas other terms, such as medical travel or health or health care tourism, were less frequent (Aydin & Karamehmet, 2017; Johnson & Garman, 2015). Many studies used various terms more or less in parallel (Hanefeld et al., 2015; Karuppan & Karuppan, 2010), but there were also suggestions to create conceptual order and/or hierarchies. For example, Majeed et al. (2018) proposed to use health tourism as an umbrella concept to cover medical and wellness tourism. The end users were typically called tourists or customers, but also other terms were used, including patients (Hwang et al., 2018; Kian & Heng, 2015), medical travelers (Chomvilailuk & Srisomyong, 2015), patient-travelers (Han & Hyun, 2014), and tourist-patients (Menvielle et al., 2014) although the phenomenon as a whole was referred to as tourism.

From a geographical perspective, Asian countries, especially Thailand (Noree et al., 2014; Prajitmutita et al., 2016) and Malaysia (Kian & Heng, 2015; Na et al., 2017), were frequently studied as destination countries of this type of tourism. Countries of origin were more widely spread out, covering not only Asian (Han & Hwang, 2013; Zhang et al., 2013) but also European (Menvielle et al., 2014; Noree et al., 2014) and North American countries (Adams et al., 2013; Karuppan & Karuppan, 2010). Most typically, studies considered travel for health care to an Asian country either from other Asian countries (e.g., Tabassum & Aurangzeb, 2014; Yu & Ko, 2012) or from across the globe (e.g., Chomvilailuk & Srisomyong, 2015; Han & Hyun, 2014). As an exception, Kesar and Mikulić (2017) have studied the subject in intra-European context. Garcia-Garzon et al. (2016) have used multilevel modeling to explore service users’ decision-making in choosing destination countries. They concluded that service users’ from Europe are more likely to agree to travel to north European countries, the United States, Australia, and New Zealand for health care. Southern Europe, the Middle East, and Southern Asia were not compelling options for their European respondents.

Some review articles on medical tourism were published during our review period. Heung et al. (2010) reviewed the existing theoretical frameworks of this type of tourism, and proposed a framework that covers prior models’ key areas and integrates supply and demand sides of medical tourism. Hanefeld et al. (2014) reviewed 100 articles published in 2011 and 2012 and discussed, among other factors, the complexity of patient motivation, the volume of travel in 13 countries and the possible inequities for the populations in the destination countries due to price inflation and doctor concentration in the private sector. Moreover, they found that complications resulting from the usage of health care services abroad were often treated within national systems.

John and Larke (2016) have examined the literature on push and pull motivations for medical tourism published between 2000 and 2016. The review identified common push factors (recommendations, insurance coverage, privacy, and confidentiality) and pull factors (costs, quality, accreditation, and waiting times). Less commonly studied push factors included lacking treatment options and distrust in the domestic health care, whereas the corresponding pull factors were practitioners’ reputation and tourists’ sociocultural familiarity with the destination context. The review by Mutalib et al. (2016) has added bioethical legislation and food and tourist attractions as important pull factors for tourists who seek health care services abroad. They also discussed ethical issues of the phenomenon, such as the inequity of health care distribution between the local population and the foreign service users. Majeed et al. (2017) have reviewed medical tourism studies and raised the issue of people looking for a combination of medical and wellness services (see also Bristow & Yang, 2015). They called for comparisons between the experience of medical tourism and other forms of tourism and for studies on the different self-identification patterns of tourists as travelers, medical tourists, patients, and general tourists.

Considering the empirical studies, a clear majority were survey studies based on either random sampling (Liang et al., 2017; Prajitmutita et al., 2016) or, more often, nonprobability sampling (Bristow & Yang, 2015; Guiry et al., 2013; Seow et al., 2017). In many cases, the exact nature of sampling was not specified in detail. Many survey studies examined actual or potential tourists’ intentions for medical travel (e.g., Aydin & Karamehmet, 2017; Bristow & Yang, 2015; Liang et al., 2017; Prajitmutita et al., 2016; Runnels & Carrera, 2012), often using the theory of planned behavior (M. Lee et al., 2012; Majeed et al., 2018; Na et al., 2016; Seow et al., 2017).

Another common perspective was to study retrospectively the experiences of service users and inquire about their demographic profile, travel motivations, information sources, the treatments used and subjective considerations on quality, satisfaction, and problems (e.g., Ren et al., 2017; Tabassum & Aurangzeb, 2014; Um & Kim, 2018; Wongkit & McKercher, 2016; Yin, 2014). Specifically cultural aspects were studied, for example, by Rahman et al. (2017) and Iranmanesh et al. (2018), who elucidated the perspectives and needs of Islamic service users. Moreover, different typologies of end users were constructed; for example, Wongkit and McKercher (2013) considered end users’ trip purpose and planning schedule to obtain a fourfold classification of dedicated, hesitant, holidaying, and opportunistic medical tourists.

There were also qualitative studies based on interview data (Hanefeld et al., 2015; Menvielle et al., 2014), focus groups (Rajagopal et al., 2013), online texts (Mutalib et al., 2017; Ozan-Rafferty et al., 2014), and video materials (Hohm & Snyder, 2015). The qualitative studies documented various phases and aspects of the decision-making process related to the use of health care services abroad, including information search (Medhekar & Newby, 2012), motivations (e.g., Adams et al., 2015; Hanefeld et al., 2015; Pan & Moreira, 2018), enabling and inhibiting factors (Rajagopal et al., 2013), and risks and risk-reducers (Menvielle et al., 2014). The experiences of service users were approached from different perspectives, including satisfaction (Mutalib et al., 2016; Ozan-Rafferty et al., 2014), discrimination (Ye et al., 2012), and commercial video testimonials (Hohm & Snyder, 2015). Moreover, explicitly ethical points of view were examined by Adams et al. (2013) and Snyder and Crooks (2012).

Finally, there were a small number of studies that utilized other approaches. Noree et al. (2014, 2016) used hospital records to study the demographic profiles, treatment use, and expenditure of medical tourists in Thailand. In a rare theoretical account of medical tourism, Cook (2010) elaborated on the notions of authenticity and embodiment and positioned the study in relation to prior works.

Travel for Specialized Health Care

This section of our scoping review covers travel for specialized health care, by which we refer to cross-border use of special biomedical treatments and procedures that serve the needs that go beyond the most common or basic health care services and wellness goals. The search for literature on such travel produced 51 articles. Biomedical treatments and procedures in question range from cross-border surrogate arrangements (Arvidsson et al., 2015; Hammarberg et al., 2015) to aesthetic surgery (Bell et al., 2011; Holliday et al., 2015) and from regenerative procedures such as stem cell treatments (H. Chen & Gottweis, 2013; Ryan et al., 2010) to assisted suicide (Richards, 2017). During the years 2010-2018, the number of articles published per year remained quite consistent, with 29 of the articles being published in the 2010-2014 period and 22 in the 2015-2018 period.

The modes of specialized health care travel that surfaced in this scoping study were roughly thematized into three distinct yet perhaps partly overlapping categories. The first category was that of reproduction: travel that relates to reproduction, surrogacy, fertility treatments, and the use of assisted reproductive technology (ART) as well as birth and abortion. The second category was surgical services: travel that relates to surgical procedures for cosmetic or medical purposes and, for example, organ transplantation. The third category referred to experimental and other procedures and treatments, including a variety of experimental treatments such as stem cell therapies and phenomena such as assisted suicide.

Articles in this category were typically published in social scientific journals and specifically in the fields of (medical) anthropology, gender studies, and sociology. Notably, seven of the articles—related to the topics of reproduction, transformative surgical tourism, stem cell cures, and assisted suicide—were published in the journal Medical Anthropology. Other social scientific journals that showed up in the search were, for example, Anthropology & Medicine, Body & Society, Gender & Society, Sociology of Health & Illness, and Health, among others. Furthermore, research on issues related to travel for specialized health care services has been published, for example, in medical journals that focus on a specific field of biomedicine (e.g., reproduction or genetics), in philosophically oriented journals that foster bioethical discussions and in journals in the field of tourism studies, such as Current Issues in Tourism.

A clear majority of empirical research on travel for specialized health care was qualitative or theoretical by design. There were only a few quantitative, survey-type studies (Gerdts et al., 2016; Stafford-Bell et al., 2014; De Neve et al., 2012), examining the experiences of abortion travelers to the United Kingdom, the outcomes of Australians’ overseas surrogacy arrangements and cross-border health care in a Turkish hospital, respectively. There was one study with a mixed-methods approach (Bennett & Pangestu, 2017), drawing from ethnography as well as survey data in mapping Indonesian couples’ travels for assisted reproduction.

There were also some review articles that reviewed literature on specific aspects of travel for specialized health care. For example, Pereira et al. (2018) have mapped the literature on complications and epidemiological issues affecting those who travel abroad for cosmetic surgery. Couture et al. (2015) have reviewed the literature on cross-border reproduction and specifically reprogenetic services, referred to as the “movement of patients and biopsied embryo cells for pre-implantation genetic diagnosis and its different applications” (Couture et al., 2015, p. 1), and have thematized existing research according to five themes: scope, scale, motivations, concerns, and governance. Overall, the emphasis of the specialized health care category was on qualitative and theoretical investigations and the conceptualization of end-user experiences and motivations related to travel for biomedical purposes. The few tourism studies journals in this sample also seemed to host both quantitative empirical research (Cheng, 2016) and solely theoretical accounts (Bell et al., 2011).

The conceptual field through which travel for specialized health care is characterized in these articles is extensive. Several studies acknowledged a close relation to a general field of “medical tourism”; however, in many cases this conceptualization was further focused on more specific niche concepts within medical tourism (Bell et al., 2011; Holliday et al., 2015; Inhorn et al., 2012; Sethna & Doull, 2012). Concepts used alongside medical tourism included, for example, those of cosmetic surgery tourism (e.g., Ackerman, 2010; Bell et al., 2011; Holliday et al., 2015, 2017; Jones, 2011), reproductive tourism (Arvidsson et al., 2015; Deomampo, 2013; Inhorn, 2011a; Walmsley et al., 2017), stem cell tourism (Brophy, 2017; H. Chen & Gottweis, 2013; Petersen et al., 2014), and transplant tourism (Scheper-Hughes, 2011; Wright et al., 2013).

Sometimes, medical mobility was discussed through the idea of commodification, in which case the use of the concept “tourism” may have been justified by the idea that specific, previously noncommodified medical services are “packaged” in new ways for tourist consumption (see Voigt & Laing, 2010). However, cross-border movement was often characterized as “travel” or simply “care” instead of tourism, and especially in relation to reproductive issues it was common to refer to “cross-border reproductive care” (e.g., Culley et al., 2011; Gürtin & Inhorn, 2011; Hammarberg et al., 2015; Van Hoof et al., 2015). Sometimes, specific textual strategies, such as putting the word tourism in quotation marks, were used to question whether tourism is a suitable concept to describe people’s movement across borders in their search of solutions to medical issues and conditions (Inhorn, 2011b).

There were also some attempts at developing new kinds of conceptualization for the specific forms of medical travel or tourism. For example, Inhorn et al. (2012) have argued that in relation to travel for assisted reproduction, the concept of tourism could as well be reconceptualized as “exile” because mobility is essentially often driven and prescribed by an experience of (legal) restrictions in the home country. Song (2010) has evoked the concept of “biotech pilgrimage” to highlight how cross-border medical travel for stem cell treatments relates to religious discourses and narratives of salvation as experimental treatments intertwine with faith in contemporary biotechnology. Bennett and Pangestu (2017) have conceptualized the Indonesian travel for assisted reproduction as “reproductive quests,” with the notion of a “quest” pointing to the understanding that travel is part of infertile couples’ arduous long-term processes of having a child within the framework of rigidly family-oriented Indonesian culture.

In terms of the end users involved in specialized health care abroad, in this body of literature (Brophy, 2017; Couture et al., 2015; Ferraretti et al., 2010; Hudson et al., 2016; Prasad, 2015; Richards, 2017; van Balen et al., 2016; Winter et al., 2016) it was typical to refer to “patients” or to people in general terms related to the treatment or procedure in question. Thus, conceptually, the figure of the “tourist” was not at all common or unquestioned in the accounts of this type of mobility. Rather, service users were considered to be people who seek to make use of specific medical technologies and treatments (e.g., ART, cosmetic surgery, stem cell therapies) and/or are subject to a specific condition or state (from neurodegenerative diseases to infertility) for which a cure or correction is needed. Sometimes, the procedure in question related to biological bodily processes rather than a pathological state (as is the case with, for example, pregnancy and birth/abortion tourism), in which case users were characterized, for example, as “pregnant women.” In the case of cross-border reproductive care and especially surrogacy arrangements, users were sometimes characterized as couples or parents (Bergmann, 2011; Deomampo, 2013; Inhorn, 2011b). Accordingly, it was not easy to characterize end users in any general terms (e.g., as opposed to “wellness tourists” as more or less “healthy” people), although some studies (e.g., Bell et al., 2011; Bennett & Pangestu, 2017) pointed out that biomedical travel and cross-border access to biomedical procedures is, in general terms, more readily available to people who are financially relatively well off.

In terms of regions of origin and destinations for biomedical travel, many studies in this category of articles described travel in the West-to-East and the North-to-South manner, especially in cases of surrogacy, stem cell treatment, and surgery-related travel (Aizura, 2010; Brophy, 2017; I. Cohen, 2013b), in which cases travel often took place from North America, Europe, or Australia to Asian destinations, such as China, India, or Thailand, or from North America to Central America. However, studies of reproductive travel also accounted for flows within regions; for example, within Europe legislative issues have generated flows from Germany, France, and the United Kingdom to countries such as Spain, the Czech Republic, and Belgium (Bergmann, 2011; Culley et al., 2011; Van Hoof et al., 2015). In Asia, cosmetic surgery services have generated travel flows between Asian countries, such as from China to South Korea (Holliday et al., 2017). There was also research on reproduction-related intra-regional service use in Southeast Asia (Bennett & Pangestu, 2017), with Singapore, Malaysia, and Thailand emerging as main destinations for assisted reproduction. In addition, due to its legislative liberties, Switzerland emerged as a West-to-West travel destination in relation to the phenomenon of suicide tourism. South-to-South reproductive travel was studied in the Middle East, where Iran emerged as a local destination hub (Inhorn, 2011a), and in West Africa, where Ghana has become a central destination for fertility-related travel (Gerrits, 2018). Particularly, travel that focuses on giving birth often seems to flow into Western destinations such as the United Kingdom or the United States.

Travel for Wellness Services

Our review indicates that the scientific interest in the transnational use of wellness services has gradually increased within different disciplines during the past decade. The total amount of articles in this category was 34, majority of which was published during the years 2017 and 2018. The studies on wellness-related travel were mainly published in journals specialized in leisure, tourism, and hospitality research (e.g., Current Issues in Tourism), which also often emphasize a business and/or marketing perspective (e.g., Journal of Travel & Tourism Marketing, Journal of Destination Marketing and Management). A few articles were also published in journals that were centered on a particular holistic treatment or wellness environment (e.g., Balneo Research Journal and The Journal of Alternative and Comparative Medicine). The present sample included only a couple of articles with a purely social scientific, an anthropologic, and/or a cultural approach to the use of wellness services abroad (Huang & Xu, 2018; Koskinen & Wilska, 2019; Quintela, 2011).

Most studies in this category referred to travel for wellness services as “wellness tourism.” In addition, the concept of “health tourism” was frequently used although the travel destinations and characteristics of the end users were more or less the same as in the studies that applied the concept of wellness tourism. Many scholars saw health tourism as an umbrella term for various terms describing health and wellness–related travel, and thereby wellness tourism was defined as a subcategory of health tourism (e.g., Koskinen & Wilska, 2019; Medina-Muñoz & Medina-Muñoz, 2014). However, this definition was not prominent in all the studies, and the concepts of health tourism and wellness tourism were also used interchangeably.

The reviewed articles also often involved a conceptual discussion on the characteristics of “medical tourism” and “wellness tourism.” On this conceptual issue, there was a consensus among the researchers in different fields that medical tourism is concerned with curing and treating illness, whereas holistic and preventive well-being promotion is central to wellness tourism. Other concepts used in this category of research reflect the servicescape of the destination. For example, the terms spa tourism (e.g., Alina-Cerasela, 2015; Elias-Almeida et al., 2016; Trihas & Konstantarou, 2016), spiritual retreat tourism (Ashton, 2018), yoga/spiritual tourism (Bowers & Cheer, 2017), wellness spa tourism (Han et al., 2017), and thermalism-medicine-tourism (Quintela, 2011) were used in the reviewed articles. Only one of the articles in this sample (Hritz et al., 2014) consistently discussed health and well-being “travel” instead of “tourism.”

Based on this review, the health condition of the end user is a key distinguishing factor between those traveling for medical services and those traveling for wellness services. The wellness service users are generally defined as relatively healthy people who are not in need of curative treatments but look for physical and mental improvements, self-pampering and a better state of being. Thus, the clear majority of the studies referred to the end users as tourists and not, for example, as patients. In spa and retreat–related studies, it was also typical to describe the end users as visitors (e.g., Dryglas & Salamaga, 2017; Kelly, 2012; Trihas & Konstantarou, 2016). However, the terms “customer” and “consumer” were used consistently only in two of the articles, although there is generally a strong emphasis on the customer experience perspective within the wellness-related research (Elias-Almeida et al., 2016; Kamenidou et al., 2014).

In the reviewed literature, the travel destinations included spas, resorts, retreats, and other kinds of wellness environments that provide accommodation and services such as spa, beauty, or other wellness treatments, physical/mind–body exercising, health and well-being–related workshops/lectures, and other “therapeutic” environments and offerings in the destination. Typically, it was pointed out that people traveling to wellness destinations aim to promote their overall well-being and quality of life in a holistic sense—physically, mentally, or even spiritually. Furthermore, it was frequently stated that people traveling for wellness are interested in services and consumer environments that combine different methods and elements of wellness enhancement in an experiential and unique manner (e.g., Y. Choi et al., 2015; Clark-Kennedy & Cohen, 2017; Han et al., 2017; Kim et al., 2017; Težak Damijanić & Šergo, 2013). The more recent studies underlined also the transformative nature of wellness-related travel, such as its effects on an individual’s quest for comprehensive self-development, stress management, and personal growth (e.g., Ashton, 2018; Bowers & Cheer, 2017).

Regarding both the travel destination and the nationality of the people traveling for wellness services, there were studies on a relatively broad scale. In our sample, Spain was the most studied travel destination, followed by Thailand and Taiwan. The other destinations mentioned were India, Poland, Portugal, Croatia, Greek, Hungary, Romania, Korea, Australia, China, Brazil, the United Kingdom, Estonia, Mexico, France, Japan, and Turkey. Interestingly, only approximately half of the reviewed articles specified the travelers’ home country, and only in three of the articles was cultural differences the main theme of the study (Alina-Cerasela, 2015; Han et al., 2017; Quintela, 2011). When the home country was mentioned, it was most often Germany or the United Kingdom. In addition, Russia, Spain, the United States, and Australia were mentioned in more than one article as a home country of the travelers.

In the survey studies, end users from several countries were examined within the same research, and the respondents were not segmented or otherwise examined based on their nationality but on the basis of their other sociodemographic characteristics. However, the survey-based study by Damijanic & Ruzic (2015) that investigated service users’ sociodemographic background and travel motives showed that the respondents’ country of origin was the most important factor behind the various travel motives. Similarly, the study by Han et al. (2017) indicated that the respondents’ cultural background—by which the authors established whether the travelers came from a more collective or individualistic cultures—had an impact on their satisfaction with and customer loyalty to the wellness spa destination.

A clear majority of the reviewed papers were quantitative studies comprising a survey. Although the need for qualitative methods was mentioned in some of the articles, only a few of the studies were purely qualitative (Huang & Xu, 2018; Medina-Muñoz & Medina-Muñoz, 2013; Quintela, 2011) or applied a mixed-methods approach (Bowers & Cheer, 2017; K. Chen et al., 2013; Islam, 2012; Kelly, 2012).

Approximately half of the studies were focused on categorizing and segmenting the end users based on sociodemographic information (age, gender, etc.) and/or their other characteristics, preferences, travel motivations, or the benefits sought. The next most common topic of research was to examine end users’ satisfaction with the travel destination or perceived value of their visit to estimate their future behavior (i.e., customer loyalty). Our review also involved a couple of theoretical papers that focused either on identifying the gaps between the current theoretical conceptualizations of wellness and the actual wellness tourism practices (Stara & Peterson, 2017) or on detecting general trends in wellness-related travel (Blazevic, 2016; Hartwell et al., 2018).

Answering Research Questions

Our review shows that the academic discussion on health and wellness–related travel is divided between tourism studies and the social sciences and the publication forums reflect this division. While social scientists are interested in the lived experiences of people who seek health and/or wellness services abroad and often consider and name them as patients, tourism researchers are interested in travelers from an industry point of view. This means that the end users are often examined to better design, develop, and target the services for different customer segments and not to enhance knowledge of the sociocultural aspects of the phenomenon. Typically, these discussion forums remain separate, and interdisciplinary discussions are rare (however, see, for example, Huang & Xu, 2018; Koskinen & Wilska, 2018; Quintela, 2011). In addition, publications in geography journals were rare (Bristow & Yang, 2015; Kingsbury et al., 2012; Liang et al., 2017), which may be considered surprising given the clearly geographical nature of the phenomenon. Social, cultural, or human-geographical approaches could help distinguish different geographical patterns of travel and bring new insights. Regarding migrants’ health-related travel, comparative studies on the prevalence of health and wellness–related travel among different migrant populations are lacking, and the existing evidence is restricted to few ethnic groups.

The tourism studies approach could benefit from a more detailed analysis of the service users’ sociocultural backgrounds. Most of the studies that take the travelers’ point of view concentrate on mapping the end users’ attitudes, interests, motives, perceived benefits, customer loyalty, or the overall tourism behavior but often pay no attention to people’s nationality or cultural background. In general, the findings indicate a lack of studies that are focused on examining cultural differences in relation to health and wellness–related travel, although it is acknowledged in the existing literature that the country of origin has a bearing on the tourists’ intentions and motives (e.g., Damijanic & Ruzic, 2015; Han et al., 2017; Huang & Xu, 2018; Koskinen & Wilska, 2019). Overall, the tourism-oriented view on health and wellness–related travel is very destination-centered, meaning that the travel destination per se comes to be seen as the key source for tourists’ increased health and wellness and thus essential for the overall tourism experience. However, seeing some destinations only as tourist destinations may ignore that some service users’ intentions are not at all touristic. The case of Thailand is an interesting illustration of this: Thailand is a destination for purely leisure type of wellness travel but also a health care destination for intra-regional travel pushed by lack of services at home (Ali & Medhekar, 2018). The most extreme example is the case of the “outsourced” Gulf patients, some of whom feel they are forced to travel to Thailand for health care due to the poor health infrastructure of their home region (Whittaker, 2015).

Furthermore, apart from travel for specialized health care, qualitative studies are still weakly represented in the literature, which may be partly due to the abovementioned lack of interest in people’s experiences in a nonbusiness sense. Thus, there is room for further contributions by in-depth studies regarding the understanding, discourses, narratives, and the overall experiences of people traveling for medical or wellness services to complement the sizable but methodologically limited body of cross-sectional, small-n survey studies. Also, random-sample studies and longitudinal panel designs would be extremely helpful in addressing both the methodological and theoretical lacunae of the existing literature. The latter would enable providing responses to one of the gaps identified by Hanefeld et al. (2013), namely the long-term health outcomes of health and wellness–related travel.

Based on our review, we argue that the literature on health and wellness–related travel as a whole is still theoretically rather underdeveloped and often unable to consider the multiplicity and interplay of factors and actors that propagate and arrange movement and mobilities across international borders in a thoroughly globalized world. Some useful theoretical resources for such considerations appear in qualitatively oriented studies on travel for specialized health care, for example, when research on reproductive travel draws on human-geographical ideas of “global reproscapes” (Inhorn, 2011b), or when cosmetic surgery tourism is interpreted through the notion of “assemblages” (Holliday et al., 2015). Such concepts enable a focus on the lived experiences of users while encouraging and even necessitating researchers to consider a variety of cultural, material, economical, legal, ideological, global, and local factors in understanding health-related cross-border travel and the related servicescapes. Moreover, our review points toward the need to consider explicitly the inherently geographical nature of the phenomenon and connect studies on health and wellness–related travel more closely to the field of human geography, including discussions on transnationalism, global networks, and global inequalities.

This scoping study traced the conceptual choices and approaches within the literature on health and wellness–related travel with a special focus on the users of the services, the people who travel. As a whole, the results illustrate the diversity and vagueness of the conceptual choices in the reviewed studies. The terminological choices often reflect more the field of study and the studied type of service than the end users’ travel intentions or the sociocultural circumstances that initially encourage traveling abroad for care.

The studies on the use of health and wellness services in the cross-border context can be divided into two separate approaches based on whether the end user is seen as a “patient” or “tourist.” The patient-centered studies mainly come from the social sciences, whereas tourism and marketing studies label the end user as a tourist or a consumer. While tourism studies often concentrate on the question of attracting tourists, social studies are more broadly concerned with patient experiences, safety, and inequalities.

In the studies that focus on health care, and especially on specialized health care, the destinations often involve specialized facilities or clinics (Culley et al., 2011; Prasad, 2015; Ryan et al., 2010; Song, 2010). This, together with the fact that the will to travel for clinical care is often propagated by a medical diagnosis of some sort, may be one crucial factor that affects the characterization of end users mainly as patients rather than tourists in the research on this subject. The conceptual choices in literature on the use of specialized health care in transnational contexts point to the understanding—especially characteristic of many studies on the topic in the social sciences—that the concept of “tourist” may sit uneasily with the experiences and practices of people traveling for medical services. The concept of tourism is then often used as a way of creating conceptual links to relevant literature rather than as an attempt to conceptualize and characterize the perceived nature of people’s movement in the cross-border context. In contrast to traditional conceptions of leisurely “tourism,” travel either for health care services or for biomedical procedures often involves features that are uncomfortable, painful, and even frightening. Moreover, legislative issues in the home country may motivate this type of travel. Travel may be encouraged by a search for a cure for medical conditions deemed incurable at home. Furthermore, the motivation may stem from many other kinds of cultural frameworks, norms, and expectations within the regions of origin (see Inhorn et al., 2012; Song, 2010).

However, the tourist approach to seeking health care abroad often bypasses the question of who the travelers are, where they come from, and which kinds of services or experiences they are looking for. Typical to tourism studies, the main focus is on developing a certain area or clinic to become more attractive for international patient-tourists. Similarly, in the context of wellness services, the end users are mainly referred to as tourists, which reflects a view of wellness-related travel as voluntary and pleasant cross-border mobility. In general, wellness tourism is illustrated as a form of experiential consumption that responds to the needs and desires for self-development and self-actualization in the form of different health-enhancing, self-pampering, relaxing, and unique consumer experiences. There seems to be a consensus among the different scholars that travel for wellness services is, to certain extent, an “elitist” phenomenon reflecting the cultural values and prevailing trends of the more affluent societies as well as the consumerist lifestyles and desires of rather well-to-do citizens. Accordingly, the users of wellness services are primarily discussed as consumer-citizens who are realizing their wellness-oriented lifestyle via the usage of wellness services abroad rather than as patients seeking help for or relief from actual health concerns.

Geographically, most of the reviewed studies focusing on the usage of health care services examine the North–South movement, whereas studies on South-to-South and intra-regional travel are still scarce. Some areas, including Africa, Latin America, and (North) Europe, remain understudied. With regard to the health and wellness–related travel of people with migration backgrounds, the context of the U.S.–Mexico border dominates the field. The European evidence on migrants’ medical travel and their reasons is growing but still scarce. A limited number of studies have considered this subject outside of North America and Europe. With regard to the use of wellness services in the transnational context, the flows of travel seem to be between countries of the Global North. Furthermore, travel to exotic destinations, which are typically located far from the country of origin of service users, is apparent in the existing literature.

In terms of motivation for travel, our review shows that people seek health care services outside the country they reside for various reasons. Often, the reasons to look for health care and specialized medical treatment abroad were related to the unavailability of services at home, lower costs, dissatisfaction with local services, and long waiting times. Also, in some cases the legislative issues, mainly with regards to reproductive health, may push people to seek services abroad. Among people with migration background, health travel to their countries of origin is related to the more familiar health care system and culture, but also experiences of discrimination and lower levels of integration were associated with these “medical returns.” From a tourism point of view, the most common push factors were recommendations, insurance coverage, privacy, and confidentiality, and the pull factors were costs, quality, accreditation, and shorter waiting times. In the case of wellness services, more holistic ideas of health were prominent; people were looking for overall well-being and quality of life physically, mentally, and spiritually.