Botterill, D., Pennings, G. and Mainil, T. (eds) Medical Tourism and Transnational Health Care. Basingstoke: Palgrave Macmillan. 2013. xiii + 227 pp £55.00. ISBN 978–0‐230–36236–9 (hbk)

Medical tourism is big business. According to the medical travel information provider Patients Beyond Borders (n.d.) every year approximately 8 million people travel internationally for medical treatment, contributing to a growing market of between US$24 and US$40 billion. These figures, as Patients Beyond Borders acknowledges, are hard to verify, with different agencies proposing highly divergent estimates. Despite these discrepancies there is widespread agreement that people increasingly seek medical treatment and care beyond the borders of the countries where they live. Unsurprisingly, these practices and associated economies are receiving attention from people working in various fields and academic disciplines. The aim of Medical Tourism and Transnational Health Care is to bring together a selection of different approaches and perspectives in one volume, with a particular interest in bridging the gap between the literature on tourism and that of medicine (p.4). The result is a volume that provides a wide-ranging overview of current research on medical tourism or, as the editors argue it should more appropriately be called, transnational health care. This distinction in terminology is more than semantic: it reflects an ambition to integrate, and in doing so, to re-think the way that discussions about travelling for medical care has historically been stratified according to academic discipline and region. In countries with national health services, such as the UK, medical tourism has been the preferred term, reflecting the way that people travelling for medical purposes are seen as consumers seeking extra services rather than patients in need of essential treatment. In contrast, in regions with privatised healthcare systems, such as the USA, medical travel is more widespread and the term used is cross-border health care. In proposing transnational health care as an alternative, the editors hope to bridge and blur these distinctions both empirically and conceptually; challenging existing assumptions about medical travel and opening up new ways of thinking about its management and regulation through this reconceptualisation. Through the sheer diversity of subject matter – the book contains contributions from authors working across a spectrum of disciplines (for example, sociology, social policy, geography, medicine, business and tourism), covering diverse health-related services (such as plastic surgery, reproductive medicine, dentistry, wellness clinics and spas) and geographical regions (including Barbados, Canada, China, the UK and the US) – the volume does achieve the first of these aims. Whether it manages the second, however, is less clear for precisely the same reason – the different chapters are so variable in subject matter that one is left slightly unsure as to how these different perspectives contribute to the agenda of transnational health care laid out in the introduction and revisited only sporadically in the rest of the volume (mainly in chapters 9 and 15). The book is structured in three sections. The first, tourists as patients, contains chapters that chart how tourists can also be patients and explore how tourist destinations, such as Barbados (Chapter 4 by Jeremy Snyder et al.), are expanding into the provision of medical services. One of the main achievements of this section is that it draws attention to the long-standing association between travel and therapy, something that is often forgotten in the pervasive emphasis on home as the best place for receiving or recovering from medical treatment. For example, Chapter 2 by David M. Bruce reminds the reader of 19th century cultures of seasonal travel for health reasons and visiting spas, while Chapter 3 by Cornelia Voigt and Jennifer H. Laing explore the interrelationship between wellness and travel in the context of contemporary tourism. The second section, patients as tourists, contains four chapters, three of which focus on practices and services that have become widely associated with medical tourism: cosmetic surgery (Chapter 6 by Ruth Holliday et al.), reproductive medicine (Chapter 7 by Wannes Van Hoof and Guido Pennings) and organ transplantation (Chapter 8 by Thomas D. Schiano). Each of these serves as a case study in the ethical, economic and political complexity of an increasingly globalised healthcare market, while Chapter 9 by Tomas Mainil et al. looks specifically at the regulatory framework of cross-border health care in Europe. Given the dramatic changes taking place in the National Health Service and the socio-political tensions around the free and equal provision of health care in Europe, this chapter provides some timely insights into how patients increasingly straddle the–at times conflicting–positions of being both citizens and consumers. The third section is an eclectic mix of chapters dealing with different topics. This ranges from high-level surveys of services and information, such as Chapter 10, in which Leigh Turner catalogues Canadian medical travel companies and Chapter 14 by Daniel Horsfall et al., which assesses the quality of information provided online by dental travel providers to normative suggestions for the management of international medical travel (for example, chapters 11 by Guido Pennings and 15 by Tomas Mainil et al.). The editors have clearly attempted to create a coherent volume through adopting this three-part structure, advocating the notion of transnational health care and attempting to standardise the start of each chapter with a list of key points. Despite this, the book remains, as is often the case with collected volumes, rather fragmented, with chapters of variable quality. Nonetheless, taken as a whole, Medical Tourism and Transnational Health Care provides a multidisciplinary survey of research that will be of use to academics with a specific interest in medical tourism as well as those working on topics affected by the emergence of international travel as part of the landscape of contemporary health care.

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