Children's Medical Tourism: Developing an inclusive base for international study

儿童医疗旅游——父母带孩子跨越国际边界接受治疗——在医疗实践中越来越多地出现，但引发了许多问题，而且研究很少。父母带孩子去另一个国家可能有不同的动机：i)除非前往目的地国家，否则可能无法获得治疗。这可能是因为在其居住国难以获得治疗或治疗费用过高；是创新的，但没有被证明有效；是虚假的或没有科学依据的。ii)出于文化原因，目的地是可取的，或者因为目的地国家更喜欢儿科医学的运作方式，或者因为文化环境影响所提供的治疗类型和/或其提供。这些动机可能重叠：例如，可能出于文化原因寻求切割女性生殖器，但在居住国也是非法的或以其他方式无法进入，而在目的地国则不被禁止。国际服务贸易的增长很可能促进了儿童医疗旅游的增长，这可以通过电子商务和廉价的国际旅行方便地获得。对儿童和家庭以及国内外卫生保健系统的影响尚不清楚。全球卫生存在巨大的不平等现象，国际边界造成的障碍在不同地点和寻求跨越边界的人的来源地之间差别很大。全球医疗保健市场几乎没有制衡机制来确保它符合儿童的利益。政府、卫生保健系统和国际社会应对儿童医疗全球化的正确方式尚不清楚。很少有研究帮助我们了解儿童医疗旅游发生的时间和地点，描述父母的背景或动机，以及描述对儿童的影响。儿童医疗旅游提出了一系列假定的问题，需要世界各地的研究人员共同努力，例如：-儿童获得医疗保健方面存在严重的全球不平等现象。目前尚不清楚儿童医疗旅游是解决了这一问题，还是使情况恶化；-某些类型的医疗旅游可能满足文化需求。目前尚不清楚全球标准制定如何与适当的文化敏感性相平衡；-进入儿童医疗旅游市场的父母在做出医疗保健选择时可能得不到足够的支持。目前还不清楚家长需要哪些信息来做出明智的选择，以及机构提供了哪些信息；-医疗和康复往往是有压力的，儿童医疗旅游涉及父母和儿童从他们的社会支持网络长途跋涉。支持儿童和家庭的战略不明确；-全球几乎每个司法管辖区都批准了《1989年联合国儿童权利公约》，但很少有研究审查该公约的义务应如何适用于儿童医疗旅游；-许多国家正在发展医疗旅游产业，但这一市场没有统一的标准或法规，包括儿童治疗；-在证明过失治疗的责任和获得跨境赔偿方面都存在困难。对儿童的疏忽治疗可能在多年后才显现出来，这是一个特殊的挑战；-医疗旅游涉及不同地区之间罕见疾病的传播；研究儿童医疗旅游提出了方法上的挑战。虽然儿童医疗旅游的原因可能多种多样，但跨境寻求治疗的一些动机可能与难以接触到人口有关。必须建立关系，让这些社区参与进来，以便进行包容性研究。

Children's medical tourism - where parents take children across international borders for treatment - is increasingly seen in medical practice, but raises many questions and has been little studied. Parents may be motivated to take their children to another country for different reasons:i) Treatment may be unavailable except by travelling to the destination country. This may be because the treatment is difficult to access or is too costly in their resident country; is innovative and has no proven efficacy, or; is bogus or unsupported by science.ii) The destination is desirable for cultural reasons, either because the way paediatric medicine operates is preferred in the destination country, or because the cultural setting affects the types of treatments offered and/or their delivery.These motivations may overlap: for example female genital cutting may be sought for cultural reasons, but also illegal or otherwise inaccessible in a resident country, while not proscribed in a destination country.The growth of children's medical tourism is likely to have been facilitated by the growth of international trade in services which can be readily accessed through e-commerce and ready access to cheap international travel. The impacts on children and families, and healthcare systems here and abroad are not understood. Global health has huge inequalities and the barrier presented by international borders varies enormously between locations and the origin of those seeking to cross them. The global market in healthcare has few checks and balances to ensure it works in the interests of children. The correct way for governments, healthcare systems and the global community to respond to the globalisation of children's medical treatment is unclear.Little research has been done to help us understand when and where children's medical tourism takes place, to describe the background or motivations of parents, and to describe the consequent impact on children.Children's medical tourism presents a range of putative problems that require researchers across the world to work together, for example:-There are severe global inequalities in children's access to healthcare. It is not clear if children's medical tourism a solution to this problem, or worsens the situation;-Some types of medical tourism may serve cultural needs. it is unclear how global standard setting can be balanced with appropriate cultural sensitivity;-Parents who access the children's medical tourism market may be poorly supported in making healthcare choices. It is unclear what information parents need to make informed choices, and what information institutions are providing;-Medical treatment and recovery is often stressful and child medical tourism involves parents and children travelling long distances from their networks of social support. Strategies to support children and families are unclear;-Almost every jurisdiction globally has ratified the UN Convention on the Rights of the Child 1989, but little research has examined how the obligations of the convention should be applied to children's medical tourism;-Many countries are developing medical tourism industries, but there is no consistent standard or regulation of this market including for childrens' treatment;-There are difficulties in both proving liability and gaining recompense across borders for negligent treatment. Negligent treatment of children may not manifest for many years, presenting a special challenge;-Medical tourism has been implicated in the transfer of unusual illnesses between different areas;Researching children's medical tourism presents methodological challenges. While reasons for child medical tourism may be diverse, some motivations for seeking treatment across borders may be associated with difficult to reach populations. Relationships must be established to engage these communities in order to undertake inclusive research.