Author posting. ©The authors (2012). This is the authors’ version of the work. It is posted here for personal use, not for redistribution. The definitive version was published in Health and Place, 18(5), 2012, pp. 935-941. doi: http://dx.doi.org/10.1016/j.healthplace.2012.06.018 You, too, can be an international medical traveler: Reading medical travel guidebooks Meghann Ormond 1 & Matthew Sothern 2 Abstract Drawing on literature on self-help and travel guide writing, this paper interrogates five international medical travel guidebooks aimed at American and British audiences interested in travelling abroad to purchase medical care. These guidebooks articulate a three-step self-help “program” to produce a “savvy” international medical traveler. First, readers are encouraged to view their home healthcare system as dysfunctional. Second, they are encouraged to re-read destinations’ healthcare landscapes as hosting excellent and accessible care. Finally, these texts explicitly enjoin readers to see themselves as active, cosmopolitan consumers whose pursuits are central to rectifying the dysfunction of their home healthcare systems. Keywords International medical travel; Patient-consumer; Intermediaries; Self-help; Travel guidebooks; Medical tourism Introduction International medical travel (IMT, sometimes also called “medical tourism”) has been broadly defined as “movements by persons from one country to another to obtain healthcare services” (Pennings, 2007, 505). This movement of people challenges the traditional territorial imaginaries of the nation-state within which health care has been produced, distributed, regulated and consumed – and which have historically been central to the biopolitical project of managing the population and legitimating state rule (Legg, 2007; Sparke, 2009; Brown and Knopp, 2010). Accounts of why people undertake IMT are often divided into push and pull factors. Push factors are generally framed in terms of structural attributes of the “sending” and “receiving” countries , including the cost of care in their home countries, avoiding waiting lists, escaping regulation, and access to experimental or non- standard treatments (see, e.g., Kangas, 2002; Connell, 2006; Turner, 2007). Attention to pull factors, by contrast, has been more attuned to the complicated motivations of individuals conditioned by cultural, linguistic and religious factors (see, e.g., Whittaker, 2008; Lee et al., 2010; Horton and Cole, 2011). The individual subject who crosses borders to access care therefore emerges as the node around which both “home” healthcare provision and the IMT destination’s provision are imagined. The anxiety surrounding how to understand the mobile subject of IMT is indexed in the debate over whether their movement should be described as “‘tourism,” “exile,” “pilgrimage” or “migration” (see, e.g., Whittaker, 2008; Kangas, 2010; Song, 2010; Ormond, 2011). The type of IMT on which we focus this paper – the personally-arranged and paid-for pursuits by individual patient-consumers is often positioned as a logical extension of the “shift from philosophies and practices of collective care and treatment to a more individualized health culture where… health is seen as primarily the responsibility” of 1 Cultural Geography, Wageningen University, The Netherlands. Email: meghann.ormond@wur.nl 2 Department of Geography and Sustainable Development, University of St Andrews, UK.