1 Medical Tourism Today: A Narrative Review of Existing Knowledge Laura Hopkins, University of Saskatchewan (MPH Student) hopkinslj@gmail.com Ronald Labonté, Professor and Canada Research Chair, University of Ottawa rlabonte@uottawa.ca Vivien Runnels, University of Ottawa (PhD Candidate, Population Health) runnels5@rogers.com Corinne Packer, Research Associate, University of Ottawa cpacker@uottawa.ca DRAFT PAPER: DO NOT CITE WITHOUT PERMISSION Introduction In The Wealth of Nations Adam Smith famously posited that “if a foreign country can supply us with a commodity cheaper than we ourselves can make it, better buy it of them with some part of the produce of our own industry employed in a way in which we have some advantage” (Smith 1776). It is unlikely that Smith could foresee the reverberations of his hypothesis of comparative advantage in the health care industry of the 21st century; until the latter part of the 20th century, health and health care were not considered commodities to be traded in the global marketplace. In this article we describe and review evidence from a narrative review of one particular trend in the global commercialization of health care: what has become commonly known as ‘medical’ or ‘health tourism’ in which individuals travel to foreign countries to seek remedies for their health issues. Existing literature suggests that the majority of medical tourists are individuals from developed nations (the global North) traveling for medical treatment to low- and middle-income nations (the global South). Motivations for this trend include lower cost and rapid access, and the high quality of care increasingly available in some facilities in the global South. But medical tourism also flows from the global South to the global North, and both directional flows have implications on health systems and health care access in destination countries. Although there are no current means of accurately tracking the exact number of individuals taking part in this growing global industry, one source estimated the number at approximately 350,000 in 2003 (Horowitz, 2007). Specific concerns exist with the apparent rapid growth of surgical, dental, fertility and organ transplant tourism. After summarizing existing evidence of medical tourism flows, we turn our attention to a discussion of these concerns, specifically the (potential) risks and benefits of such flows for both source and destination countries. Methods The review consisted of a search of electronic databases and was undertaken between May 27 and July 15, 2009. Searched databases include PubMed, Scopus, Cinahl, and CAB Health. Given the recent emergence of literature related to medical tourism, the search strategy was more complicated than would usually be the case. “Medical tourism” has yet to be established as a searchable MeSH or otherwise indexed term. As a result, the number of search terms used to elicit a comprehensive literature database was extensive and included, alone or in combination: medical tourism, health tourism, medical, health, surgery, surgical, reproductive, fertility, stem