Medical tourism and reproductive outsourcing: the dawning of a new paradigm for healthcare.

Medical tourism, a term that also can be used to describe medical outsourcing, is characterized by travel away from one's home region to procure treatment in another. It may take one of two forms: obligatory or elective. The former occurs when necessary treatments are unavailable or illegal in the place of origin. The latter includes elective and medically indicated procedures that, although available at the place of origin, may be delivered more quickly or in a more cost-effective manner in another location. Reproductive outsourcing is a special form of medical tourism that has quickly become an important area of present-day medicine because the changes of the last four decades have left all but the most advanced fertility centers breathless as they try to adjust their treatment protocols in effective and ethical manners. Legal and policy limitations have created a global environment where, in a rising number of instances, individuals and couples must travel elsewhere to procure fertility procedures that are unavailable back home. With low cost airfares to and from America, a growing number of "medical cartographers" have set out to map which places are the "best" (in terms of cost, effectiveness and timeliness), for what procedures, and for whom. On the other hand, physicians, legal experts and policy makers have only begun to shape how government and health care agencies should formally guide or regulate medical tourism. In doing so, a number of factors may challenge the limits of ethics, policy and legality in this most important trend in modern medicine.