Will the growth of medical tourism improve surgical safety throughout the world or will economic factors create separate systems: one for the domestic population and one for inbound medical tourists willing to pay for a higher class of care? While some would argue that a two class system presently exists in several industrialized countries, including the United States, a favorable outcome realized from the growth of medical tourism would be improved surgical quality standards and outcomes for all patients.

The answer to the question is important for several reasons. First, there is an unserved burden of global surgical care. Improved standards, outcomes, manpower and per patient expeditures in developing countries would help meet the needs of underserved domestic populations.

Second, important ethical, political and socioeconomic problems arise when there are different healthcare standards for different people in a given country. We should strive for the highest accreditation standards for everyone.

Third, a potential backlash to medical tourism might occur if citizens feel they are getting second class care at the expense of medical tourists. For example, how would Americans feel if the Center for Medicare and Medicaid Services reimbursed for care outside of the United States?

Politicians like to say that all boats benefit from a rising tide. Let’s hope some don’t sink.