Decision-making about bariatric and cosmetic medical tourism from countries with universal healthcare: a rapid systematic review

A growing number of people are travelling abroad for medical treatments (known as medical tourism; MT), driven by globalisation of the healthcare market. Medical tourists from countries with universal healthcare strain resources when returning with complications which require aftercare or further treatment. This rapid systematic review synthesised literature on decision-making of medical tourists, focusing on cosmetic and bariatric MT as high-demand and high-risk areas, to identify opportunities to support informed decision-making (PROSPERO registration number: CRD420251000992). Guided by Cochrane guidance for rapid reviews, three databases (MEDLINE®, PsycINFO, and Web of Science) plus grey literature (Overton) were searched on the 24th February 2025 for qualitative, quantitative, or mixed methods studies that focused on outbound cosmetic or bariatric medical tourists from countries with universal healthcare. Narrative synthesis, thematic synthesis, and triangulation were applied. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. Public involvement shaped the search methods and data interpretation. A total of 25 studies (12 qualitative, 11 quantitative, and two mixed methods) were included. Quantitative data indicated a primary motivator of cost. Thematic synthesis identified three overarching themes: (1) Medical Tourists as Constrained Consumers: Decision-Making under Systemic Healthcare Limitations, (2) Crowdsourcing Trust: Peer-Produced Evidence and Trusting Strangers in the Absence of Support, and (3) Informed but Invested: Navigating Risk Through Emotional Commitment. Triangulation identified quantitative research gaps particularly around information seeking behaviour and the effect of emotional investment on risk perception. Medical tourists are mainly limited in their decision-making by inaccessibility of universal healthcare and, subsequently, cost of treatment. Medical tourists are emotionally invested in receiving surgery, resulting in them minimising perceived risks. Medical tourists also rely heavily on anecdotal information, especially from online communities, in a context of inaccurate information and low social support. Prospective studies with generalisable samples are needed, particularly for bariatric tourism. Limitations include the limited value of available quantitative data in understanding the decision-making process of medical tourists. Given the strong financial appeal of surgery abroad, efforts to reduce the harms of MT should prioritise harm reduction strategies over deterrence, which leverage the persuasive power of anecdotal evidence and strengthen communication with domestic healthcare providers.