All authors approved the Belinostat fda final manuscript as submitted. Funding: Canadian Institutes of Health Research (CIHR) (grant number RNL-132178); Newfoundland and

Labrador RDC (grant number 5404.1423.102); Memorial University of Newfoundland (MUN); EA-E is supported by the Dean’s PhD fellowship, Faculty of Medicine, MUN; PEH is supported by the CIHR CGS-Master’s award. Competing interests: None. Patient consent: Obtained. Ethics approval: The study was approved by the Health Research Ethics Authority (HREA) of Newfoundland and Labrador and written consent was obtained from all the participants. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
Globalisation and the commodification of health are contributing to increased

patient mobility as patients cross borders to access health services in neighbouring jurisdictions. Within the last decade, this international trade in cross-border health goods services has rapidly expanded.1 2 Thus, modern health systems are a rich and complex network of interactions that cross national boundaries.1–3 The WHO inclusively defines health systems as “all the activities whose primary purpose is to promote, restore or maintain health,” recognising that the health system extends beyond that of the public health sector.4 Despite this inclusive definition, most analyses are limited to an examination of the public sector within geopolitical territorial boundaries.3 Such an analysis, while attractive in terms of planning national healthcare services,

distorts our understanding of the health system, which increasingly does not correspond to the notion of the health system contained within the ‘nation-state’. This goes to the core of the issue that this research addresses. Most of the research to date has focused on ‘medical tourism’, which has connotations of a degree of affluence, holidays Carfilzomib and healthcare that may not reflect the circumstances of all mobile patients.5 6 Given this terminology, it is not surprising that research has most often documented patients in higher income countries (HICs) moving to countries with lower healthcare costs.7 8 Patient mobility for planned healthcare is, however, also a substantial feature in low-income and middle-income countries (LMICs), whereby patients from LMICs cross international borders to HICs to purchase health services and products.9 Such cross-border health-seeking behaviour hides the true burden of disease, and impacts on domestic health markets, regulation, resource allocation and equity of access.