Y.Y. Brandon Chen and Colleen M. Flood challenge the assumption that it is up to the critics of medical tourism to clearly demonstrate the problems there- with — arguing that, given the clear equity problems that arise with differential treatment in receiving countries, the burden of proof should lie with the proponents of medical tourism. They discuss how the limited empirical evidence suggests that modern medical tourism — in which patients from developed countries seek treatment in low- and middle-income countries — has a net negative impact on health equity and access to health care, especially primary and preventative health care, in destination countries. Chen and Flood suggest that developed countries should focus on ensuring sufficient domestic health care systems and insurance for their populations in order to reduce demand on the part of their citizens for medical tour- ism. Destination countries should insist upon direct cross-subsidization of the public health care system by the medical tourism industry.