Medical Tourism in Developing Countries

Promoting Medical Tourism ● 105the Chinese tend to have heavy accents that are problematic in verbal communication(albeit irrelevant for research). However, knowledge of theChinese language is an advantage for the Chinese diaspora that may seekout native speakers to provide their medical care. In this way, Arab-speakingJordan has an advantage when it comes to attracting foreign Arab speakersto its hospitals.Language is also important in another aspect of trade in medical services:outsourcing. Fluency in English, coupled with a large number of highlyeducated people skilled in IT and engineering, has enabled India to developa comparative advantage in outsourcing. It has been predicted that soonIndia will begin outsourcing its labor to the former British colonies inAfrica where English is spoken (and labor is cheap). 27 For the same reasons,French companies are moving call centers to their former colonies, especiallyto Senegal where the population is purported to have the best Frenchaccents. 28Brain Drain and Brain GainThe medical tourism industry is affected by brain drain and brain gain. Theformer refers to the loss of human capital when skilled workers leave thecountry where they were trained in order to pursue opportunities abroad.The cost incurred by the home country is especially high when doctors andnurses emigrate, as their training is especially expensive (in South Africa,some 10,000 health professionals emigrated during 1989–97, to a cost of67.8 billion rand in terms of human capital investment 29 ). The costsinclude the value of employment and productivity that the migrant wouldhave contributed. In addition, the country loses the migrant’s taxes (resultingin a decrease in government revenue), savings (resulting in a decreasein the rate of investment), and fertility (resulting in a decrease in the futurehuman capital pool). But the most pronounced long-term cost associatedwith out-migration is the loss of human capital as the more trained themigrant, the greater the loss.Doctors and nurses from developing countries have gone outside theirhome countries for both push and pull factors. According to theNew England Journal of Medicine, 25 percent of all doctors in the UnitedStates are graduates of foreign medical schools. 30 Of those, 60 percent arefrom developing countries. The top eight countries of origin of foreigndoctors in the United States are developing countries, led by India. 31 Aboutone-quarter of doctors in United States, UK, Canada, and Australia areforeign-born and some 75 percent are from developing countries. 32 In manyWestern countries there are special visa schemes and adjustments in