Medical Tourism in Developing Countries

108 ● Medical Tourism in Developing CountriesThe countries under study are increasingly successful in retaining skilledworkers. Authorities have recognized that they must emphasize retention,since educating people who then leave, taking their skills along, eliminatesthe macroeconomic benefit of expenditure on training. Government policyis thus aimed at providing a vibrant medical tourism industry at home thatcan offset the need to work abroad and thereby helps keep human capitalat home. The importance of a domestic environment that can inducedoctors and nurses to stay at home has been recognized in the literature.David Warner notes that a globalized medical care system (such as the onewhere medical tourism exists) will “help many countries slow or reverse thebrain drain of trained medical personnel who currently emigrate and findit difficult to support themselves if they stay at home.” 43 Similarly, ThomasFriedman claims that outsourcing allows Indians to “compete at the highestlevels, and be decently paid, by staying at home . . . [they] can innovatewithout having to emigrate.” 44In addition to retaining skilled workers, it is also important to inducereverse movements of doctors and medical staff that have been trained inforeign countries. Again, authorities in developing countries have recognizedthis need and have introduced supportive policies, including financialinducements for housing, as well as business credits. Moreover, as economicdevelopment occurs, the lifestyle gap between LDCs and MDCs is nolonger as large as it once was, further inducing reverse migration. Suchincentives have been especially successful in India, where Indians in thediaspora are coming home in droves. According to Nasscom, a trade groupof Indian outsourcing companies, some 30,000 technology professionalshave moved back to India in 18 months in 2004–5. 45 They are buildingcommunities that resemble the suburbs they left behind in the UnitedStates and are actively closing the lifestyle gap. While there is obviously awide range of sentiments that draw expatriates back to their homeland,many are clearly not monetary or quantifiable, but rather have to do withthe spiritual, emotional, and nostalgic dimension associated with homeland,culture, roots, extended family, and belonging. All this is summed up bythe sentiment succinctly expressed by the founder of Escorts Hospitals,Naresh Trehan, who moved from the United States to India to invest inmedical tourism: “I make one tenth of what I was making in the U.S. butI’m ten times happier.” 46 Such anecdotal evidence of reverse migration isbolstered by findings of the National Bureau of Economic Research:“A special counter-flow operating on the U.S. . . . is the tendency of foreignbornAmerican [science] stars to return to their homeland when it developssufficient strength in their area of science and technology.” 47