Medical Tourism in Developing Countries

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Promoting Medical Tourism ● 127Table 5.9 Growth and business competitiveness indexes, 2005Growth competitiveness index2005 Score (Rank)Business competitiveness index2005 (Rank)Argentina 3.6 (72) (64)Chile 4.9 (23) (29)Costa Rica 3.7 (64) (50)Cuba n.a. n.a.India 4.0 (50) (31)Jordan 4.3 (45) (43)Malaysia 4.9 (24) (23)Philippines 3.5 (77) (69)S. Africa 4.3 (42) (28)Thailand 4.5 (36) (37)5.9 (1) Finland (1) U.S.2.37 (117) Chad (116) ChadNote : Ranking is among 117 countries (GCI) and 116 countries (BCI). There is no composite score forthe BCI, just individual scores that provided too much detail for this study.Source : World Economic Forum, Global Competitiveness Report 2005–06, (New York: Palgrave Macmillan,2006), tables 1, and 3.LiberalizationCapitalism is not monolithic. Differences between countries manifest themselvesin the relative size of the private sector as well as the degree of priceliberalization and regulation. Since capitalism is also dynamic, the proportionof private versus public ownership changes over time, as does the degree ofprice manipulation and overall government involvement in the economy.Liberalization of capitalist economies includes privatization, deregulation,and the freeing of prices. 105 With respect to property rights, liberalizationentails an increase in privatization, resulting in an increase in theproportion of property owned by the private sector. With respect to thecompetitive environment, liberalization entails an increase in competitionthrough the reduction of trade barriers, regulation, and expanded exemptionsfrom antitrust laws. It cuts the bureaucratic impediments to businessexpansion. With respect to government intervention in the economy, liberalizationentails an increased reliance on the market and free prices to conveyinformation to economic players and a concomitant decrease ingovernment economic guidance. By the early 1980s, a consensus emergedthat a growing public sector was unlikely to bring about the desired growthin LDCs, so many countries embarked upon various forms of liberalization.The countries where medical tourism has been successful are ones that haveundergone a thorough liberalization process. More liberalized sectors of the
128 ● Medical Tourism in Developing Countrieseconomy have grown faster during the 1990s than the less liberalized ones.Hotels and restaurants experienced a growth of 10 percent per year duringthe 1990s, medical and health 9.0, and air transport 6.1. The highest, ITbusiness services, grew by 21.1 percent. 106As a result of liberalizing policies, Thailand is ranked twentieth out of104 countries in the world with respect to the ease of doing business 107 (thisWorld Bank ranking is considered so important that it is touted by the Thaigovernment in its efforts to attract foreign investment 108 ). Malaysia andChile are not far behind (twenty-first and twenty-fifth respectively). 109Some liberalizing steps are taken specifically for the development of medicaltourism. For example, the Malaysian government is promoting its healthcaresector by introducing liberal investment policies (such as generous taxdeductions for companies as well as deregulation—complete or partial—offinance, energy, transport, and telecommunications 110 ). Moreover, Malaysiahas altered its property ownership rules to allow foreigners to purchase property.It is especially interested in attracting foreigners/expatriates from acrossSoutheast Asia who want a second home and will require health care whenthey take up residence. 111 In other cases, medical tourism was enabled byliberalization (for example, within Europe, medical tourism took off in partbecause of deregulation of airfares and the emergence of numerous smallairlines that made hopping to Latvia for dental work feasible 112 ).Liberalization and HealthThere are conflicting goals when it comes to liberalization and publichealth. Liberalization is pursued because it revitalizes the economy, bringingdynamism and change. However, it also brings restructuring of public firmsand introduces efficiency in business, both of which have huge implicationsfor employment. In the short run, the negative implications are loss ofwork, which translates into lower incomes, and a deterioration of health.Furthermore, the liberalization of the economy that is so necessary formedical tourism can adversely affect the poor and cause additional problemswith health. This is because they will have reduced access to goods andservices at affordable prices and there can be employment implications(such as job loss), as restructuring and adjustment occurs. Therefore, theWorld Bank claims, “There is a strong case for instituting complementarypolicies to ensure that the efficiency gains from liberalized markets translateinto more effective attainment of social goals.” 113Liberalization and TradeThe most important form of liberalization aimed at helping medical tourismis in trade. In discussing the Chilean liberalization reforms, Ellen Wasserman
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List of AcronymsAIDS Acquired Immun
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2 ● Medical Tourism in Developing
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10 ● Medical Tourism in Developin
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Table 1.1 Economic indicators and t
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Plastic Surgery is Not Peanuts ●
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178 ● Medical Tourism in Developi
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188 ● NotesTreatment Abroad Could
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190 ● Notes60. Emerging markets i
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192 ● Notes21. Woodward et al.,
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194 ● Notes57. Economist, July 31
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196 ● Notes25. New York Times, De
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198 ● Notes73. Rupa Chanda, “Tr
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200 ● Notes16. Peter Schofield,
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202 ● Notes56. Thomas Friedman, T
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204 ● Notes99. Chanda, “Trade i
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206 ● Notes21. Marvin Cetron, Fre
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208 ● Notes71. Chanda, “Trade i
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210 ● Notes116. Cited in Rashmi B
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212 ● Notes2. Simonetta Zarrilli,
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214 ● Notes30. Joint Commission I
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216 ● Notes65. Mattoo and Rathind
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218 ● Notes102. It is a problem i
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220 ● Notes29. Larry Solomon, “
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224 ● Selected BibliographyBower,
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226 ● Selected BibliographyJohans
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228 ● Selected BibliographyRoffe,
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232 ● Indexbrain drain/gain 105-9
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234 ● Indexdestination countriesa
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236 ● Indexhealth careon airplane
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238 ● IndexJJohanson, Misty 44, 9
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240 ● Indexmedical tourism (conti
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242 ● Indexpublic health (continu
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244 ● Indextourism sectormarket s
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