Medical Tourism in Developing Countries

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