Medical Tourism in Developing Countries
Medical Tourism in Developing Countries Medical Tourism in Developing Countries
CHAPTER 6Promoting Medical Tourism:The ObstaclesThis book began with three illustrations of medical tourism: anAmerican woman goes to Mumbai for hip replacement and laterconvalesces among palm trees, an Englishman has Lasik surgery inThailand while his family frolic at a beach resort, and a Canadian motherskips the national insurance queue by taking her daughter to Costa Ricafor surgery. Each example had positive connotations such as cost savings,exotic landscapes, successful surgery, and family vacations. However, such arosy picture is not always real. Each of these three scenarios presents ampleopportunity for unforeseen problems—medical and otherwise. The logisticsof medical travel raise questions of how to solve these problems once theyoccur. Moreover, in receiving medical care in a developing country, medicaltourists submit themselves to that nation’s administrative and legal processesin the event of a problem.The above examples of medical tourism present many possibilities forthe system to go awry and reveal the potentially negative underbelly of theindustry. Until destination LDCs minimize such occurrences by successfullyconforming to world rules and standards, they will be constrained in theirefforts to further expand their medical tourism industries. It is not enoughto have the critical mass of advantages discussed in chapter 5. Rather, it isalso necessary to overcome a critical mass of international and nationalobstacles. These obstacles include barriers to trade in medical services andare mostly, but not exclusively, legal in nature. At the macro level, theyinclude rules and regulations that (i) limit the supply of medical tourismincluding international controls pertaining to patents; (ii) set internationalstandards and require accreditation, certification, and licensing; and(iii) determine portability of insurance (Cuba faces additional obstacles due
140 ● Medical Tourism in Developing Countriesto the U.S. trade embargo). 1 In addition, governments set barriers thatcontrol their borders (such as visa restrictions).At the micro level, namely, the level of the individual patient, there arealso barriers that prevent the expansion of medical tourism. These relate tothe inadequacy of legal protection in developing countries as compared towhat Western patients are accustomed to (such as recourse to courts forcompensation through malpractice insurance). Questions about how potentialproblems will be resolved must all be answered to the satisfaction of theinternational patient who might otherwise be unwilling to risk medicalcomplications and extended stays in foreign hospitals.Although the nature and magnitude of trade obstacles differ from jurisdictionto jurisdiction, the resolution of both macro and micro legal issueswill be critical over the next decade and will determine the growth of medicaltourism worldwide. This chapter explores these obstacles and highlightscurrent efforts at their elimination. It does not contain an exhaustive treatmentof the issues, but rather presents an overview that might be a startingpoint for future studies.Obstacle I: International RegulationsNumerous international regulatory agreements are relevant for trade inmedical services and products. The most comprehensive one, GATS, regulatesinternational trade in medical services through the four modesdescribed in chapter 2. Two fundamental regulations bind signatory countries:nondiscrimination (member states cannot discriminate between suppliersfrom different countries) and transparency (member states mustadhere to full disclosure of all their trading practices including laws andregulations that might affect trade). Also, a subgroup of GATS is studyinghow the following agreements affect the transfer of technology to developingcountries: Agreement on Technical Barriers to Trade (TBT) andAgreement on the Application of Sanitary and Phytosanitary Measures(SPS). With respect to the former, WHO has a standard-setting group thatsets international standards for biological materials and components ofpharmaceuticals products. 2 The latter encourages countries to developdomestic legislation that is based on international standards included in theagreement that can then be considered WHO-consistent. In addition, theWorld Trade Organization (WTO) implemented the TRIPS Agreement in1995. To conform to international regulations about intellectual property,signatory countries promoting medical tourism have introduced new legislationand amended the old with respect to copyrights, trademarks, andpatents.
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CHAPTER 6Promot<strong>in</strong>g <strong>Medical</strong> <strong>Tourism</strong>:The ObstaclesThis book began with three illustrations of medical tourism: anAmerican woman goes to Mumbai for hip replacement and laterconvalesces among palm trees, an Englishman has Lasik surgery <strong>in</strong>Thailand while his family frolic at a beach resort, and a Canadian motherskips the national <strong>in</strong>surance queue by tak<strong>in</strong>g her daughter to Costa Ricafor surgery. Each example had positive connotations such as cost sav<strong>in</strong>gs,exotic landscapes, successful surgery, and family vacations. However, such arosy picture is not always real. Each of these three scenarios presents ampleopportunity for unforeseen problems—medical and otherwise. The logisticsof medical travel raise questions of how to solve these problems once theyoccur. Moreover, <strong>in</strong> receiv<strong>in</strong>g medical care <strong>in</strong> a develop<strong>in</strong>g country, medicaltourists submit themselves to that nation’s adm<strong>in</strong>istrative and legal processes<strong>in</strong> the event of a problem.The above examples of medical tourism present many possibilities forthe system to go awry and reveal the potentially negative underbelly of the<strong>in</strong>dustry. Until dest<strong>in</strong>ation LDCs m<strong>in</strong>imize such occurrences by successfullyconform<strong>in</strong>g to world rules and standards, they will be constra<strong>in</strong>ed <strong>in</strong> theirefforts to further expand their medical tourism <strong>in</strong>dustries. It is not enoughto have the critical mass of advantages discussed <strong>in</strong> chapter 5. Rather, it isalso necessary to overcome a critical mass of <strong>in</strong>ternational and nationalobstacles. These obstacles <strong>in</strong>clude barriers to trade <strong>in</strong> medical services andare mostly, but not exclusively, legal <strong>in</strong> nature. At the macro level, they<strong>in</strong>clude rules and regulations that (i) limit the supply of medical tourism<strong>in</strong>clud<strong>in</strong>g <strong>in</strong>ternational controls perta<strong>in</strong><strong>in</strong>g to patents; (ii) set <strong>in</strong>ternationalstandards and require accreditation, certification, and licens<strong>in</strong>g; and(iii) determ<strong>in</strong>e portability of <strong>in</strong>surance (Cuba faces additional obstacles due