Medical Tourism in Developing Countries

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.