Medical Tourism in Developing Countries

Promoting Medical Tourism ● 151law, is to ensure that the final word in teleradiology goes to theU.S. accredited doctor. 40 In the United States, there is the U.S. MedicalLicensing Exam (USMLE) for doctors, and the National CouncilLicensure Examination for Registered Nurses (NCLEX-RN). In Thailand’sBumrundgrad Hospital, the over 200 surgeons are all board-certified in theUnited States. In Lebanon, the Council for National Health Tourism hascollected statistics on the training of the country’s physicians, especiallypertaining to specializations that have taken place in European and NorthAmerican universities and that can be used to signal quality to potentialpatients. 41Obstacle III: InsuranceMedical tourism in developing countries has taken off despite facing anunorganized demand based largely on cash transactions and word of mouth.The expansion of medical tourism would be several orders of magnitudegreater if source-country health insurances extended their coverage toinclude medical services outside the country. If insurance were portable,demand for medical tourism would undoubtedly expand. This has beenrecognized by numerous scholars. Benavides claimed that “the nonportabilityof health insurance is the major difficulty hampering developingcountry delivery of health services to foreign patients.” 42 Mattoo andRathindran argue that insurance programs in the United States that prohibittreatment abroad are the reason that more patients do not engage inmedical tourism. According to the World Bank, “a major barrier to consumptionabroad of medical services is the lack of portability of healthinsurance.” 43 As a result, the lack of insurance portability is an obstacle thatdeveloping countries are striving to eliminate.By way of introduction, a few words about health insurance are warranted.In the three principal source countries, three different modelsof health care exist. 44 In the United States there is the private insurancemodel, with voluntary insurance premiums paid, through the employer, tothe insurer. 45 In addition, the public sector participates in health insurancethrough Medicare and Medicaid. In the UK there is the public welfare modelthat covers 100 percent of the population and is paid through general taxation.In Germany, as well as numerous EU countries, there is the socialinsurance model funded by mandated wage-based contributions. It alsocovers 100 percent of the population. How do these health-care systemsdeal with the question of insurance portability? The answer is different forpublic and private schemes.