Medical Tourism in Developing Countries

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Promoting Medical Tourism ● 155a lower fee is a lower payment (the example given was a hernia repair thatcost $5,000 in the United States and $1,300 in Hungary, plus $600 in travelcosts). Whether all the gains from trade are accrued to the insurer or someare passed on to the consumer (in the form of lower premiums) are detailsto be worked out. Moreover, they calculated that the United States wouldsave $1.4 billion annually if even only one in ten U.S. patients underwenttreatment abroad. 65 They conclude that private insurance coverage shouldbe neutral with respect to the location of the provider, and that reimbursementshould include travel costs.What about the public sector? It has been argued that it is understandablethat governments would have protective inclinations and prevent publichealth insurance to pay for treatment overseas. 66 Yet, while this mightbe true for the United States, it is not true in the UK and Canada whereprotectionist bias might be subservient to the realities of overburdened andoverstretched national health plans. They may in fact seek outside medicalservices as a way of alleviating their burden and decreasing their totalhealth-care bill. It may raise numerous questions (such as the equity issuesinvolved in covering medical tourism abroad may allow Canadian andBritish patients to jump the queue).Encouraging Portability: Efforts by Destination CountriesAuthorities and providers in developing countries are anxious to do theirpart in order to achieve portability of source-country insurance. To thatend, they are continuing bilateral negotiations with selected institutions andinsurances. For example, in India there are ongoing negotiations withBritain’s National Health Service (NHS) to work as a subcontractor, doingoperations and medical tests at a fraction of the cost in Britain. 67 TheRockland Hospital in India has begun talks with the UK as well as severalother countries in order to become registered with them so as to attractmore patients from those countries. 68 Such negotiations will only increasein the aftermath of the influential CII-McKinsey report that suggested themedical tourism industry in India approach large payers in developed countries(such as private insurances, the NHS, and others) and negotiate withthem, preferably as a group of providers rather than individual hospitals. 69Moreover, destination countries are speeding up their efforts to achievehospital accreditation and international medical staff licensing. Such signalingof quality is an important step on the road to insurance portability.American insurance companies might seek JCI accreditation and successfulpassing of the USMLE and NCLEX-RN exams and LDCs should be readyto comply.
156 ● Medical Tourism in Developing CountriesDestination countries are also complying with international regulationspertaining to health matters as well as insurance. They need to participatein the commitments made under the auspices of GATS. As a result of suchcommitment, they accept two legal obligations. 70 First, countries must grantmarket access to foreign competitors. Second, they must treat foreign competitorsno less favorably than domestic service providers. The UnitedStates, the EU, and numerous other source countries are signatories, sodeveloping countries should not be far behind.Finally, LDCs are willing to work with middlemen that have sprung upat various levels. Despite the cost of such services, they provide invaluableinformation and access. Medical brokers in source and destination countriesserve as middleman who, for a fee, find the best insurance deals. In India,Third Party Administrators are middlemen serving as a link between thegovernment, insurance, and the individual patients both at home andabroad. 71 IREX India Limited is an agency that serves as a coordinating linkbetween insurance companies and hospitals. In England there is a newcompany called Treatment Choices with medical insurance advisers thatfind patients who are in the queue for medical services options abroad. 72Given that such middlemen are increasingly coming into existence, theroute through which providers and source-country insurers can communicateis being developed.Obstacle IV: Legal Recourse and Protection of PatientsOne potential inhibitor to medical tourism is the lack of legal recourse inthe event of a problem. A patient who independently pursues a procedurein another country will only have that country’s legal system within whichto resolve a dispute. Further, other countries’ legal systems are not as conduciveto litigation as the United States’, and they may not be equippedto resolve a dispute as efficiently as U.S. patients would expect. This couldprove to be a major deterrent for people with preconceived notions aboutsub-par health care in other countries, who would want the assurances oflegal recourse to fall back on. Yet, it is important to note that foreigndoctors also carry malpractice insurance, albeit potentially with lower coveragethan U.S. malpractice insurance. Furthermore, in the Indian legalsystem for example, malpractice cases are handled by special consumercourts and damages are limited to actual damages, meaning that a largejury award for punitive damages (as might be given in the United Stateswhere state courts and juries are used) would not be conceivable. 73 Thereis also no uniform code as to what is considered medical negligence andmalpractice.
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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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100 ● Medical Tourism in Developi
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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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