Medical Tourism in Developing Countries

Promoting Medical Tourism ● 161diversify into the production of other goods and services more suited totheir conditions. A similar shift in the spatial location of medical servicesupply has occurred. Several decades ago, American hospitals such as theMayo Clinic drew patients from across the world. While the United Statesremains attractive to international patients for specialized procedures, 83 theforeign demand is shifting towards lower-cost providers across the world.In addition, domestic consumers in Western countries are finding it costeffectiveto travel to developing countries. Where does that leave sites suchas the Mayo Clinic? While it still draws international patients for sophisticatedand complicated medical procedures, it has had to reorient its servicesto respond to the changing overall composition of its patients (for example,along with many hospitals across the United States, the Mayo Clinic nowprovides luxury health care for Americans, also known as concierge orboutique services 84 ).Ironically, the economic reality of shifting production locations meansthat the ten countries under study are likely to lose their advantage in theproduction of medical tourism as they develop and their production costsincrease (as Gary Becker noted, when they no longer have the comparativeadvantage, the supply locus of medical tourism will move elsewhere 85 ).It also has implications for Western medicine that needs to deal with notonly the loss of international patients but, more importantly, the loss ofdomestic patients as they seek lower-cost care across the world.Bottom line: With globalization, the spatial location of production isshifting more rapidly than it did in the past, and comparative advantagesin the provision of medical care are not set in stone. This is true both forsource and destination countries.Choice, Substitutes, and DemandIn an effort to meet national health-care demand, many Western governmentsare considering expanding the options for patients in terms of wherethey receive care. In the United States, President Bush has suggested anextension of portability of coverage so patients can obtain health care inmore places across the country. 86 Indeed, the introduction of MedicalSavings Accounts (MSAs) would, perhaps, enable consumers to buy healthcare wherever they want. Exploring the idea of crossing the public/privatedivide rather than state boundaries, Canadian provincial governments beganconsidering the use of public funds to pay for procedures in private hospitals(currently public health coffers pay only for elective procedures andonly when waiting times at public facilities are in excess of six months). 87In both countries, demand outstrips supply and the health-care systems are