Medical Tourism in Developing Countries

166 ● Medical Tourism in Developing Countriesdecrease in revenue of American hospitals is further reinforced by thedecreased demand by foreign patients. Some of those patients have substitutedU.S. medical care for other alternatives, perhaps because they arecloser or more culturally compatible. Others have been affected by post–September 11 regulations that have made travel to the United States difficult(such as Boston’s teaching hospitals that earned much revenue from thenow discontinued Saudi Arabian programs to treat patients in the UnitedStates. 103 ).In addition to decreasing the revenues of some hospitals, medical tourismwill lead to a redistribution among medical specialties within any givenhospital. The clinical procedures most heavily promoted by developingcountries’ clinics and most actively consumed by Americans and Europeansare elective in nature. They include plastic surgery and dental work. Theyare also the most profitable, regardless of whether they are provided inBangkok or Baltimore, Manila or Miami. In multispecialty medical practices,and particularly in U.S. academic medical centers, there is significantsubsidization of primary medical care services by the procedure-based specialties.In American university hospitals, expensive procedures such assurgery often subsidize family care and preventive medicine departments.By embarking on medical tourism, Americans will increasingly purchase themost profitable medical procedures from offshore suppliers. One result: afurther weakening of the U.S. primary care system, with even fewerresources to implement aggressively the preventive practices needed toreduce downstream medical costs from chronic diseases such as diabetes,heart disease, et cetera.Bottom line: the reality of medical tourism calls for an evaluation of therelative role of specialties in American hospitals as well as the nature anddirection of future capacity expansions.Manpower ConsiderationsWhen Western patients substitute domestic health care for internationalcare, their actions will have an effect on source-country medical labor markets.The composition of medical manpower supply is bound to change forthe following reasons. First, foreign medical and nursing graduates, animportant component of the Western medical labor supply, will have newoptions as a result of medical tourism. As career opportunities in their homecountries improve (due to the expansion of medical industries), emigratingto the United States or staying back after the conclusion of their trainingabroad will seem less and less attractive. They will stay at home or returnto their homes to partake in the rising medical tourism industry and thus