Medical Tourism in Developing Countries

176 ● Medical Tourism in Developing Countriescrowds out public health. As a nascent industry, medical tourism needsgovernment cooperation to get off the ground. Such cooperation takes variousforms, not the least of which is funding. Given scarce resources, suchfunding will have to come from some other program within the healthsector, and it might very well be public health. Governments also give subsidiesto medical tourism (such as land subsidy), and the pressure for suchsubsidies to remain or grow exists as nascent industry turns into adolescentindustry. Moreover, the tourism industry often requires foreign imports inorder to develop which will deplete scarce foreign currency reserves thatmight be used to import, for example, antimalaria medicine that can treatlarge numbers of people. Promoting medical tourism in this way leads to acommercialization of medical care as the profit motive and commercialinterests become paramount (according to Debra Lipson, world expert inhealth insurance and public health, “There is a tremendous amount ofcommercial interest driving this trend [of medical tourism], rather thanhealth care interests.” 22 ). Moreover, the emphasis on medical technologymight take resources away from health care for those who really need it(poor people demand basic health care that is nontechnical). A WHO studynoted that the increase in medical tourism “may facilitate access to highlevelservices by the better off; but it may also divert human resources frompublic services to more profitable private services for the elite or foreignmarkets, thus reducing staffing levels, lowering staff quality, and/or raisingsalary costs for the public sector.” 23 In that way, medical tourism can distortpriorities within developing countries.The crowding-out effect is amplified when there is a bandwagon effectand every hospital tries to get in on the medical tourism act. In the shortrun, a focus on international patients will leave fewer resources for the localpopulation. Medical professionals are likely to be affected, as expandingcorporate hospitals will draw doctors away from the public sector by offeringhigher salaries and better working conditions. Top specialists in privatehospitals are increasingly senior doctors from the public sector, creatingwhat Chanda called an internal brain drain “as better quality health careprofessionals flow from the public health care segment to the corporatesegment with its better pay and superior infrastructure.” 24 In Malaysia, forexample, private hospitals account for 20 percent of hospital beds butemploy 54 percent of the country’s doctors. 25Medical tourism thus can create a dual market structure in which onesegment is of higher quality and caters to wealthy foreigners (and local highincomepatients) while a lower quality segment caters to the poor. In thisdual market, health care for the local population is crowded out as the bestdoctors, machines, beds, and hospitals are lured away from the local poor.