Medical Tourism in Developing Countries

Inequalities in Health Care ● 177A dual medical care market also causes “crème skimming,” a situationin which those who need less, but can pay more, are served at the expenseof those who need more but cannot pay. Two seemingly contradictory trendsare relevant in this respect. Public hospitals, especially those with good reputationsfor their associations with research establishments, are often overusedby the rich (who have other options). At the same time, even those who havepublic insurance prefer to go to the private sector because they believe thequality is higher (and, often, it is also more available).The dual medical system exists not just between rich and poor patients,but also between urban and rural regions. Indeed, health care in rural areasin all countries under study is inferior to that in the urban areas.Government facilities are of lower quality, there are fewer private sectorchoices, the highest quality medical personnel are drawn to the cities, andsophisticated medical technology is less likely to reach remote areas. Thisimbalance between urban and rural health care is also reflected in spendingon health care. 26In addition, the dual system extends to foreigners who happen to be ina developing country and become ill enough to require unplanned medicalattention. They then compete with locals for access to health care and, asDeborah McLaren points out, to the extent that doctors exist, they are morewilling to treat foreign tourists. 27In developing countries that pursue medical tourism, both the privateand the public sectors have come under scrutiny and have been criticizedfor focusing on the rich rather than the poor. Criticism has been especiallyvirulent against Cuba, where only one-fourth of the beds in CIREN(the International Center for Neurological Restoration in Havana) are filledby Cubans, 28 and where so-called dollar pharmacies provide a broader rangeof medicines to Westerners who pay in foreign currency. 29 The Cubanmedical system has been described as medical apartheid, because it makeshealth care available to foreigners that is not available to locals. 30According to table 7.2, health-care inequalities are perceived to be quitehigh. Out of 59 countries ranked with respect to perceptions of inequality,India is ranked 57th. Only one, Costa Rica, is ranked in the 20s (27th),higher than the United States.Crowding In of Public HealthMedical tourism can crowd in public health, namely it can improve andexpand public health care. A vibrant and successful medical tourism industrygenerates economic growth that in turn results in greater national andpersonal income. If people on the whole have more income, they can afford