Medical Tourism in Developing Countries

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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
178 ● Medical Tourism in Developing CountriesTable 7.2 Perceptions of health care inequalitiesCountryHealth care for rich vs. poorArgentina 2.0 (49)Chile 2.0 (46)Costa Rica 3.5 (27)Cuban.a.India 1.6 (57)Jordan 2.6 (37)Malaysia 3.1 (33)South Africa 1.8 (50)Philippines 2.0 (48)Thailand 2.4 (39)USA 3.1 (32)Ecuador 1.2 (59)Note : Perceptions are based on reactions to the following statement: Thedifference in the quality of health care available to rich and poor citizensis small (1 strongly disagree, 7 strongly agree). Country rank is inparentheses (out of 59).Source: World Economic Forum, Global Competitiveness Report 2000(New York: Oxford University Press, 2000), table 6.05.more private health care. The entire country benefits from highly skilleddoctors who stay in their countries to partake in the growing medical tourismindustry. In order to remain competitive, these doctors encourage theirinstitutions to be competitive, to everyone’s benefit. Also, a vibrant medicaltourism industry can cooperate with the public sector so that nonpayingpatients can make use of facilities in the private sector. This might entailthe cross-subsidization of one set of patients by another with respect toshared hospital beds, medical professionals’ time and expertise, and diagnosticmachinery. Cross-subsidization also extends to insurance, as in Chilewhere private insurance companies transfer member contributions to publichealth insurance to pay for indigent care. 31Telemedicine, while not directly related to medical tourism, is neverthelesspart of the technological innovation associated with the globalizationof health care. With increased telemedicine across countries, patients whootherwise would not receive care due to distance are able to benefit. Forexample, South Africa’s Department of Health is conducting a pilot studyin telemedicine, linking sites across the country to hospitals for teleradiology,telepathology and teleopthalmology for readings, interpretations, andconsultations. 32 Thailand and Argentina are also experimenting with usingtelemedicine to bring health care to remote regions of the country. Malaysia
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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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Table 5.4 Indicators of physical in
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Page 201 and 202: 188 ● NotesTreatment Abroad Could
Page 203 and 204: 190 ● Notes60. Emerging markets i
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Page 227 and 228: 214 ● Notes30. Joint Commission I
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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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Medical Tourism in Developing Countries

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