Medical Tourism in Developing Countries

180 ● Medical Tourism in Developing Countriescondition on its loans that revenue from a lucrative sector be used for socialprograms such as health (as it did, for example, when oil was discoveredin Chad and it provided loans to build a pipeline and develop the sector. 34 )Direct foreign investment in health services might also help improve basichealth care for the poor, as Richard Smith noted (it is the debt-free investmentthat can bring additional resources and expertise and so improve therange, quality, and efficiency of services 35 ). Similarly, in discussing whyIndia should promote medical tourism, Gupta, Goldar, and Mitra claimedthat one reason is “to improve health services available within the country.”36 They go on to say that accumulating foreign currency, which is oneof the objectives of medical tourism, can be achieved without adverselyaffecting the objective of improving public health services. Given that foreigninvestment will occur mostly in a health-care system that is commercialized,such investment could increase health care for the poor when thewealthy pay for their health care provided by the new foreign enterprises.In Chile, policy makers have hinted at the role of medical tourism in promotingbasic health. The Chilean Minister of Health, Pedro Garcia, saidthat profits from medical establishments that deal with foreign patientsshould be reinvested in the hospitals to expand services. 37 In response tocriticism that health care is becoming too concerned with profits and foreignearnings, Cuba’s Servimed claimed many of its profits get reinvestedin the local health care (specifically, 60 percent of profits are reinvested intheir hospitals and 40 percent go into other aspects of health care, includinglocal 38 ).It is not just policymakers who draw the link between medical tourismand public health. Scholars have also addressed the subject. For example, ascholarly work by Henderson on health-care tourism notes, in the finalparagraphs, that revenue might be used to invest in public health. She notesthat it is possible to view medical tourism as positive because “public-privatesynergies can be achieved with local patients gaining from economies ofscale, the introduction of more and better equipment, consultant staff whowork in both domains, and progress in medical knowledge.” 39This book picks up where Henderson left off. It does not, however, offera single blueprint that all promoters of medical tourism should follow. Suchan ambitious endeavor would be difficult to achieve since destination countriesstart off with different institutions and varying arrangements betweenthem. Indeed, that Cuba is unique has already been established with respectto many characteristics. But so is Chile, with its particular brand of private/public mix and India, with its corporatization of medical care. Therefore,although this discussion will not end with a blueprint, it will bring us closer