Medical Tourism in Developing Countries

Inequalities in Health Care ● 183be clear, as must its relationship with private schemes. Having all these channelsin place is still part of capacity to provide for public health, similar tohaving the actual funding. 47 But capacity is only part of the story.In addition to capacity, the government must want to improve publichealth, in other words, it must make it a priority. This is the second conditionthat must be met in order for medical tourism to fund public health.Do governments in developing countries really want to deal with publichealth issues? Do they merely pay lip service to it or is there agenuine effort to spread basic health care to all? In response to such questions,Derek Yach said, “When political courage, individual commitment,organizational support and financing combine, the health of populationsbenefits. However, this rarely happens.” 48In order to assess how sincerely LDC’s governments are approaching theproblem of public health, several indicators may be considered. First, onemight monitor public statements and policy promises. However, politicianscould either be paying lip service since health care is a politicized sector, orthey might truly be motivated but have their hands tied by a variety ofconstraints. Alternatively, one might evaluate laws that have been enactedand assess if they were broken. Such an assessment is difficult to make giventhe corruption, bureaucracy, and inefficiency associated with both legal andpolitical institutions. Finally, one might also observe government expenditureon basic public health. Even if expenditure is high, it does not meanthat basic health needs are being satisfied. 49 That is illustrated by twoexamples. First, in 2000, the general performance of the U.S. health caresystem was ranked 37th by the WHO (out of 191 member countries) whileCuba’s was ranked 39th. 50 At the same time, health care expenditure percapita was $5,274 in the United States and $236 in Cuba. Second, India’shealth-care system has barely four doctors for every 10,000 people, comparedto 27 in the United States. 51 Yet health care accounts for only5.1 percent of India’s GDP, compared to 14 percent in the United States. 52Incentives are crucial in national health-care performance if they translateinto appropriate investment in basic health care as well as the developmentof mechanisms for the distribution of wealth. As Seror points out inher study of Cuba, those factors depend on ideology that is reflected in howthe government and others finance, administer, and regulate health care. 53This by no means implies that one must have a communist government inorder to have health-care incentives. Rather, it is meant to highlight thatincentives are real when they are enveloped in priorities and commitmentsthat link the government health authorities to the remote rural patient.In conclusion, although medical tourism provides the capacity for thegovernment to fund public health care, it will not do so in the absence of