Medical Tourism in Developing Countries

184 ● Medical Tourism in Developing Countriesincentives. Moreover, if a country has both the capacity and the incentive,then the crowding-in effect is likely to outweigh the crowding-out effect.How does one know if crowding out or crowding in has occurred?Indeed, how do we know if revenues earned by corporations revert back tofinance the public sector or if the corporations have honored the terms onwhich they were granted subsidies? There are no boundaries, no clear-cutdemarcations that need be crossed to indicate one way or another. To theextent that indicators of crowding out and crowding in are identified, methodsfor measurement are set, and data are available, then countries couldmake an assessment of the effect of medical tourism on public health.If crowding out is found to exist, then public policy must mitigate the negativeimpact of medical tourism on the poor local populations. In that effort,it must ensure that there are laws in place to protect patients’ rights, as wellas penalties in place to punish those who refuse to treat patients who cannotpay. If crowding in is found to exist, that warrants appropriate encouragementand expansion. Either way, the relationship between medical tourismand public health is complex and precarious and requires fine balancing.Economic Development: Are We There Yet?Less developed countries are like passengers on a journey, impatient to getto their destination. That destination is a higher level of economic development,a level not delineated by specific boundaries or thresholds, yet it isone that is recognizable when reached. Medical tourism is viewed as a wayto speed up the journey, to bypass useless stops and frustrating dead-ends.For some countries, it is a feasible growth strategy. Those countries standout among LDCs. If asked the question “Are we there yet?” the answer forthem is yes, they have arrived. They have surpassed other countries withrespect to numerous economic indicators, they have developed political andlegal institutions, they have a vibrant tertiary education in sciences,et cetera. Because of their advantages (described in chapter 5), ten destinationcountries can develop medical tourism and transform it into an engineof growth. These same advantages enable the countries to overcome domesticand international obstacles to the development of medical tourism(described in chapter 6). For many of the same advantages, these countriesare also likely to have existing mechanisms through which redistributivefiscal policy can be effective in alleviating public health-care problems sothat medical tourism may become the great equalizer, bringing affordablehealth care to all those who seek it. Undoubtedly, medical tourism providesthe capacity for the public sector to grow and, if alleviating poor publichealth is a priority, for its revenue to be appropriately channeled.