Medical Tourism in Developing Countries

18 ● Medical Tourism in Developing Countriesproduced and the way in which it is produced. In order to enable thistransformation, it is likely that relevant institutions were sufficientlydeveloped.Descriptions such as “high-tech,” “service oriented,” and “powerhouse”raise questions about the basis for dividing countries into less and moredeveloped groups. The experience of India, Malaysia, and Thailand, amongothers, might bring to an end the post–World War II division of the worldinto the more and the less developed countries. Both Thomas Friedmanand Clyde Prestowitz 63 point out how some developing countries are willingand increasingly able to race with the United States. Paul Kennedy suggestedthat countries on top of the totem pole do not stay there forever, 64so by implication, the superior technological position of the United Statesis not set in stone. Moreover, the economic historian Angus Maddisonnoted that in the 18 centuries before 1820, the countries that are todayconsidered less developed produced some 80 percent of the world’s output.The technological revolution slowed them down (so that at the beginningof the twentieth century, their share was down to 40 percent) but in 2005,their share was once again slightly above that of the more developed countries.65 Clearly the demarcations between more and less developed countriesare changing, as is the composition of both groups. 66The Tourism and Medical Sectors in the Countries under StudyJust how important are the tourism and medical sectors in the countriesunder study? In answer, indicators of the relative size of those sectors arepresented in table 1.2. The proportion of GDP derived from the travel andtourism industry (TTI) indicates its importance in the economy. Accordingto these data, only half of the countries under study have double-digit values,none of which exceeds 20 percent. This indicator had been used in aprevious study by the author to classify countries as “tourist-dependent,”“tourist-friendly,” or “tourist-restrained.” 67 None of the countries listed intable 1.2 falls into the tourist-dependent category, although Costa Rica,Cuba, Jordan, Malaysia, and Thailand are tourist-friendly (as their TTIcontributes between 10–20 percent of their GDP). While it may not besurprising that tourism is an important component of Caribbean exports,it is less obvious that tourism continues to be America’s biggest serviceexport. 68The relative importance of the medical sector is assessed by observingthe public and private sector expenditures on health as a proportion ofGDP. Only in Costa Rica and Cuba does the public sector expenditureexceed 6 percent while Jordan and South Africa are the only countries