Medical Tourism in Developing Countries

34 ● Medical Tourism in Developing Countriesdependency on the international markets that develops (with respect toboth the sale of their primary product and the purchase of inputs andtechnology for production). Agricultural regions are at a disadvantagebecause they face unfavorable terms of trade when they export primaryproducts. Such terms of trade have repercussions on income, technology,and development, all of which become characterized by a dependent linkto outside economies.Most components of dependency theories went out of fashion in the 80sand 90s, since those decades were characterized by the promotion of marketeconomies and big capitalism. Yet, at the turn of the new millennium somedependency concepts have been resurging. Indeed, those who are opposedto globalization and view it as an American-led method of global exploitationmight also recognize some features of dependency.Tourism has borne the brunt of the contemporary dependency literature.Britton applied the original dependency theory of the 1970s to tourism, 55while Hall and Tucker edited a volume on the contribution of postcolonialismto tourism studies. 56 The terms “neo-colonialism” and “imperialism”have been used repeatedly in the literature. Both are part of thediscussion below on dependency in tourism that focuses on key issues ofthe dependency scholarship.Tourism-related Dependency in Developing CountriesAfter the breakup of the Soviet Union, Cuba stayed afloat largely as a resultof its foreign tourists—medical and leisure—who provided $2.1 billion in2003 (half of the country’s hard currency revenues). 57 This did not pleasethe communist authorities because it highlighted Cuban dependency onforeign markets. They are not alone in their apprehension. Numerousscholars as well as LDC leaders believe the tourist industry’s dependency onthe West is dangerous.The roots of their sentiments lie in the fact that LDCs supply touristservices purchased mostly by consumers from the MDCs. Thus, economicactivity both directly and indirectly generated by tourism depends on foreigndemand that is all too often inconsistent and volatile. If tourism playsan important role in a destination country, then its GDP is dependent onforeign demand, and a drop in tourist visits translates into a decrease innational income.Moreover, investment in the tourist industry often comes from foreignsources (usually Western), further fostering dependency. According to JozsefBorocz, “For destination societies, the high concentration of capital in theintricately interwoven hotel, airline and tour operator branches may create