Medical Tourism in Developing Countries

Plastic Surgery is Not Peanuts ● 35classic situations of foreign trade and direct foreign investment dependency.”58 The more dependent the destination countries, the weaker theirbargaining position, and therefore, the greater the preconditions set byforeign investors. The chief of these is repatriation of profits, as hotel andrestaurant businesses want complete control over their profits. When profitsare repatriated, destination countries experience leakages and negative externalitiesthat often outweigh the positive effects of multipliers and linkages.In addition to profit repatriation, other aspects of foreign investment intourism also produce leakages, including imported skills, expatriate labor,imported commodities and services, imported technology and capitalgoods, and increased oil imports. Leakages reduce the impact of tourism oneconomic development and so raise questions about who the beneficiariesof tourism really are.In addition to foreign investment, tour operations are also conducive toleakages and other negative externalities. Most Western tourists travelto developing countries as part of a prepaid package that is paid up front,to Western tour operators. When a holiday is all-inclusive, only a tinyportion of tourist expenditure reaches the destination country (John Leafound that only 40–50 percent of the tour retail price remains in the hostcountry; if both airline and hotels are foreign owned, this number drops to22–25 percent. 59 ).Such evidence of dependency in LDC tourist industries led some scholarsto state that the relations between Western states and developing countriesare fundamentally no different from what they were at the peak ofcolonialism. The volatility of demand and the outflow of profits are reminiscentof the disadvantages of monocrop economies in which developingcountries exported raw materials and crops despite decreasing terms oftrade. Indeed, to the extent that LDCs have replaced raw materials withtourism, they are no less dependent on the West than they were previously.According to Cynthia Enloe, “Tourism is being touted as an alternative tothe one-commodity dependency inherited from colonial rule. Foreign sunseekersreplace bananas. Hiltons replace sugar mills.” 60 By putting all theirdevelopment eggs in the tourism basket, are LDC authorities depending onthe West to provide them with an engine of growth?Plastic Surgery is Not PeanutsWhile the tourist industry in many developing countries may indeed fosterdependency relationships, medical tourism is an exception. It does not raisethe dependency concerns that dependency theory so clearly delineates. Ashinted in chapter 1, medical tourism in the countries under study tends to