Medical Tourism in Developing Countries

52 ● Medical Tourism in Developing CountriesAn estimated 43 million people are without health insurance and 120 millionwithout dental coverage—numbers that are both likely to grow. 46Having insurance is not a complete solution to medical expenses. Insurancedoes not cover all procedures, as elective procedures and much dental workfall outside the coverage boundaries. In order to afford medical insurance,many people have high deductibles. In order to stay solvent, insurance companiesare decreasing their coverage. Under those circumstances, it is notsurprising that more patients will seek medical care outside their countries.And if they do, the patients as well as the insurance companies stand to gain.Indeed, a study by Mattoo and Rathindran showed that if only one in tenpatients in the United States went abroad for fifteen procedures, the savingsfor the entire health industry would be some $1.4 billion per year. 47In addition, the long waiting periods for health care are a push forpatients in Britain, Canada, and other countries with national health services.If the waiting list is too long and there is no money for private medicalcare, a trip to Thailand starts to seem like a good idea.Also part of the push is the quality of care relative to price, namely thevalue of the service (for this reason, medical tourism has also been calledMedical Value Travel 48 ). Undoubtedly, when patients engage in comparisonshopping, they are comparing value as much as price, asking themselveswhat they get for their money. This is increasingly a concern, as the WorldBank points out: “As tourists at all price levels become more sophisticatedin the global market, value, in addition to price, becomes a critical element inthe decision to visit one destination rather than another [italics mine].” 49Quality is sought in the nature of services and the way they are provided.In Chile, South Africa, and Malaysia, a Western tourist might have accessto more sophisticated diagnostic methods than she could afford at home.For many tourists who seek medical care abroad, the sophistication of Asianhospitals comes as a surprise. In addition, it is the concomitant courtesyand efficiency that is part of the value (the personal attention in Asianhospitals has been described as a culture shock by those who are used tothe worst of Western medicine 50 ). Incidentally, the perception of quality isas important as the quality itself. The Argentine soccer star Diego Maradonawent to Cuba for drug treatment because he believed in the quality of thetreatment. He said, “I trust Cuban medicine and I know they will cureme.” 51 His belief led him to Cuba.Sometimes the push has nothing to do with price, but rather the unavailabilityof a particular service, facility, or drug treatment. Alternatively, if theservice is illegal, residents travel abroad to where the services are legal and/orin experimental stages (this includes patients with leukemia, cancer, AIDS,and diabetes 52 ).