Medical Tourism in Developing Countries

68 ● Medical Tourism in Developing CountriesTable 4.1 Perceptions of public spendingCountryComposition of public spendingArgentina 2.1Chile 3.7Costa Rica 2.8Cuban.a.India 2.8Jordan 4.0Malaysia 4.4South Africa 3.9Philippines 2.7Thailand 4.1USA 3.9Singapore 5.8Zimbabwe 1.4Note : Later reports do not contain this particular data hence were not used.Source : World Economic Forum, Global Competitiveness Report 2000 (New York:Oxford University Press, 2000), Tables 3.02 and 3.03.and thus alleviated the pressure on the public health care. 9 China’s experienceshows that the state can be involved in health care in different ways,both crucial and both situation-specific.At the outset, it should be stated that the health sector is fundamentallydifferent from other sectors in the economy. As noted in a U.S. Departmentof Commerce trade conference document, “The ethical and human welfaredimensions make [the health sector] qualitatively distinct from most otherindustries and endow it with a high degree of political sensitivity [italicsmine].” 10 Health is a political issue, and in many countries the right tohealth care is stipulated in the national laws (no country goes as far as Cubain that its constitution addressed the subject in greater detail than is common11 ). Political issues translate into economic questions about how muchgovernment involvement should there be in the health sector. This topichas been debated for decades. In a Center for Global Development studyof LDC health issues, Ruth Levine identified the importance of governmentsin delivering medical care in poor countries, stating that they are thechief funders of health care. 12 The CII-McKinsey report on the state ofhealth in India noted that government expenditure meets 80 percent of thefinancing need. 13The public share of health expenditure, presented in chapter 1, is reproducedin table 4.2 together with private health expenditure. It is clear thatCuba has the highest public health expenditure as a percent of GDP (6.5),