Medical Tourism in Developing Countries

70 ● Medical Tourism in Developing CountriesIn addition to planning, the public sector also engages in governmentexpenditure by creating agencies and departments that provide services forvisitors, including cultural, recreational, and entry clearance (i.e., visas).Given scarce resources, government involvement in tourism can result incrowding out of private activity, as discussed in chapter 7. Also because ofscarcity, trade-offs must occur within the public sector, as governmentsmust decide which sector to promote. There is much evidence across lessand more developed countries of an economic activity replaced by tourism(for example, commercial salt mining at the Wieliczka salt mine in Polandhas been phased out to make room for the one million tourists visiting eachyear). 16One way to measure government involvement in tourism is by observingexpenditure as a percent of total government spending. Using that measure,the World Travel and Tourism Council found the top spenders in 2004to be the Cayman Islands (28.9 percent). 17 Destination countries understudy have significantly lower expenditures. As evident from table 4.3, onlyArgentina, India, and the Philippines have values over 4 percent.Role of the State in Medical TourismWhile there are decades of developing countries’ state involvement in healthcare and, somewhat more recently, in tourism, medical tourism is too newand no comprehensive comparable data are available on its public/privatecomposition. However, on the basis of secondary evidence, it is clear thatthe variation is huge among destination countries, with Cuba at one end,Table 4.3 Expenditure on tourism as a percent of total governmentspendingCountryExpenditure on TourismArgentina 4.2Chile 3.7Costa Rica 3.9Cuba 1.6India 4.3Jordan 3.1Malaysia 3.2Philippines 4.6South Africa 2.3Thailand 3.1Source : World Travel and Tourism Council, Country League Tables 2004 (Madrid:Travel and Tourism Economic Research, 2004), Table 13.