Medical tourism causes complications By Christina L Madden
Forty-five million Americans are currently uninsured and health expenditures in
the United States are rising faster than wages and inflation. Despite spending
more on health care than any other industrialized nation, the United States in
2000 ranked 37th in the World Health Organization's evaluation of health care
systems around the globe. Reforming domestic health care was a big issue in the
US presidential campaign, yet a growing number of Americans and insurance
providers are turning to international solutions.
About 750,000 Americans traveled overseas for medical treatment in 2007, and
the number of so-called medical tourists could increase to more than 15 million
in 2017. In previous decades, the medical tourism industry was dominated by
cosmetic and dental
procedures. Today everything from knee replacements to major heart surgery can
be obtained in developing countries where internationally accredited health
centers provide high-quality treatment with lower costs and shorter waiting
periods than in the United States.
A heart-valve replacement priced at US$200,000 or more in an American hospital
can cost $10,000 in India, according to the University of Delaware, including
airfare and a post-operative vacation package. Average savings in Thailand are
about 70% compared with the United States, and between 50% and 75% in Latin
America.
Thailand's Bumrungrad Hospital treated 400,000 international patients in 2007,
including 65,000 Americans. Thanks to an increase in foreign patients, the
hospital's total revenue for 2008 is predicted to rise to $618 million.
Overall the effects of medical tourism are mixed. On the one hand, the industry
can boost a developing country's gross domestic product and investment in
health facilities. Upgrades in a country's hospitals also tend to decrease
external brain drain, as top physicians find local jobs instead of leaving for
employment in developed nations.
A study by the Confederation of Indian Industry predicts that by 2012 the
medical tourism industry could add up to $2.3 billion to the country's annual
GDP. The head of India's Wockhardt hospitals, which cater to foreigners,
reported two dozen Indian doctors returning from the United States and Britain
to work in his facilities.
In many cases, however, medical tourism threatens to exacerbate unequal access
to quality health care in developing countries. Although relatively cheap by
most Western standards, the private hospitals that treat foreigners are out of
reach for the majority of people, and the revenue they bring in rarely makes
its way to the public sector. According to a 2006 report by the World Health
Organization, less than 4% of India's total government spending in recent years
has gone toward health.
External brain drain is often replaced by internal brain drain, as doctors
leave public health care centers to work in private hospitals. Last year NPR
reported on a shortage of Thai doctors in the capital's public hospital because
of the higher pay offered at Bumrungrad.
Some doctors, however, split their time between public and private facilities
to balance serving the public sector with earning enough income to support
their families. An editorial in Thai English-language newspaper The Nation
cites the promotion of medical tourism as a factor in the country's failure to
meet its goal of providing one doctor per 1,800 citizens.
The situation in Cuba has been described as "medical apartheid". Top quality
treatment that is available to foreigners and to the Cuban elite is off limits
to most of the country's population who can't afford to pay for health care in
dollars. Based on interviews with Cuban citizens, Canada's National Post
reported that access to basic pharmaceuticals was severely limited, either
priced in dollars or restricted to the black market.
Some countries are responding to this public health dilemma. Private hospitals
in the Philippines have been asked to accommodate more local charity patients.
India's Health Secretary Naresh Dayal has suggested that private hospitals
should provide medical treatment to poor patients free of charge as revenues
increase. Others have proposed that India tax the currently subsidized private
hospitals to support public health initiatives.
So far, a set of best practices on balancing medical tourism with improvements
in public health has yet to make its way into international agreements or
hospital accreditation processes.
Nonetheless, the major cost savings associated with medical tourism are
attracting more patients and health insurance companies than ever before. Blue
Cross & Blue Shield of South Carolina now facilitates travel from the
United States to Thailand and other international hospitals through its
Companion Global Healthcare subsidiary.
Legislation was introduced in West Virginia that would provide incentives to
state employees who go abroad for medical treatment. According to Business
Week, more and more insurers will be offering overseas options to their
policyholders in the next five to 10 years.
Medical tourism is not an alternative to significant reform of the US health
care industry. Aside from the negative effects on public health overseas - plus
the environmental impact of long-distance air travel linked to the industry -
medical tourism is not predicted to reduce the country's health spending by
more than 1% to 2%. The overseas options will cost health care providers in the
United States roughly $16 billion in 2008, according to the Deloitte Center for
Health Solutions - a figure that may jump to $373 billion or more within a
decade.
By introducing global competition to an industry that's long been considered
immune to outsourcing, medical tourism may up the ante on reforming coverage,
cost, and quality at home.
Christina L Madden joined Global Policy Innovations in July 2007. She is
also a political analyst for Americans for Informed Democracy and works on
international development issues with MediaGlobal, a partner organization of
the United Nations Development Program.
(Published with permission of the Global
Policy Innovations program at the Carnegie Council for Ethics in
International Affairs.
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