Thursday, February 22, 2018

Much more to medical tourism

The issue of “Medical Tourism” (MT) enters the national debate from time to time. MT involves the creation of medical services, primarily aimed at “sick” people who would choose to travel to a country other than their own, for services that might not be available in their own country (usually for legal reasons) or cost less than in their home countries.

The usual argument that is advanced in favour of this activity is a purely economic one, and those who support such an approach to health care readily cite the economic benefits of this enterprise.

Of course, they fail to consider that those who promote MT also have a stake in it, in terms of the export of and dependence on complex, foreign technology for use in diagnosis and treatment, the recruiting of foreign consultants to train local doctors in the creation of the necessary local medical expertise and the importation of the expensive phar­maceuticals required. A significant fraction of the turnover in the MT industry is spent in developed countries.

The development of an MT industry causes an inevitable “brain drain” not to another country but to the private sector. So Govern­ment subsidises medical education, which is unavailable to the taxpayers who funded it because of the shift to the money-making sector.

Such a situation serves to exacerbate existing health disparities due to unequal access to services. This can lead to worsening inequity in the health system or the evolution of a two-tiered system. Medical tourism will undoubtedly worsen the unavailability of skilled manpower in the public health system. When private hospitals begin to contribute to the GDP (gross domestic product), they no doubt will demand Govern­ment subsidies which, in turn, can lead to the establishment of specialty corporate hospitals through the use of State funds.

While all of this is important—and there are many issues that are socially unjust in such a scheme —there is also the vexing issue of what I would call “frivolous” services, especially in areas such as cosmetic surgery. Hence, valuable medical expertise is denied to the population because the wealthy may want a bunion removed or a nose straightened.

“Reproductive tourism” has its own unique challen­ges. A recent case involving reproductive tourism that attracted media attention was that of a French woman who travelled to the US to be inseminated with her brother’s sperm; there was also the 59-year-old British lady who sought fertilisation services in Italy.

It would take literally a book’s worth of writing to properly discuss the issue of MT. This is an issue that involves not only the financial bottom line but there are far-reaching social, ethical and legal implications and, more specifically, policy issues that impact upon the health system. It certainly is not primarily a matter for economists to determine.

Steve Smith

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