Medical Tourism's Impact on Health Care Equity and Access in Low- and Middle-Income Countries: Making the Case for Regulation

Journal of Law, Medicine and Ethics - Tập 41 Số 1 - Trang 286-300 - 2013
Y.Y. Brandon Chen1, Colleen M. Flood
1University of Toronto

Tóm tắt

Travelling internationally to acquire medical treatments otherwise unavailable or inaccessible in one’s home country is not a novel concept. Conventionally, such medical travel largely entailed patients from developed countries or wealthy patients from the developing world seeking care in Western facilities like the Mayo Clinic in the U.S. and myriad private clinics along Harley Street in London, England. What is different about the topical phenomenon known as “medical tourism” is the growing trend of health services export in the opposite direction. The number of patients travelling from the developed world to low- and middle-income countries (LMICs) for treatments has ballooned in recent years, primarily driven by difficulties with accessing affordable care at home. According to a liberal estimate by the Deloitte Center for Health Solutions, the number of Americans travelling abroad for care rose from 750,000 in 2007 to 1.6 million in 2012. On the flip side, Thailand reportedly treated a total of 1.3 million foreign nationals in 2007, which represented a 16% leap from 2001.

Từ khóa


Tài liệu tham khảo

76. See Kanchanachitra, et al., supra note 4, at 775.

Connell, 2011, “A New Inequality? Privatisation, Urban Bias, Migration and Medical Tourism,”, Asia Pacific Viewpoint, 52, 260, 10.1111/j.1467-8373.2011.01454.x

Kanchanachitra, 2011, “Human Resources for Health in Southeast Asia: Shortages, Distributional Challenges, and International Trade in Health Services,”, The Lancet, 377, 769, 10.1016/S0140-6736(10)62035-1

Varman, 2007, “Rising Markets and Failing Health: An Inquiry into Subaltern Health Care Consumption Under Neoliberalism,”, Journal of Macromarketing, 27, 162, 10.1177/0276146707301333

Lautier, 2008, “Export of Health Services from Developing Countries: The Case of Tunisia,”, Social Science and Medicine, 67, 101, 10.1016/j.socscimed.2008.01.057

93. See Hazarika, , supra note 5, at 249.

Leng, 2010, “Medical Tourism and the State in Malaysia and Singapore,”, Global Social Policy, 10, 336, 10.1177/1468018110379978

Thomas, 2010, “Effective Public-Private Partnership in Health Care: Apollo as a Cautionary Tale,”, Indian Journal of Medical Ethics, 7, 2

68. Report of the Expert Meeting on Universal Access to Services, TD/B/COM.1/EM.30/3 (Geneva: United Nations Conference on Trade and Development, 2006), at 13, available at <http://www.unctad.org/en/Docs/c1em30d3_en.pdf> (last visited January 30, 2013).

37. See Turner, , supra note 11, at 312–313.

90. See Cortez, , supra note 2, at 110. However, the number of expatriate doctors who have returned to work in the Apollo hospital group was said to be 123 according to Hopkins et al., supra note 8, at 191.

Wibulpolprasert, 2003, “Integrated Strategies to Tackle the Inequitable Distribution of Doctors in Thailand: Four Decades of Experience,”, Human Resources for Health, 1, 1, 10.1186/1478-4491-1-12

Meghani, 2011, “A Robust, Particularist Ethical Assessment of Medical Tourism,”, Developing World Bioethics, 11, 16, 10.1111/j.1471-8847.2010.00282.x

122. See Alsharif, et al., supra note 106, at 330–331.

Leng, 2007, “Medical Tourism in Malaysia: International Movement of Healthcare Consumers and the Commodification of Healthcare,”, Asia Research Institute Working Paper Series, 3

22. See Cortez, , supra note 2, at 89.

112. See Connell, , supra note 40, at 266.

25. Tattara, G. , “Medical Tourism and Domestic Population Health,” University Ca'Foscari of Venice, Department of Economics Working Paper Series, no. 02/WP/2010 (2010): 1–16, at 8, available at <http://ssrn.com/abstract=1544224> (last visited January 30, 2013).

81. See Wibulpolprasert, and Pengpaibon, , supra note 43, at 10.

116. See Pocock, and Phua, , supra note 39, at 2.

113. See Hopkins, et al., supra note 8, at 191; id., at 267.

Mills, 2011, “The Financial Cost of Doctors Emigrating from Sub-Saharan Africa: Human Capital Analysis,”, BMJ, 343, 1, 10.1136/bmj.d7031

17. WHO Statistical Information System (WHOSIS), World Health Statistics 2011, available at <http://www.who.int/whosis/whostat/2011/en/index.html> (last visited January 30, 2013).

57. Even, D. and Zinshtein, M. , “Haaretz Probe: Israel Gives Medical Tourists Perks Denied to Citizens,” Haaretz (Israel), November 18, 2010, available at <http://www.haaretz.com/print-edition/news/haaretz-probe-israel-gives-medical-tourists-perks-denied-to-citizens-1.325275> (last visited January 30, 2013). For a discussion of “private health service” programs that had similarly allowed Israeli patients to choose their surgeons for additional fees but were found illegal by the Israeli High Court of Justice in 2009, see in this issue Gross, A. , “Is There a Human Right to Private Health Care?”.

48. See Leng, , supra note 6, at 348.

Keckley, 2009, Medical Tourism: Update and Implications

67. See Johnston, et al., supra note 10, at 7.

96. See Chinai, and Goswami, , id.

23. See Connell, , supra note 1, at 43.

88. See Herrick, , supra note 8, at 23.

McLean, 2008–2009, “The Global Market for Health Care: Economics and Regulation,”, Wisconsin International Law Journal, 26, 591

100. All India Lawyers Union (Delhi Unit) v. Government of N.C.T. of Delhi & Others , (2009) WP(C) No. 5410/1997 (Delhi H.C.), at para. 20, available at <http://www.indiankanoon.org/doc/1508125/> (last visited January 30, 2013).

Whittaker, 2011, “Cross-Border Assisted Reproduction Care in Asia: Implications for Access, Equity and Regulations,”, Reproductive Health Matters, 19, 107, 10.1016/S0968-8080(11)37575-1

Kanchanachitra, 2013, Thai Health 2009: Stop Violence for Well-Being of Mankind, Report by Institute for Population and Social Research (Mahidol University)

Herrick, 2010, Medical Tourism: Global Competition in Health Care, 37, 193

Gupta, 2008, “Medical Tourism in India: Winners and Losers,”, Indian Journal of Medical Ethics, 5, 4

80. See Pachanee, and Wibulpolprasert, , supra note 73, at 315.

84. See Wibulpolprasert, and Pengpaibon, , supra note 43, at 3.

105. See Id. ( Thomas, and Krishnan, ), at 2.

55. See Wibulpolprasert, and Pachanee, , supra note 41, at 12; Kanchanachitra, et al., supra note 4, at 775.

74. Id. (Pocock and Phua).

Bookman, 2007, Medical Tourism in Developing Countries, 10.1057/9780230605657

45. See Chambers, , supra note 41.

Cohen, 2011, “Medical Tourism, Access to Health Care and Global Justice,”, Virginia Journal of International Law, 52, 1

119. See Pocock, and Phua, , supra note 39, at 6.

123. See Blouin, , supra note 79, at 294; Cortez, , supra note 2, at 342.

16. Cohen, I. G. , “VJIL Symposium: Response to Commentary on Medical Tourism, Access to Health Care, and Global Justice,” April 9, 2012, blog post, Opinio Juris, available at <http://opiniojuris.org/2012/04/09/vjil-symposium-response-to-commentary-on-medical-tourism-access-to-health-care-and-global-justice/> (last visited January 30, 2013).

56. See Connell, , supra note 40, at 264.

52. See NaRanong, and NaRanong, , supra note 19, at 340.

Sengupta, 2005, “The Private Health Sector in India,”, BMJ, 331, 1157, 10.1136/bmj.331.7526.1157

Scheyvens, 2013, “Exploring the Tourism-Poverty Nexus,”, Current Issues in Tourism, 10, 231, 10.2167/cit318.0

Connell, 2011, Medical Tourism, 10.1079/9781845936600.0000

110. See Leng, , supra note 53, at 13.

99. See Connell, , supra note 40, at 267.

20. See Turner, , supra note 11, at 311; Johnston, et al., supra note 10, at 8.

Selvaraj, 2009, “Deepening Health Insecurity in India: Evidence from National Sample Surveys Since 1980s,”, Economic and Political Weekly, 44, 55

Saniotis, 2008, “Medical Bioethics and Medical Tourism in Thailand,”, Eubios Journal of Asian and International Bioethics, 18, 150

Tata, 2009, Medical Travel in Asia and the Pacific: Challenges and Opportunities

64. See NaRanong, and NaRanong, , supra note 19, at 341.

98. See Connell, , supra note 1, at 152–153.

Hamilton, 2007, “Medical Tourism Creates Thai Doctor Shortage,”

Rasiah, 2009, “Privatising Healthcare in Malaysia: Power, Policy and Profits,”, Journal of Contemporary Asia, 39, 50, 10.1080/00472330802506790

109. See Gupta, Sen , supra note 12, at 5.

58. See NaRanong, and NaRanong, , supra note 19, at 340.

Shetty, 2010, “Medical Tourism Booms in India, but at What Cost?”, The Lancet, 376, 671, 10.1016/S0140-6736(10)61320-7

Thornton, 2013, “Poverty and Economic Growth: Trickle Down Peters Out,”, Economic Inquiry, 16, 385, 10.1111/j.1465-7295.1978.tb00509.x

101. Id., at para. 30.

42. See Leng, and Whittaker, , supra note 26, at 288.

30. See de Arellano, Ramírez , supra note 8, at 196.

Leahy, 2009, “Bionetworking: Experimental Stem Cell Therapy and Patient Recruitment in India,”, Anthropology and Medicine, 16, 147, 10.1080/13648470902940689

62. See NaRanong, and NaRanong, , supra note 19, at 341.

50. See Hopkins, et al., supra note 8, at 194.

46. See Wibulpolprasert, and Pachanee, , supra note 41, at 12.

13. See Hopkins, et al., supra note 8, at 193.

Blouin, 2013, “Patients Beyond Borders: A Study of Medical Tourists in Four Countries,”, Global Social Policy, 10, 315

Chanda, 2002, “Trade in Health Services,”, Bulletin of the World Health Organization, 80, 158

72. Government Health Expenditure in India: A Benchmark Study (New Delhi: Economic Research Foundation, 2006): at 15.

Leahy, 2008, “Medical Tourism: The Impact of Travel to Foreign Countries for Healthcare,”, The Surgeon – Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 6, 260, 10.1016/S1479-666X(08)80047-9

111. See Alsharif, et al., supra note 106, at 329.

18. See Kanchanachitra, et al., supra note 4, at 771.

97. See Tata, et al., supra note 89, at 24.

Spinaci, 2006, Tough Choices: Investing in Health for Development, Experiences from National Follow-Up to the Commission on Macroeconomics and Health

Saniotis, 2007, “Changing Ethics in Medical Practice: A Thai Perspective,”, Indian Journal of Medical Ethics, 85, 164

Wibulpolprasert, 2004, “International Service Trade and its Implications for Human Resources for Health: A Case Study of Thailand,”, Human Resources for Health, 2, 1, 10.1186/1478-4491-2-10

36. See Connell, , supra note 1, at 70.

66. See Leng, , supra note 6, at 349.

115. See NaRanong, and NaRanong, , supra note 19, at 338.

Stoddart, 2006, “Will Increasing Medical School Enrolment Solve Canada's Physician Supply Problems?”, Canadian Medical Association Journal, 161, 983

47. See Kanchanachitra, et al., supra note 4, at 775.

10.1186/1475-9276-9-24

Pocock, 2006, “Incoherent Policies on Universal Coverage of Health Insurance and Promotion of International Trade in Health Services in Thailand,”, Health Policy and Planning, 21, 310, 10.1093/heapol/czl017

38. See Leng, , supra note 6, at 342.

Hazarika, 2010, “Medical Tourism: Its Potential Impact on the Health Workforce and Health Systems in India,”, Health Policy and Planning, 25, 248, 10.1093/heapol/czp050

59. See Kanchanachitra, et al., supra note 4, at 775; “NHC Joins Opposition to Medical Hub Plan,” supra note 49.

77. Linder-Ganz, R. and Even, D. , “Panel Recommends Using Money from Medical Tourism to Fund Israelis' Healthcare,” Haaretz (Israel), May 29, 2011, available at <http://www.haaretz.com/print-edition/news/panel-recommends-using-money-from-medical-tourism-to-fund-israelis-healthcare-1.364638> (last visited January 30, 2013).

86. See Connell, , supra note 1, at 54.

Arndt, 1983, “The “Trickle-Down’ Myth,”, Economic Development and Cultural Change, 32, 1, 10.1086/451369

49. “NHC Joins Opposition to Medical Hub Plan,” Bangkok Post, November 4, 2010, available at <www.Factiva.com,DocumentNo.BKPOST0020101104e6b40000d> (last visited February 19, 2013).

92. See Figures derived from data provided in Kanchanachitra et al., supra note 4, at 771 (Table 2).

10.1377/hlthaff.25.2.380

Labonté, 2006, The Brain Drain of Health Professionals From Sub-Saharan Africa to Canada

94. See Hopkins, et al., supra note 8, at 192.

Cohen, 2002, “Brain Drain and Health Professionals,”, BMJ, 324, 499, 10.1136/bmj.324.7336.499

Turner, 2007, ““First World Health Care at Third World Prices’: Globalization, Bioethics and Medical Tourism,”, BioSocieties, 2, 303, 10.1017/S1745855207005765

Duggal, 2007, “Poverty and Health: Criticality of Public Financing,”, Indian Journal of Medical Research, 126, 309

65. Id.; Patra, and Sleeboom-Faulkner, , supra note 27, at 160.

69. See Leng, and Whittaker, , supra note 26, at 288.

NaRanong, 2011, “The Effects of Medical Tourism: Thailand's Experience,”, Bulletin of the World Health Organization, 89, 336, 10.2471/BLT.09.072249

24. See Cortez, , supra note 2, at 93.

34. By pointing out the nexus between medical tourism and the private health care sector in most destination countries, we do not imply that medical tourism cannot occur within a public health care regime, nor do we wish to suggest that medical tourism does not pose a threat to health care human resources when led by the public sector. Arguably, it is possible for internal brain drain to take place in the public health care context when, for example, physicians reallocate treatment times originally designated for domestic patients to foreign patients.

Wibulpolprasert, 2013, “Addressing the Internal Brain Drain of Medical Doctors in Thailand: The Story and Lesson Learned,”, Global Social Policy, 8, 12, 10.1177/14680181080080010104

91. Madden, C. , “Medical Tourism Causes Complications,” Asia Times (Hong Kong), November 7, 2008, available at <http://www.atimes.com/atimes/Asian_Economy/JK07Dk01.html> (last visited January 30, 2013).

10.1177/14680181100100030202

33. See Bookman, and Bookman, , supra note 7, at 7.

44. Id. (Wibulpolprasert and Pengpaibon), at 6. Admittedly, not all physicians who exited the public health care system ended up entering into the private system; some of them, for example, simply went into retirement or left for opportunities in other countries.

108. See Johnston, et al., supra note 10, at 5; Government of India, Ministry of Tourism, Press Release, Medical Tourism Included Under the Marketing Development Assistance (MDA) Scheme (November 15, 2010), available at <http://www.pib.nic.in/newsite/erelease.aspx?relid=67035> (last visited January 30, 2013).

78. See Even, and Zinshtein, , supra note 57.

Pocock, 2011, “Medical Tourism and Policy Implications for Health Systems: A Conceptual Framework from a Comparative Study of Thailand, Singapore and Malaysia,”, Globalization and Health, 7, 1, 10.1186/1744-8603-7-12

Leng, 2010, “Guest Editors' Introduction to the Special Issue: Why Is Medical Travel of Concern to Global Social Policy?”, Global Social Policy, 10, 287, 10.1177/1468018110379627

124. See Johnston, et al., supra note 10, at 10.

Cortez, 2008, “Patients without Borders: The Emerging Global Market for Patients and the Evolution of Modern Health Care,”, Indiana Law Journal, 83, 71

Basu, 2008, “When Does Growth Trickle Down to the Poor? The Indian Case,”, Cambridge Journal of Economics, 32, 461, 10.1093/cje/bem053

107. See Whittaker, , supra note 51, at 110.

102. See Tattara, , supra note 25, at 10.