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A close look at the boom in Asia’s medical tourism

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Millions of tourists apparently travel to foreign countries in search for more affordable cosmetic treatments.  However, medical tourism is said to have increased in Asian countries manifold making them a hub of such medical services.  With this rising exodus of medical tourists, Asian countries derive multiple benefits as well as pose a risk.  Here is how.

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Asian countries are fast becoming the preferred despitations for medical surgeries, which appeal to both the people of western and Asian countries owing to the lower costs and the medical excellence.  Countries such as Taiwan, India, Singapore, Thailand, South Korea and Malaysia figure amongst the top Asian medical tourist destination and are a proof of how the medical tourism trend has reverted from high income countries to low income ones.

These countries are travelled particularly for cheaper medical treatments, such as transplantation, cosmetic and dental surgeries.  The governments of these countries are particularly investing in adapting international medical techniques and accreditations followed in western countries, with an eye to clinical specialism.  This has also led to the internationalisation of healthcare services, wherein the country promotes its tourism and healthcare services simultaneously.

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These countries benefit tremendously from medical tourism through the revenues and there is also an additional human resource benefit derived out of medical tourism as emigrated health workers are attracted to return to their native country- thus reversing the “brain drain” concept.

Positive spillovers may include the expansion of health-sector infrastructure and also roads and telecommunications. Equity benefits are created potentially by hospitals cross-subsidizing care for domestic patients, or helping to fund capital investment. All patients can then use capital investments, such as MRI scanners, in the hospital or health system. Finally, there are symbolic dividends — ascension into the elite club of trading nations through domestic high-tech service industry development.

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So do these anticipated benefits occur? The truth is that we simply do not have enough data on country indicators.

The involvement of transnational corporations may result in profits from medical tourism and ancillary activities being remitted overseas. While some evidence suggests medical tourism generates modest contributions to GDP, there are concerns about human resource migration to the private sector, with professionals lured by better salaries and work opportunities.

It is possible resources will be taken away from the domestic population and instead invested into private hospitals, where foreign patients benefit from a high staff-to-patient ratio and expensive, state-of-the-art medical equipment. Such private activity is further supported by tax breaks and public subsidies for the training and education of health workers.

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Another possibility is that investment is directed towards urban tertiary care rather than more appropriate domestic-population needs in rural primary care centers. The implications clearly vary depending on whether international patients are using spare capacity or competing with domestic patients.

However, there is a curious gap in research and policy analysis. System-level evaluation of medical tourism policy and impact is absent. There is also a lack of independent government-funded work examining the pros and cons of medical tourism, and how benefits are distributed across the population.

Medical tourism initiatives are launched as national policy platforms with much fanfare. However, it becomes difficult to distinguish aspiration from reality given the veneer of country promotion strategies, provider rhetoric, and industry grandstanding. In addition, one may question the political will that exists to grapple with the nature of system-level impacts.

Deeper empirical understanding of these impacts could inform policy and the regulation or stimulation of private sector activities. This may include ways to ensure human resources are made available to the domestic population — benefitting the domestic health system. Certainly medical tourism has the potential to influence the distribution of healthcare resources to the poorer local population. However, it remains to be seen whether universal health coverage in East Asian countries and medical tourism development can go hand in hand.

National strategies must understand the risks within medical tourist markets. It is necessary to engage with the evidence when considering the benefits and demand for medical tourism globally. There is no simple upward curve: travel to particular countries may be volatile, reflecting their own political, climatic and economic events. There are also shifts in consumer preferences and exchange rates.

To date there has been relatively limited success by medical tourist providers in tapping revenue streams from private and workplace insurance systems or outsourcing from western public health systems. It is difficult to prevent regulatory interest and public investment from being captured by the private sector and that the interests promoting medical tourism development are adequately countered.

Medical tourism may benefit individual patients, treating clinicians and the private healthcare providers. However, it is time to ask — do the benefits add up?

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