Medical tourism under attack and on the back foot

 

A key question on whether or not medical tourism helps or hinders local hospitals and local healthcare has been discussed in academic papers on medical tourism. It has also been discussed (and discounted) at many international medical tourism conferences.

Opponents of inbound or outbound medical tourism have sometimes been vocal but mostly quiet. Medical tourism promoters have in general dismissed these concerns. But in the last few months, several countries and regions have taken action to restrict inbound or outbound medical tourism; the industry seems not to have noticed.

The defence

Those defending medical tourism use many ideas and reasons which most of you will be familiar with. The problem is that they are like those scientists and rulers who for decades argued that the world was flat and if you sailed too far in the wrong direction you would fall off the edge!

The defenders have many good points but they lack the evidence to back up their arguments. They are saying, “Trust me, I am a medical tourism expert. I know about this stuff”. But is that enough?

The attack

Most of those who attack medical tourism are isolated individuals or groups, or their reasons are fairly plain when medical tourism threatens to impact on their business and income. But social media is changing that.

The logic that “a quart cannot go into a pint jug” is the main attack. Most health systems round the world are stretched and suffering from inadequate funding just as an ageing population, new discoveries, new equipment and new customer demands make healthcare more used and more expensive.

Plugging the gaps in healthcare provision

In many ways, medical tourism helps to plug the gaps between what the public want and what they can afford, and between what a country can provide and afford. So outbound medical tourism is, in the main, relatively easy to defend,

But inbound medical tourism is not about local healthcare customers, it is about hospitals and doctors making more money, so is much harder to defend.

Bans on outbound medical tourism

Whether Nigeria will stop people going abroad is one to watch. The reason they worry is that medical tourism eats up foreign exchange that the country does not have. It will probably succeed, as most of those going overseas are public officials - politicians and state employees, and their families - using public money to pay the medical bills.

I expect other African countries to follow Nigeria’s lead.

Bans on inbound medical tourism

IMTJ Medical Tourism Under Attack

You cannot stop people coming into a country for medical care. So the only way that you can stop it is to order local hospitals not to promote or accept inbound medical tourism.

The Ontario ban in Canada was done very quickly as the politicians were backed into a corner by a coalition of healthcare professional bodies. What years ago would have been private negotiations were held in public on conventional and social media. This illustrates the power of the crowd.

The Israeli ban is messier and may not work as colleagues seeking to privatise healthcare outnumber Health minister Yael German in the cabinet. The minister has constant battles with health funds, insurers and hospitals, which are also fighting with each other.

In both cases, medical tourism has lost out to political forces stronger than itself

Healthcare control

Around the world, there is a move to more universal healthcare, either using public or private money or services.

Some countries do this with a light touch, but others are becoming as controlling as an old style Eastern European state.

From 2016, Dubai will control the regulation of health insurers, health insurance brokers, medical tourism agencies, hospitals and clinics. They will control healthcare and health insurance prices, medical tourism packages as well as ensuring every resident, expatriate, and perhaps visitor has health insurance. At the same time, Dubai claims to support a free market healthcare economy.

Others have or will follow, and the more control any state has on healthcare, the more it can control outbound or inbound medical tourism.

The defenders of medical tourism

Where were the "medical tourism experts” “global and local medical tourism trade bodies’’ and all the others claiming to speak for medical tourism, when Israel, Ontario and Nigeria were making new rules?

I read hundreds of pages of news each day, and never saw a single body, person or organization publicly seeking to defend medical tourism against its critics.

If a country tried to ban some element of tourism, you would have global, regional and local organizations making as much public and private noise as possible.

Put simply, no politician or country takes any of the medical tourism organizations seriously. The medical tourism industry does not have a credible voice.

Conclusion

Medical tourism is under attack by powerful forces and is defenceless. It will remain defenceless until there are properly structured and truly representative trade associations that are driven by honest concern for the industry rather than the profit motive.  Such an organization must use evidence based data rather than dubious facts and questionable opinion to show why, or where, inbound or outbound medical tourism benefits the local population.

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