Challenges in medical tourism
SINCE 2011, OUR TEAM has undertaken significant on the ground research in Barbados about the country’s developing medical tourism sector.
We have examined the perspectives of numerous medical tourism stakeholders by drawing on interviews, focus groups, informal conversations, and media and policy reviews of the medical tourism sector in Barbados.
Our research covers the concerns and hopes for the development of this industry. In particular, hopes for the ability for the current regulatory structure in Barbados to ensure the industry develops in such a way that is beneficial for the country, and, if possible, contributes to processes aimed at enhancing access to and quality of health care.
Hence, while the potential to access foreign revenue is driving medical tourism development in Barbados, many health care providers and health policymakers see it as an opportunity to increase equitable access to and quality of care for local citizens.
For example, it is widely thought that high-paying medical tourists are most attracted to technologically savvy treatments abroad. Health policy experts are quick to point out that the provision of such care in Barbados for international patients can also benefit local patients through the introduction of such technologies on the island.
Meanwhile, critics are concerned that most local patients will, in fact, be priced out of accessing such care and thus the presence of new types of secondary and tertiary care for international patients will not enhance equitable access to care for local citizens.
Another such quality issue has to do with the retention of health workers, where it is thought that many of the “bright and brightest” are recruited abroad.
The introduction of new private sector clinics treating high paying international patients will result in existing clinics and hospitals having to compete with such facilities for the best workers, forcing them to provide better opportunities for remuneration, advancement and continued training than are currently offered.
Consequently, some Barbadians view the introduction of a medical tourism sector as an opportunity to improve care quality by enhancing working conditions for health workers on the island, and nurses in particular.
Additionally, medical tourism clinics can provide new training opportunities for medical trainees on the island, exposing them to the latest treatments.
While it is certainly possible for such quality gains to be realised, once again many local stakeholders pointed out that privately paying international patients would mostly benefit from such transformations as well as some of the island’s wealthiest residents.
Governments can limit the presence of medical tourism providers and require commitments from the facilities to provide care to locals during the licensing process. Regulations can be put in place to ensure that payments for treatment are standardised across medical tourism providers and local hospitals to prevent local hospitals from switching to more lucrative medical tourism provision.
Finally, to fund public health care infrastructure, local governments can tax medical tourism providers. In similar vein, the government can regulate the time that health care workers spend working in medical tourism and require that some amount of their time be spent working in the public system.
Other regulations that can help prevent brain drain would be to increase the number of physicians and nurses in the country through increased training spots, and use conditional scholarships as an incentive for newly trained professionals to stay in the country.
This could also be combined with reforming the way in which the state supports medical schools and alleviates medicate debt. The island could condition loan forgiveness for medical debt on service outside the medical tourism hubs with the general populace. Furthermore, it is widely agreed that standards of care should be reinforced by requiring foreign providers in the sector to meet Barbadian licensing standards and by meeting any requirements set out by local health worker unions.
The protection of these unions is perceived as a necessary means of protecting the safety standards of health care in Barbados.
While all of these regulatory efforts should be pursued, two notes of caution are in order. First, negative effects of medical tourism on destination country health care is unlikely to be completely eliminated, so we are talking about managing or reducing the effects, not eliminating them.
Lessons to learn
Second, the lessons of informed observers regarding other destination countries should make us nervous on follow through. It is much easier for politicians to promise to remediate ill effects or even to pass regulations to that effect than it has been to get the political and legal systems of medical tourism hubs to actually enforce those promises.
As discussions of the medical tourism industry in Barbados demonstrate, the health equity implications of medical tourism sector growth are complex and require careful consideration to ensure that the benefits from this practice are realised by the greatest number of people, and particularly populations that face barriers to accessing health care.
Challenges remain even in contexts where there is the political will and adequate governance to enforce tax adjustments and monitor health worker practices and contribution to the public sector. For example, existing trade commitments under the General Agreement On Trade In Services may test the implementation of these policies and programmes.
Regulations on the services available in the medical tourism sector may be considered trade barriers, necessitating the development of regulations that do not warrant trade sanctions.
Additionally, while governments may view the regulation of medical tourism as an important means of protecting the health care system from disruptions, these regulations may also be viewed as barriers to investment in the industry and consumption of the services.
Competition between destinations seeking to grow their medical tourism sector may result in a regulatory race to the bottom, with countries weakening their regulations to meet the demands of investors and consumers.
While international guidelines could potentially establish rules about medical tourism practices that limit race to the bottom activities, currently international bodies face numerous challenges in detecting and enforcing rule violations.
Overall, while legal regulatory mechanisms such as licensing and malpractice legislation play an important role in developing a regulatory structure that addresses the health equity concerns associated with this practice, there are numerous challenges to the implementation of these regulations given the transnational scope of this industry.
These are the views of Krystyna Adams, Valorie A. Crooks, I. Glenn Cohen, and Rebecca Whitmore of Simon Fraser University, a public research university based in British Columbia, Canada. They produced a paper entitled Medical Tourism In The Tropics: New Regulation Is Needed To Tackle Equity And Quality Concerns In Barbados.