Chapter 1 Page 4 | Patients Going Abroad: A Burgeoning Industry

The story of modern medical tourism is, at one level, also part of the story of the changing global economy, of giant and accelerating shifts in the production of goods and services to nations that have lower costs than the United States and Western Europe. The catch-all phrase for this is  “globalization,”  and it represents, depending on whom one listens to, anything from the end of civilization as we know it to the last, best hope of mankind. The truth, as always, is more complicated, though that is of little solace to workers in the United States whose jobs have been outsourced, whose factories have been off-shored, who are still trying to figure out just exactly how  “free trade”  is helping them.

For the estimated 42 million people (1) in the United States who lack adequate medical insurance, however,  the globalization of quality medical care and services actually is one of the benefits of free trade. And the availability overseas of comparatively inexpensive elective procedures, including plastic and cosmetic surgery,  gives
Americans who are willing to travel outside the country options to which they are turning in increasing numbers.

Medical care, however, is not like manufacturing textiles or CDs or writing computer programs or providing technical support via telephone.  In the United States, and everywhere else, the first requirement of a medical-care system is that care be available locally, and the second is that it is available swiftly in an emergency. No one is going to go abroad for a simple check-up, for a flu shot, to have a cavity filled, to set a broken bone  —  not unless they live near a border and it is convenient to do so.  Increasing numbers of Americans willing to travel overseas for certain kinds of treatments and surgeries will not have a radical impact on the general delivery of health-care services in the United States anytime soon. In some areas, the effect is ambiguous; medical tourism is a back-up system, a safety valve for the American health-care system.

That an uninsured North Carolina man would have heart valve surgery in a state-of-the-art hospital in India with top-flight surgeons and eight registered nurses tending to his needs for $10,000 instead of in a hospital near his home for $200,000, as reported by CNN in January 2005,   does not deprive the hospital in the United States of $200,000 in revenue. The man didn’t have insurance and he didn’t have the money. Having surgery in India was a way to save or extend his life in a way that he could afford. His only choice in the United States was to wait until he had a heart attack so that he could be treated on an emergency basis. Assuming he survived, sticky financial negotiations that might have led to his bankruptcy would be left until later.

Medical tourism, in the short run,  provides a similar safety valve for the public health-care systems of Canada and Western Europe where the problem is not so much cost as it is accessibility. People needing or wanting non-emergency medical treatment can wait months to see a doctor. Canadians may even venture to the United States for care, despite the cost, to avoid average waits that were as high as 17.9 weeks in 2004. (2)

In June 2005, the Deccan Herald News Service of India reported that the largest holiday tour operator in Great Britain, Thomas Cook,  and the Apollo Group of India were in advanced negotiations over all-inclusive medical tourism packages. Those close to the deal speculated that the number of Britons who might travel to India for health care could rise from 400 or so annually into the tens of thousands,  should the trip become sufficiently routine.

(1) National Center for Health Statistics, 2004 National Health Interview Survey. Early Release of Selected Estimates. (Author’s Note, 2009: This has been a much-debated number for some years. But most sane people agree that the number of uninsured and underinsured people in the United States is “a lot.”)

(2) Fraser Institute (Vancouver, B.C.) 14th annual edition of  “Waiting Your Turn: Hospital Waiting Lists in Canada” (2004).

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