The cure or the cause? The impact of medical tourism on global health inequality

By Ella Barclay.

Migration motivated by the improvement of one’s health is not a new phenomenon. Nineteenth-century doctors around the world prescribed visits to foreign spas to improve wellbeing and London’s Harley Street was one of many internationally renowned centres for medical care. Despite this, there has been a recent boom in such movement, with individuals increasingly opting to access care beyond their state borders (Morgan, 2010). This phenomenon, termed ‘medical tourism’, has developed into a globalised industry, with states now viewing healthcare as a commercialised product. Various destinations have chosen to profit from this trend, even marketing themselves as ‘international healthcare capitals’ (Hanefeld et al., 2014). However, concerns have been raised regarding the actual value of this phenomenon, with many questioning whether this growing market is helping or hindering global equality.

Medical tourism as the cure

Contrary to the assumption that the healthcare industry thrives in economically developed countries, the rise of medical tourism has been described as a case of ‘reverse globalisation’ (Connell, 2013), shifting power and wealth back into less economically developed states (LEDCs). These destinations have embraced the commercialisation of international medical care, offering up affordable treatment to citizens of, typically, more economically developed states who wish to travel abroad for their procedures and simultaneously experience the tourist aspects of these ‘exotic’ destinations (Johnson et al., 2010). Funnelling large sums of their state budget into this sector, LEDCs have profited greatly from this phenomenon, with medical migrants contributing significantly to the medical and tourist sectors.

(Image: Annie Spratt on Unsplash)

The growth of this industry within LEDCs also counters the effects of ‘brain drain’, by creating jobs within the healthcare sector (Oberman, 2013). Where the mass migration of medically trained individuals to Western states was previously the norm, leading to labour shortages within native states, the rise of medical tourism in LEDCs has created many new healthcare centres, offering highly paid jobs to citizens (Cohen, 2011). This again boosts the state’s economy by allowing for a ‘return investment’ in their residents; the individuals who are trained within (and, therefore, funded by) the state remain within that territory to ‘give back’ to the economy. Here, one could argue that Western states will suffer from labour shortages as we heavily rely on this migrant workforce. However, as people increasingly seek treatment abroad, the strain on state resources will be simultaneously alleviated. Subsequently, the wait time for elective treatments within national systems will be reduced, thereby benefiting medical tourists and residents alike.

Lastly, with the growth of the global market for any commercialised good comes competition and innovation (Lee et al., 2011). Each state wants to offer the newest and best treatment to its high-paying customers, thereby continually funding medical research, technology development and infrastructure, to ensure they are the go-to medical tourist destination. This ongoing competitiveness has hastened medical advancements over the past two decades and greatly improved the quality of healthcare available globally.

Medical tourism as the cause

The novelty of this phenomenon means the medical tourism market is not well regulated. Although the quality of care provided by verified clinics is improving, there are no regulations in place to prevent unqualified and illegitimate clinics from targeting foreign patients. Defined by critics as ‘rogue medical tourism’ (Hunter and Oultram, 2010), individuals offer impossibly cheap treatments, exploiting the naivety and frugality of medical migrants by allowing non-medical staff to carry out procedures in unsanitary and inadequate surroundings. This aspect of medical tourism not only causes harm to the individual but also re-asserts the strain on their home healthcare system, as they will inevitably want to address any ‘botched’ treatments within their own country.

International clinics may also offer treatments that are illegal in other states, such as euthanasia or stem-cell research (Higginbotham, 2011). The availability of these treatments could be seen to enhance autonomy, however, there remains a question of where the line can be drawn concerning treatment that is seen as unethical in one state yet permitted and even promoted in another. Evidently, claims of ‘enhanced quality of healthcare globally’ by proponents of medical tourism are debatable.

Similarly, there is a question of whether this supposedly high-quality healthcare benefits all persons, or simply the elite few who can enjoy the luxury of medical tourism. Having recognised the potential economic value of this industry, state funding currently prioritises healthcare efforts that serve foreign, wealthy patients, as these yield a profit. More money is put into the development of the luxury provision of healthcare, than into the necessary provision of healthcare to impoverished persons; in an effort to harness the full potential of medical tourism, states are neglecting the wellbeing of their own citizens (Bookman and Bookman, 2007). Not only are these individuals denied access to this high-quality care due to their inability to pay, but they also lack basic health rights, such as access to sanitation and clean water, highlighting the need to invest in this lower sector of care provision, not de-fund it. This constitutes a ‘dual medical system’, in which the standard of care available is dependent on one’s socioeconomic status, thereby increasing healthcare inequalities within the state (Manna et al., 2020). Although medical tourism may reverse the effects of globalisation by placing wealth back in the hands of LEDCs, on a national scale the growth of this industry makes the disadvantaged worse off. Claims that this phenomenon is benefiting LEDCs when inequality within these states only grows are misinformed.

Conclusion

Medical tourism may have the potential to benefit global health inequality, but the current over-investment into this sector is exacerbating the already compromised health of those worst-off, creating a dichotomy within the provision of healthcare. To view health as a commercialised product rather than a human right is to ignore the importance of access to healthcare for basic wellbeing and growth. Until this inequality is addressed, and a basic level of care is provided to all within and across states, it is both misguided and unethical to invest in a global industry that favours luxury over human rights.

Ella Barclay is a PhD student in Sociology at the University of the West of England. Her research focuses on the sexual and reproductive rights of undocumented migrants within the UK’s hostile environment and involves ethnographic research with migrant mothers in Bristol. Ella completed the MSc in Migration and Mobility Studies at the University of Bristol in 2020 and is an MMB Alumni Ambassador.

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