Medical Tourism's Impact on Health Care Equity and Access in Low- and Middle-Income Countries: Making the Case for Regulation

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See Hopkins , supra note 8, at 193.

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See Turner , supra note 11, at 311; Johnston , supra note 10, at 8.

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See Cortez , supra note 2, at 89.

See Connell , supra note 1, at 43.

See Cortez , supra note 2, at 93.

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See Leahy , supra note 9, at 260; Patra Kumar P. and Sleeboom-Faulkner M. , “Bionetworking: Experimental Stem Cell Therapy and Patient Recruitment in India,” Anthropology & Medicine 16, no. 2 (2009): 147–163, at 160.

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See de Arellano Ramírez , supra note 8, at 196.

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See Bookman and Bookman , supra note 7, at 7.

By pointing out the nexus between medical tourism and the private health care sector in most destination countries, we do not imply that medical tourism cannot occur within a public health care regime, nor do we wish to suggest that medical tourism does not pose a threat to health care human resources when led by the public sector. Arguably, it is possible for internal brain drain to take place in the public health care context when, for example, physicians reallocate treatment times originally designated for domestic patients to foreign patients.

Saniotis A. , “Medical Bioethics and Medical Tourism in Thailand,” Eubios Journal of Asian and International Bioethics 18, no. 5 (2008): 150–151, at 150.

See Connell , supra note 1, at 70.

See Turner , supra note 11, at 312–313.

See Leng , supra note 6, at 342.

There is evidence that the coalescence of the private health sector and the medical tourism industry occurs in Southeast Asia as well as in countries such as India and Tunisia. See Pocock N. and Phua K. H. , “Medical Tourism and Policy Implications for Health Systems: A Conceptual Framework from a Comparative Study of Thailand, Singapore and Malaysia,” Globalization and Health 7, no. 12 (2011): 1–12, at 6; see Gupta Sen , supra note 12; Lautier , supra note 14.

Connell J. , “A New Inequality? Privatisation, Urban Bias, Migration and Medical Tourism,” Asia Pacific Viewpoint 52, no. 3 (2011): 260–271, at 263; Id. (Pocock and Phua), at 8.

Wibulpolprasert S. and Pachanee C.A. , “Addressing the Internal Brain Drain of Medical Doctors in Thailand: The Story and Lesson Learned,” Global Social Policy 8, no. 1 (2008): 12–15, at 12; other sources estimate the salary of doctors in private clinics to be about 8–10 times greater than that of doctors in state hospitals, as seen in Chambers A. , “Thai Embrace of Medical Tourism Divides Professionals,” The Guardian (London), April 26, 2011, available at <http://www.guardian.co.uk/global-development/poverty-matters/2011/apr/26/thailand-medical-tourism-divides-professionals> (last visited January 30, 2013).

See Leng and Whittaker , supra note 26, at 288.

Wibulpolprasert S. and Pengpaibon P. , “Integrated Strategies to Tackle the Inequitable Distribution of Doctors in Thailand: Four Decades of Experience,” Human Resources for Health 1, no. 12, (2003): 1–17, at 5; Rasiah , supra note 32, at 60; Tattara , supra note 25, at 10.

Id. (Wibulpolprasert and Pengpaibon), at 6. Admittedly, not all physicians who exited the public health care system ended up entering into the private system; some of them, for example, simply went into retirement or left for opportunities in other countries.

See Chambers , supra note 41.

See Wibulpolprasert and Pachanee , supra note 41, at 12.

See Kanchanachitra , supra note 4, at 775.

See Leng , supra note 6, at 348.

“NHC Joins Opposition to Medical Hub Plan,” Bangkok Post, November 4, 2010, available at <www.Factiva.com,DocumentNo.BKPOST0020101104e6b40000d> (last visited February 19, 2013).

See Hopkins , supra note 8, at 194.

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Hamilton J. , “Medical Tourism Creates Thai Doctor Shortage,” National Public Radio, November 29, 2007, available at <http://www.npr.org/templates/story/story.php?storyId=16735157> (last visited January 30, 2013); NaRanong and NaRanong , supra note 19, at 338.

See Wibulpolprasert and Pachanee , supra note 41, at 12; Kanchanachitra , supra note 4, at 775.

See Connell , supra note 40, at 264.

Even D. and Zinshtein M. , “Haaretz Probe: Israel Gives Medical Tourists Perks Denied to Citizens,” Haaretz (Israel), November 18, 2010, available at <http://www.haaretz.com/print-edition/news/haaretz-probe-israel-gives-medical-tourists-perks-denied-to-citizens-1.325275> (last visited January 30, 2013). For a discussion of “private health service” programs that had similarly allowed Israeli patients to choose their surgeons for additional fees but were found illegal by the Israeli High Court of Justice in 2009, see in this issue Gross A. , “Is There a Human Right to Private Health Care?”.

See NaRanong and NaRanong , supra note 19, at 340.

See Kanchanachitra , supra note 4, at 775; “NHC Joins Opposition to Medical Hub Plan,” supra note 49.

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See NaRanong and NaRanong , supra note 19, at 341.

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See NaRanong and NaRanong , supra note 19, at 341.

Id.; Patra and Sleeboom-Faulkner , supra note 27, at 160.

See Leng , supra note 6, at 349.

See Johnston , supra note 10, at 7.

Report of the Expert Meeting on Universal Access to Services, TD/B/COM.1/EM.30/3 (Geneva: United Nations Conference on Trade and Development, 2006), at 13, available at <http://www.unctad.org/en/Docs/c1em30d3_en.pdf> (last visited January 30, 2013).

See Leng and Whittaker , supra note 26, at 288.

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See Pocock and Phua , supra note 39, at 8; Pachanee C. A. and Wibulpolprasert S. , “Incoherent Policies on Universal Coverage of Health Insurance and Promotion of International Trade in Health Services in Thailand,” Health Policy and Planning 21, no. 4 (2006): 310–318, at 316.

Id. (Pocock and Phua).

Labonté R. , The Brain Drain of Health Professionals From Sub-Saharan Africa to Canada, African Migration and Development Series No. 2 (Cape Town: Idasa Publishing, 2006): at 43–44.

See Kanchanachitra , supra note 4, at 775.

Linder-Ganz R. and Even D. , “Panel Recommends Using Money from Medical Tourism to Fund Israelis' Healthcare,” Haaretz (Israel), May 29, 2011, available at <http://www.haaretz.com/print-edition/news/panel-recommends-using-money-from-medical-tourism-to-fund-israelis-healthcare-1.364638> (last visited January 30, 2013).

See Even and Zinshtein , supra note 57.

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See Pachanee and Wibulpolprasert , supra note 73, at 315.

See Wibulpolprasert and Pengpaibon , supra note 43, at 10.

Stoddart G. and Barer M. , “Will Increasing Medical School Enrolment Solve Canada's Physician Supply Problems?” Canadian Medical Association Journal 161, no. 8 (1999): 983–984; Frenk J. , “Patterns of Medical Employment: A Survey of Imbalances in Urban Mexico,” American Journal of Public Health 81, no. 1 (1991): 23–29; Kamalakanthan A. and Jackson S. , “The Supply of Doctors in Australia: Is There a Shortage?” University of Queensland, School of Economics, Discussion Paper No. 341 (2006): 1–36, at 18.

See Cohen , supra note 15, at 11–12; Pang T. Lansang M. A. , and Haines A. Editorial , “Brain Drain and Health Professionals,” BMJ 324, no. 7336 (2002): 499–500, at 500.

See Wibulpolprasert and Pengpaibon , supra note 43, at 3.

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See Connell , supra note 1, at 54.

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See Herrick , supra note 8, at 23.

Tata S. , Medical Travel in Asia and the Pacific: Challenges and Opportunities (Bangkok: UN Economic and Social Commission for Asia and the Pacific, 2009): at 24, available at <http://www.unescap.org/ESID/hds/lastestadd/MedicalTourismReport09.pdf> (last visited January 30, 2013).

See Cortez , supra note 2, at 110. However, the number of expatriate doctors who have returned to work in the Apollo hospital group was said to be 123 according to Hopkins et al., supra note 8, at 191.

Madden C. , “Medical Tourism Causes Complications,” Asia Times (Hong Kong), November 7, 2008, available at <http://www.atimes.com/atimes/Asian_Economy/JK07Dk01.html> (last visited January 30, 2013).

See Figures derived from data provided in Kanchanachitra et al., supra note 4, at 771 (Table 2).

See Hazarika , supra note 5, at 249.

See Hopkins , supra note 8, at 192.

Saniotis A. , “Changing Ethics in Medical Practice: A Thai Perspective,” Indian Journal of Medical Ethics 4, no. 1 (2007): 24–25, at 25; Chinai R. and Goswami R. , News Article, “Medical Visas Mark Growth of Indian Medical Tourism,” Bulletin of the World Health Organization 85, no. 3 (2007): 164–165, at 165.

See Chinai and Goswami , id.

See Tata , supra note 89, at 24.

See Connell , supra note 1, at 152–153.

See Connell , supra note 40, at 267.

All India Lawyers Union (Delhi Unit) v. Government of N.C.T. of Delhi & Others , (2009) WP(C) No. 5410/1997 (Delhi H.C.), at para. 20, available at <http://www.indiankanoon.org/doc/1508125/> (last visited January 30, 2013).

Id., at para. 30.

See Tattara , supra note 25, at 10.

Shetty P. , “Medical Tourism Booms in India, but at What Cost?” The Lancet 376, no. 9742 (2010): 671–672, at 672.

Thomas G. and Krishnan S. , Editorial, “Effective Public-Private Partnership in Health Care: Apollo as a Cautionary Tale,” Indian Journal of Medical Ethics 7, no. 1 (2010): 2–4, at 3; see Connell , supra note 40, at 266.

See Id. ( Thomas and Krishnan ), at 2.

See Blouin , supra note 79, at 294; see also Alsharif M. Labonté R. , and Lu Z. , “Patients Beyond Borders: A Study of Medical Tourists in Four Countries,” Global Social Policy 10, no. 3 (2010): 315–335, at 327–329. It is noteworthy that New Zealand did consider the possibility of imposing a medical tourism tax in 2009, as reported in Armstrong G. , “‘Medical Tourism’ Levy Under Scrutiny in New Zealand,” eTurboNews.com , October 25, 2009, available at <http://www.eturbonews.com/12431/medical-tourism-levy-under-scrutiny-new-zealand> (last visited January 30, 2013). However, even in this example, the tax revenues would be earmarked to cover the potential costs of treating foreign patients who suffer from medical injuries while seeking care in New Zealand rather than to expand health care access for domestic patients.

See Whittaker , supra note 51, at 110.

See Johnston , supra note 10, at 5; Government of India, Ministry of Tourism, Press Release, Medical Tourism Included Under the Marketing Development Assistance (MDA) Scheme (November 15, 2010), available at <http://www.pib.nic.in/newsite/erelease.aspx?relid=67035> (last visited January 30, 2013).

See Gupta Sen , supra note 12, at 5.

See Leng , supra note 53, at 13.

See Alsharif , supra note 106, at 329.

See Connell , supra note 40, at 266.

See Hopkins , supra note 8, at 191; id., at 267.

Arndt H. , “The ‘Trickle-Down’ Myth,” Economic Development and Cultural Change 32, no. 1 (1983): 1–10, at 3–4.

See NaRanong and NaRanong , supra note 19, at 338.

See Pocock and Phua , supra note 39, at 2.

Scheyvens R. , “Exploring the Tourism-Poverty Nexus,” Current Issues in Tourism 10, nos. 2–3 (2007): 231–254, at 239; see also Akama J. , “The Efficacy of Tourism as a Tool for Economic Development in Kenya,” DPMN Bulletin 7, no. 1 (2000), available at <http://www.dpmf.org/images/tourism-economic-devt-john.html> (last visited January 30, 2013) (it is suggested that as much as two-thirds of tourism profits in Kenya are leaked to foreign businesses).

See for example, Meghani Z. , “A Robust, Particularist Ethical Assessment of Medical Tourism,” Developing World Bioethics 11, no. 1 (2011): 16–29, at 28.

See Pocock and Phua , supra note 39, at 6.

Basu S. and Mallick S. , “When Does Growth Trickle Down to the Poor? The Indian Case,” Cambridge Journal of Economics 32, no. 3 (2008): 461–477, at 469.

Thornton J. Agnello R. , and Link C. , “Poverty and Economic Growth: Trickle Down Peters Out,” Economic Inquiry 16, no. 3 (1978): 385–394; Formby J. Hoover G. , and Kim H. , “Economic Growth and Poverty in the United States: Comparisons of Estimates Based upon Official Poverty Statistics and Sen's Index of Poverty,” University of Alabama Economics, Finance and Legal Studies Working Paper Series, No. 00-11-01 (2000), available at <http://ssrn.com/abstract=249068> (last visited January 30, 2013); Schilcher D. , “Growth Versus Equity: The Continuum of Pro-Poor Tourism and Neoliberal Governance,” Current Issues in Tourism 10, nos. 2–3 (2007): 166–193.

See Alsharif , supra note 106, at 330–331.

See Blouin , supra note 79, at 294; Cortez , supra note 2, at 342.

See Johnston , supra note 10, at 10.