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Leigh Turner IJHS 2010

Leigh Turner IJHS 2010

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Published by: LeighTurner on Feb 14, 2012
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Globalization and Medical Care
Leigh Turner 
Health services are now advertised in a global marketplace. Hip andknee replacements, ophthalmologic procedures, cosmetic surgery, cardiaccare, organ transplants, and stem cell injections are all available for purchasein the global health services marketplace. “Medical tourismcompaniesmarket “sun and surgerypackages and arrange care at internationalhospitals in Costa Rica, India, Mexico, Singapore, Thailand, and othedestination nations. Just as automobile manufacturing and textile productionmoved outside the United States, American patients are “offshoring” them-selves to facilities that use low labor costs to gain competitive advantagein the marketplace. Proponents of medical tourism argue that a globalmarket in health services will promote consumer choice, foster competi-tion among hospitals, and enable customers to purchase high-quality careat medical facilities around the world. Skeptics raise concerns aboutquality of care and patient safety, information disclosure to patients, legalredress when patients are harmed while receiving care at internationalhospitals, and harms to public health care systems in destination nations.The emergence of a global market in health services will have profoundconsequences for health insurance, delivery of health services, patient- physician relationships, publicly funded health care, and the spread of medical consumerism.
Medical brokerages and international hospitals marketing “medical tourism” packages first attracted customers by selling inexpensive face lifts, tummy
International Journal of Health Services, Volume 40, Number 3, Pages 443–467, 2010© 2010, Baywood Publishing Co., Inc.doi: 10.2190/HS.40.3.dhttp://baywood.com
tucks, breast implants, liposuction, and other forms of cosmetic surgery. Theytargeted price-conscious customers wanting procedures not covered under  private health insurance or publicly funded health plans. Purchasers couldlower their “out-of-pocket” costs by comparison shopping and finding low-costmedical procedures. Some companies promoted “discountsurgery or “firstworld health care at third world prices.” Typical advertising pitches featured“surf and surgery” holidays in Thailand and “surgeon and safaritrips toSouth Africa. Health care was packaged together with more commonplacetourist attractions. Marketing executives proclaimed that their goal was to “putthe ‘hospital’ back in ‘hospitality.’” Though brokerages and destination hospitalsstill advertise cosmetic surgery “bargains,” they now sell a wide array of servicesto a much broader clientele. “Medical tourism” is promoted as a solution to thehigh price of medical care in the United States, as well as treatment delays incountries with publicly funded health care. In Canada, the United Kingdom,and other countries with publicly funded health care programs, medical brokerages attract customers tired of waiting for hip and knee replacements,cataract surgery, and other procedures. In Canada, for example, such businessesas Speedy Surgery and Timely Medical Alternatives solicit clients able toafford purchase of expedited care. The United States provides a differentand potentially much broader customer base for medical brokerages andinternational hospitals. It offers a large population of individuals lackinghealth insurance, with limited economic resources, and needing access totreatment for medically necessary care rather than cosmetic procedures. Therapid proliferation of medical tourism companies in the United States is pre-sumably connected to the number of Americans unable to obtain health insuranceor affordable access to local health care facilities. Even medical tourism com- panies based in Canada attempt to tap into the large market of uninsured andunderinsured Americans seeking access to health care at medical facilitiesoutside the United States.Marketing campaigns promoting “medical tourism” try to link health careto adventure, relaxation, and holiday fun (1–3). The reality of internationalhealth-related travel is often quite different from the images of enticing beaches, romantic settings, and exotic resorts posted on many medicaltourism company websites. In the United States, popularization of “medicaltourism” is related to social inequalities, loss of employer-provided healthinsurance, rising premiums for health insurance, limited public fundingof health care, and lack of access to affordable health care. Many factorscontribute to the high cost of care in the United States, but the low salariesof local health care workers make facilities in such countries as Indiaand Thailand far less expensive than hospitals in the United States.“Medical tourism” reveals the shape that medicine takes when it is com-modified, subjected to international competition, and subsumed within a globalmarket economy.444 / Turne
UNINSURED IN AMERICAIn 2006, 47 million individuals in the United States lacked health insurance (4).In low-wage sectors of the U.S. workforce, more than 75 percent of employeesdecline health insurance (5). They cannot afford health insurance premiums;their earnings go to cover the cost of immediate needs such as food and shelter.As employers reduce benefits and cut health plans, increasing numbers of middle-class Americans are losing employer-provided health insurance. Tatteredsocial safety nets leave many Americans without access to publicly fundedcare. Forced to use personal savings, tap lines of credit, or go into debt to cover the cost of medical care, growing numbers of Americans are entering the globalmarketplace and trying to find care they can afford.The high cost of health care in the United States drives many low-incomeand middle-class Americans with serious health problems into bankruptcy (6).Short of outright bankruptcy, medical debt is a risk factor for being unableto gain access to treatment (7). As medical bills accumulate, sick individualslose access to health care providers and health care facilities. Some caregiversrefuse to provide treatment until patients pay their bills and clear their debts.In other instances, whether out of embarrassment, a sense of stigmatization,fear of legal action or attracting the attention of debt collectors, or other factors,many patients avoid seeking medically necessary care because of their unpaidmedical bills.Denial of coverage on the basis of preexisting conditions means that indi-viduals who can afford to purchase health insurance are often unable to gainaccess to coverage for the medical interventions they are most likely to need.Inclusion of coverage for these procedures can generate premiums exceeding$2,500 per month. High deductibles and co-payments mean that even individualswith insurance sometimes cannot afford the medical care they require. Whether or not they have health insurance, low-income and middle-class Americans withlimited finances are often unable to afford the cost of care at local institutions.SomeAmericanslivinginborder statestraveltofacilitiesinMexicoorCanadafor medical care. Other citizens fly to India, Thailand, the Philippines, or elsewherefor comparatively inexpensive health care.OUTSOURCING EMPLOYMENTThe emergence of international supply chains, the Internet, global telecommuni-cations, global transportation networks, and interconnected economies has both pushed and pulled jobs toward regions where workers are paid low wages andhave few benefits (8). Capital flows across borders to regions where goodsand services are produced for the lowest possible costs and sold for maximum profits. In the United States, this process first affected workers in manufacturingindustries. It then spread through many other sectors of the U.S. economy.The United States once had a huge textile production industry. Most of thoseMedical Tourism and Global Marketplace in Health Services / 445

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