Medical tourism versus human rights

Surgery isn’t a commonly listed cruise ship activity. However, hospital cruise ships – staffed with Indian healthcare professionals picking up intended ‘consumers’ and taking them into international waters in order to get past national regulations – is just one phenomenon to evolve from the complex and diverse growth of medical tourism.

Medical tourism refers to cross-border travel of individuals who are seeking biomedical and other health-related services, but according to Kristen Smith – a third-year PhD student in Social Health at the University of Melbourne who recently carried out fieldwork in Mumbai on the effects of this industry on the local community – medical tourism also refers to an evolving and complex industry encompassing strange practices and equally disturbing bioethical issues; and an industry which is having a major impact on the delivery of health services around the world.

During her fieldwork in Mumbai, Ms Smith found that outside the potential economic benefits of medical tourism, there was very little discussion about the impact of this evolving industry on the city.

“There are three key arguments that tend to say medical tourism is great for health systems, and they hinge on the idea that attracting foreign exchange into the country will increase export earnings, lower fiscal deficits, raise the standard of healthcare through competition, and increase the national income which will in turn allow greater equity as the population would be better able to afford private healthcare,” Ms Smith says.

“Sadly all of these arguments seem to be little more than economic rationalisations that are sorely out of line with the reality of the current situation, specifically in terms of the way medical tourism is highly likely to drive up costs of healthcare for the citizens of India both directly and indirectly.

“In countries such as India, the medical tourism industry is being developed as technologically advanced, and as one offering highly specialised health services. This acts to distort the healthcare priorities of a country still grappling with health issues such as high infant and maternal mortality, tuberculosis and malaria.”

Ms Smith also predicts that the cost of medical services for Mumbai residents will increase as a result of a predicted influx of medical tourists.

“The main issue at the moment is the current push by private hospitals in the region to gain national and international accreditations,” she says.

“These accreditations allow the hospitals to become competitive in a global market and attract international patients.

“In turn, this has driven up the prices of their services for patients, as many of the hospitals have to outlay large amounts of money to upgrade their facilities. Sadly, many of the people who had relied on the low-cost services provided by these hospitals can no longer afford the care offered, which forces them to rely on the overcrowded, low-quality services offered in the struggling, under-resourced public hospitals.”

Even another publicised benefit of medical tourism in India, that standards of private tertiary healthcare offered in the country will be raised across the board comes with a price, according to Ms Smith.

“As already mentioned, medical tourism will serve to drive up the costs for patients in the city, as price-setting in the Indian health system has been shown to occur within the private sector. It will also exacerbate the ‘brain-drain’ of high-quality healthcare specialists from the public system to the private system and away from rural areas to the cities and continue to place upward pressures on the commercialisation of healthcare in the country,” she says

However, a rich patient in Mumbai can access specific, high-quality care regardless of their nationality and be treated in a room with a flat screen television, sea views, access to gyms, swimming pools and a selection of a post-surgery recuperative five-star beach-side retreats, while the overwhelming majority of Mumbai’s 21 million people simply cannot afford a basic level of care. According to Ms Smith, this undersores an emerging global shift towards the privatisation and commercialisation of healthcare, which in turn has served to devalue the idea of health as a social or human right.

“The promotion of medical tourism also advances the view that medicine and healthcare can be treated in the same way as other goods and services traded on the open market. The unabashed use of the term ‘health consumer’ being merely one indication of this understanding, where health can be understood as a ‘thing’ to be consumed.

“Much of the privatisation of health systems in developing countries has been forced by the World Bank and the IMF through conditional lending arrangements. Sadly, international experience over the past century has shown that when healthcare services are commodified in this manner, the direct consequence is the creation of cycles of inequality within populations.”