Abstract
BackgroundIn resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems.MethodsWe used primary data from 344 subsidized and 471 non-subsidized inbound medical travellers during June to December 2013 drawn from the North, Centre and South regions of the Maldives where three international airports are located. Using a researcher-administered questionnaire to acquire data, we calculated annual out-of-pocket (OOP) spending on health, food and non-food items among households where at least one member had travelled to another country for medical care within the last year and estimated the poverty head count using household income as a living standard measure.ResultsMost of the socio demographic indicators, and costs of treatment abroad among Maldivian medical travellers were similar across different household income levels with no statistical difference between subsidized and non-subsidized travellers (p value: 0.499). The government subsidy across income quintiles was also similar indicating that the Maldivian health financing structure supports equality rather than being equity-sensitive. There was no statistical difference in OOP expenditure on medical care abroad and annual OOP expenditure on healthcare was similar across income quintiles. Diseases of the circulatory system, eye and musculoskeletal system had the most impoverishing effect – diseases for which half of the patients, or less, did not receive the public subsidy. Annually, 6 and 14% of the medical travellers in the Maldives fell into poverty ($2 per day) before and after making OOP payments to health care.ConclusionEvidence of a strong association between predominant public financing of medical travel and equality was found. With universal eligibility to the government subsidy for medical travel, utilization of treatment abroad, medical expenditures abroad and OOP expenditures on health among Maldivian medical travellers were similar between the poor and the rich. However, we conclude mixed evidence on the linkages between public financing of medical travel and impoverishment which needs to be further explored with comparison of impoverishment levels between households with and without medical travel.
Highlights
In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services
The World Health Organization (WHO) estimates that a hundred million people are pushed into poverty as a result of payments to health care and a billion people suffer each year because they cannot access the health care they need [1]
Medical travelers fall out of both of these protection measures as most medical tourism services are provided by private health facilities and financial protection is limited for services sought out of the local health system or the public health system
Summary
In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems. Medical travel can help people acquire health services inaccessible in the domestic health system because of long waiting times, legal restrictions, cost of care or because of unavailability of the service. OOP spending is widely believed to be a poor way to finance health care as it falls disproportionately on the most vulnerable, when they often need the service the most [6]. Empirical evidence on the payments to healthcare and its impact on this group of people who seek health care across borders are lacking
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