Abstract
BackgroundGlobalisation has prompted countries to evaluate their position on trade in health services. However, this is often done from a multi-lateral, rather than a regional or bi-lateral perspective. In a previous review, we concluded that most of the issues raised could be better addressed from a bi-lateral relationship. We report here the results of a qualitative exercise to assess stakeholders' perceptions on the prospects for such a bi-lateral system, and its ability to address concerns associated with medical tourism.Methods30 semi-structured interviews were carried out with stakeholders, 20 in India and 10 in the UK, to assess their views on the potential offered by a bi-lateral relationship on medical tourism between both countries. Issues discussed include data availability, origin of medical tourists, quality and continuity of care, regulation and litigation, barriers to medical tourism, policy changes needed, and prospects for such a bi-lateral relationship.ResultsThe majority of stakeholders were concerned about the quality of health services patients would receive abroad, regulation and litigation procedures, lack of continuity of care, and the effect of such trade on the healthcare available to the local population in India. However, when considering trade from a bi-lateral point of view, there was disagreement on how these issues would apply. There was further disagreement on the importance of the Diaspora and the validity of the UK's 'rule' that patients should not fly more than three hours to obtain care. Although the opinion on the prospects for an India-UK bi-lateral relationship was varied, there was no consensus on what policy changes would be needed for such a relationship to take place.ConclusionsWhilst the literature review previously carried out suggested that a bi-lateral relationship would be best-placed to address the concerns regarding medical tourism, there was scepticism from the analysis provided in this paper based on the over-riding feeling that the political 'cost' involved was likely to be the major impediment. This makes the need for better evidence even more acute, as much of the current policy process could well be based on entrenched ideological positions, rather than secure evidence of impact.
Highlights
Globalisation has prompted countries to evaluate their position on trade in health services
A total of 30 semi-structured interviews were carried out, 20 in India and 10 in the UK. These two countries were chosen because: (i) the UK has some experience with cross-border mobility of patients within the European Union; (ii) India has already made some inroads as an exporter of health services, for instance in the provision of telemedicine services, and is one of the biggest players in medical tourism; and (iii) the two countries have historical ties, a common language, commonalities in the educational system, and there is a large Indian Diaspora population living in the UK, which would facilitate this type of trade
The balance in the number of interviews between the two countries reflects the wider range of stakeholders in India, as a destination for medical tourism, given the variety of the different providers of health services, and the different levels of government and private sector that would be involved in such a decision
Summary
Globalisation has prompted countries to evaluate their position on trade in health services. Medical tourism can be defined as the movement of patients across an international border for the purposes of obtaining healthcare This is usually motivated by long waiting times, high costs of medical care or unavailability of care in the patients’ home country [6,7]. This definition includes both patients paying out of pocket and the potential scenarios where governments or insurance companies pre-arrange foreign healthcare treatment for patients. Currently the vast majority of medical tourism occurs from patients arranging and paying for the medical services abroad themselves, arguably the biggest potential for this market lies within governments or insurance companies pre-arranging foreign care for patients. This, occurs under general regional or global agreements, which are by definition multi-lateral
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