Abstract
BackgroundMedical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The commodification and export of private health services is often promoted due to perceived economic benefits. Research indicates growing concern for health inequities caused by medical tourism, which includes its impact on health human resources, yet little research addresses the impacts of medical tourism on health human resources in destination countries and the subsequent impacts for health equity. To address this gap, we use a case study approach to identify anticipated impacts of medical tourism sector development on health human resources and the implications for health equity in Guatemala.MethodsAfter undertaking an extensive review of media and policy discussions in Guatemala’s medical tourism sector and site visits observing first-hand the complex dynamics of this sector, in-depth key informant interviews were conducted with 50 purposefully selected medical tourism stakeholders in representing five key sectors: public health care, private health care, health human resources, civil society, and government. Participants were identified using multiple recruitment methods. Interviews were transcribed in English. Transcripts were reviewed to identify emerging themes and were coded accordingly. The coding scheme was tested for integrity and thematic analysis ensued. Data were analysed thematically.ResultsFindings revealed five areas of concern that relate to Guatemala’s nascent medical tourism sector development and its anticipated impacts on health human resources: the impetus to meet international training and practice standards; opportunities and demand for English language training and competency among health workers; health worker migration from public to private sector; job creation and labour market augmentation as a result of medical tourism; and the demand for specialist care. These thematic areas present opportunities and challenges for health workers and the health care system.ConclusionFrom a health equity perspective, the results question the responsibility of Guatemala’s medical education system for supporting an enhanced medical tourism sector, particularly with an increasing focus on the demand for private clinics, specific specialities, English-language training, and international standards. Further, significant health inequalities and barriers to care for Indigenous populations are unlikely to benefit from the impacts identified from participants, as is true for rural-urban and public-private health human resource migration.
Highlights
Medical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries
These issues include stakeholder perceptions of the impetus, or push, to meet international standards and accreditations in health care training and practice; opportunities and demand for English language training for health workers; the migration or movement of health workers from the public to private sectors and within the private sector; the creation of new jobs and augmentation of labour market competition as a result of medical tourism; and the demand for more specialist care. Participants indicated that these anticipated impacts, or areas of concern, included both opportunities and challenges for the health professions as well as for Guatemala’s health system, which we explore in greater detail with regard to implications for health equity in the discussion section
Nowadays ... teachers, facilities... everything’s being evaluated” for competency against various standards. The push towards this accreditation of hospitals and clinics to gain or expand entry into the medical tourism sector, had participants raising questions about the impact that seeking accreditation might have on the day-to-day functioning of these facilities and their health workers
Summary
Medical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The intentional nature of this practice differentiates medical tourism from the care that is provided to ill and injured vacationers, while the private nature of this arrangement differentiates medical tourism from cross-border care for international patients that is coordinated and paid for by governments or their agencies [2]. In other words, this practice takes place outside established cross-border care agreements between countries. Varied procedures are offered across the hospitals and clinics seeking to attract medical tourists, including cardiac, orthopaedic, cosmetic, and dental surgeries [13, 14]
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