Importing competition - 經濟

Doris avatar
By Doris
at 2008-08-19T19:33

Table of Contents

Importing competition
Aug 14th 2008
From The Economist print edition
http://www.economist.com/opinion/displaystory.cfm?story_id=11920756

The coming boom in medical travel could help both rich and poor

Health care has long seemed one of the most local of all industries. Yet
beneath the bandages, globalisation is thriving. The outsourcing of record
keeping and the reading of X-rays is already a multi-billion-dollar business.
The recruitment of doctors and nurses from the developing world by rich
countries is also common, if controversial. The next growth area for the
industry is the flow of patients in the other direction ﹣known as "medical
tourism" ﹣which is on the threshold of a dramatic boom.

Tens of millions of middle-class Americans are uninsured or underinsured and
soaring health costs are pushing them and cost-conscious employers and
insurers to look abroad for savings. At the same time the best hospitals in
Asia and Latin America now rival or surpass many hospitals in the rich world
for safety and quality. On one estimate, Americans can save 85% by shopping
around and the number who will travel for care is due to rocket from under
1m last year to 10m by 2012 ﹣by which time it will deprive American hospitals
of some $160 billion of annual business.

Brain drain or net gain?

The coming boom has its critics. Some worry that a flood of foreigners into
developing countries will divert money and expertise from state health
systems that are already overwhelmed ﹣an internal brain drain that will worsen
care for ordinary people. Others decry it as a distraction from the need to
cut costs and improve quality in rich-world health systems.

But the private sector cannot be blamed for the failings of state-run health
bureaucracies in developing countries, which neglected the poor long before
medical tourists arrived. And the foreigners픠arrival could improve things in
developing countries, for the poor as well as the rich. Although the
hospitals that cater to medical tourists will of course employ local staff,
they will also create jobs, tempt home emigre doctors and nurses, encourage
locals to train as medics, spread know-how and treat local people.

The flight of America's "medical refugees" is indeed a symptom of a troubled
health system back home. Yet medical tourism need not be a distraction from
necessary reforms, but could be a catalyst to them. The prospect of losing
revenues to India or Thailand is already shocking hospital administrators and
insurers into raising standards, increasing price transparency and lowering
costs. It may even bring the growing political pressure for reform to a head.

If medical tourism is to live up to this promise, several barriers must
first be swept away. In parts of America arcane restrictions still forbid
out-of-state doctors from consulting with patients on the internet or by
phone, which inhibits follow-up care for medical tourists. Legal and
insurance barriers make it hard for employers to give employees a financial
incentive to choose medical tourism over local options ﹣ even though insurers
are allowed to offer such incentives to prompt patients to pick cheaper
doctors inside America.

In developing countries, the system for training doctors and nurses is often
monolithic and state-financed. That makes it hard for the private-sector
medical business to grow without depleting state coffers. A sensible model is
the one employed in the Philippines, which allows nurses to work in the
private sector or abroad if they repay their student loans. And part of the
financial windfall which sick foreigners could bring to poor countries that
welcome them should be spent on medical care for the poorest. If governments
make the best of the boom, then medical tourism should improve the health of
rich and poor alike.


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