IMTJ
Academic Conference on International Medical Travel
and Cross-Border Healthcare
Programme
(subject to alterations)
Wednesday,
25 May 2016
Welcome
- Meghann
Ormond and Neil Lunt, co-organisers
Session 1: Cross-sectoral governance of
medical mobilities
-
Andrea Whittaker – ‘Medical travel and its discontents: Home country
reactions to the departure of medical travellers for care overseas’
-
Arturo Vargas Bustamante – ‘Developing the medical travel industry in Latin
America: Comparing different public/private organizational arrangements in
Costa Rica, Cuba and Mexico’
-
Sabina Stan – ‘Transnational patient mobility and healthcare mobilities and
governance processes in Europe: towards a rising European healthcare system?’
- Zsofia Papp – ‘Patient or traveller? Lessons
learned from health tourism development’
Session 2: Social and economic impacts in
destinations
- Meghann
Ormond – ‘What are medical tourism’s effects on its destinations? A
healthcare and socio-economic impact assessment at the sub-national level for Penang,
Malaysia’
- Michael
Guiry – ‘The Economic Impact of Medical Tourism on Countries’ Travel and
Tourism Sector: An Exploratory Investigation’
- Beth
Kangas – ‘Building a Destination around a World-Class Medical Center:
Rochester, Minnesota, the Mayo Clinic, and the Destination Medical Center’
- Juan Bosco Gimeno – ‘Impact of tourism on Spain’s private
healthcare sector’
- Sunita Reddy – ‘Corporatization of Health Care: Medical Tourism and
Medical Markets in India’
Session 3: Health equity impacts in
receiving countries
- Johanna
Hanefeld – ‘How medical travel affects health systems - evidence
from mixed methods research in South Africa’
- Valorie Crooks – ‘Do people in patient's home countries care about
the health equity impacts of medical tourism abroad? An examination of Canadian
stakeholder perspectives’
- Alejandra Giraldo – ‘Health tourism in Spanish public health centres’
- Valorie Crooks – ‘Medical tourism development in Guatemala: An
empirical examination of health human resource impacts’
Thursday, 26
May 2016
Session 4: Cross-border care arrangements
- Maria Teresa Martinez Almanza – ‘Border
medical tourism: The case of Ciudad Juarez, Mexico’
- Tomas Mainil – ‘Putting the EU Cross
Border Health Care Directive into practice: A UK perspective with EU policy
implications’
- Betty Rouland – ‘Emergence of a
transnational care network: Private services and Libyan migrants in Sfax,
Tunisia’
- Ricardo
Pagan – ‘Health tourism trends in the United Kingdom: Are they net
exporters of health services?’
Session 5: Intermediaries
- Jacqueline
Sanchez Taylor – ‘Contested tourism: Parallels between sex tourism and
cosmetic surgery tourism’
- Lila
Skountridaki – ‘Issues of Trust between Medical Tourism Facilitators and
Medical Doctors engaging in the Transnational Healthcare Market’
Session 6: National strategies
- Neil Lunt –
‘Medical travel: what we know
and why we don’t’
-
Jin Ki Nam – ‘Globalization of healthcare in Korea: Policy and political issues’
- Leyla Bayan – ‘Key factors
in selecting Tehran as a medical tourism destination’
- Maria
Kuklina – ‘‘Prospects of development of medical
tourism and its informational systems in Russia: The case of the Baikal region’
- Daniel
Horsfall – ‘The end of medical tourism?’
Session 7: Overview of key themes in medical travel studies and agendas
for future research
- Neil
Lunt, Meghann Ormond, Andrea Whittaker, Valorie Crooks, David Bell and Ruth
Holliday, followed by a moderated discussion including all conference
participants
Abstracts
Session 1: Cross-sectoral governance of medical mobilities
Andrea Whittaker and Chee Heng Leng – ‘Medical travel and its
discontents: Home country reactions to the departure of medical travellers for
care overseas’
- Much of the scholarship on IMT addresses the
impacts and benefits of IMT on receiving countries. These have centered on
equity concerns. By contrast there have been few studies of the impact of
international medical travellers’ home countries and the local reactions to the
departure of citizens to pursue medical care overseas. In this paper we trace the various reactions
from consumers and governments in the US, Indonesia, Nigeria, Australia, United
Arab Emirates and the UK to the growth in travel of citizens overseas for
care. Concerns include the financial
losses to the local health system, inequity of access, safety concerns, the
incursion of costs to the public health system by returning patients and the
loss of public confidence in the local health care system. In some cases reactions to medical travel
reflect long-standing geopolitical rivalries and local politics as much as
medical issues. We trace the responses by various governments and the medical
travel industry to concerns from consumers and health officials, including
regulation, promotion of the local health system, investment and strengthening
in the local health system and co-option.
Arturo Vargas Bustamante – ‘Developing the medical travel industry
in Latin America: Comparing different public/private organizational arrangements
in Costa Rica, Cuba and Mexico’
- · This study uses a comparative political economy
approach to analyze the role of different government and private organizations
in the development of a rapidly evolving medical travel industry in Latin
America. The study first constructs a typology to characterize the emergence
and development of the medical travel industry in developing countries,
focusing on the role of government institutions and private organizations. This
framework considers two main dimensions to characterize coordination
arrangements, degree of centralization and privatization. This framework is
later tested with empirical evidence from three Latin American countries that
have experienced different public/private organizational arrangements in the
creation and promotion of their respective medial travel industries. The case
of Costa Rica illustrates the case of a centralized government strategy to
develop this industry in close coordination with private organizations. The
case of Cuba demonstrates the organizational arrangements of a primarily
centralized and centrally planned government strategy with very limited private
involvement. The case of Mexico displays a decentralized strategy with a
plurality of public/private organizational arrangements at the central, regional
and local level. In each case we identify the main factors that encouraged the
development of the medical travel industry and analyze the specific markets
that that each country has targeted. We conclude that two factors explain the
rapid development of a medical travel industry in this comparative study, the
higher degree of centralized authority given to a professional government
entity and the effective coordination between this entity and private
organizations.
Sabina Stan – ‘Transnational patient mobility and healthcare
mobilities and governance processes in Europe: Towards a rising European
healthcare system?’
- ·
The paper argues that the governance of
transnational patient mobility in Europe has to be approached from an
encompassing perspective that includes other types of healthcare mobilities and
of healthcare governance in the European Union. Starting from this perspective
the paper argues that, while healthcare services have traditionally been seen
as being relatively insulated from the process of European integration, we are
already witnessing their re-configuration in a rising European healthcare
system. The paper therefore uncovers the structuring lines of this system by
concentrating on three interrelated processes that contribute to linking
European healthcare systems into a larger EU-level one: 1) ‘horizontal’
healthcare governance through the diffusion of healthcare privatisation reforms
across the EU; 2) intra-European mobility of patients and healthcare workers;
3) ‘vertical’ healthcare governance through EU directives, ECJ rulings and
bilateral investment agreements. The paper argues that, while transnational
patient mobility provides, together with healthcare worker mobility, the human
glue to the rising European healthcare system, the process of healthcare
privatisation provides its dynamo. Indeed, as privatisation leads to segmented
labour markets and inequalities of access to services, it thus also fuels the
mobility of healthcare workers and patients. These mobilities in turn feed into
the use of and employment in private healthcare services. The resulting vicious
cycle of privatisation helps construct an increasingly uneven European
healthcare system, in terms of the distribution of access to services by
patients, of wages and working conditions of healthcare workers, as well as of
financial control and policymaking both among and inside EU countries.
Judit Sulyok and Zsofia Papp – ‘Patient or traveller? Lessons
learned from health tourism development’
- · Ageing population with good health conditions
and a keen for travelling with leisure purposes is an important segment for a
lot of destinations and facilities. In accordance with the European Union’s
goal – supporting healthy ageing and increasing mobility of seniors –, the
paper presents lessons learned from a health tourism product development funded
by the EU Cosme programme. From the European Union point of view, the supported
project linked to health (including medical and wellness) tourism are mainly initiated
by tourism stakeholders. Probably this is also a reason why these projects
(including Off to Spas) focus on tourism product development – with a lack of
sharing knowledge between different projects. The presentation therefore puts
an emphasis on interpreting the lessons learned from the project management and
product development process. The 15 month-long ‘Off to Spas’ project’s main
objective is to create a new health tourism product attractive for seniors
outside of the summer season. The paper is based on a comprehensive research
background, including secondary analysis, primary research of the potential
travellers, and the feedbacks of two study tours to the involved destinations.
The outcomes highlight important implications for medical tourism development.
On one hand, the project’s destinations have both strong emphasizes on medical
tourism services, on communication of the healing effects. This is not always
perceived the same by the potential travellers. The consumer survey among the
potential travellers pointed out that Swedish seniors consider themselves
healthy, open-minded with a lot of travel experience all over the world that
results an important challenge for the destinations with strong healing
attractions and services.
Sunita Reddy – ‘Corporatization of Health Care: Medical
Tourism and Medical Markets in India’
- · India is one of the preferred destinations for
the international patients, owing to the one-tenth cost, English speaking,
well-trained medical doctors and the state support. While the overall
perception about medical tourism is positive and useful for India’s economic
growth, a critical public health perspective on the growth of corporate health
care shows that there are many misplaced priorities, where medical markets get
the boost. India had a presence of private sector since Independence, but post
health sector reform, the growth and nature of private and corporate health
care changed drastically. Post nineties, health policies clearly promotes
growth of private and corporate sector, at the cost of State subsidies. Seeing health
care and medical tourism as a business proposition, the business houses have
invested in building corporate hospitals and hire reputed physicians. The
growth of corporate hospitals, have led to rise in cost, differential treatment
to its own patients over foreign patients and two-tier system. Those who can
pay get the ‘best’ services and those who cannot depend on the weakening and
overloaded public health institutions. The growth of these corporate sector is
again skewed in terms of locations and also in catering to only those services
which are in demand globally and do not cater to the epidemiological needs of
the country. The terms and conditions set forth by the State to serve some
percentage of the poor are often violated and there is no power to regulate.
Session 2: Social and economic impacts in destinations
Meghann Ormond and Lim Chee Han – ‘What are medical tourism’s
effects on its destinations? A healthcare and socio-economic impact assessment
at the sub-national level for Penang, Malaysia’
- · Medical tourism has begun to receive significant
attention from national governments around the world given its widely-touted
potential to drive economic and medical services development. The Malaysian
government, for example, has identified medical tourism as one of the country’s
most important economic growth sectors. Yet medical tourism is not evenly
spread out across the country, nor are its effects. Rather, they are
concentrated in specific sub-national regions. The Malaysian state of Penang,
for instance, currently hosts more than half of the country’s total medical
tourist visits. Expecting the sector to continue to thrive and significantly
contribute to the state’s economy, the Penang state government is also very
supportive of the sector’s growth. However, though medical tourism is
considered economically promising, the state government is also concerned with
ensuring the quality of and access to healthcare for local residents,
especially those belonging to the middle- and lower-middle-income groups. While
some research has pointed to the potential for medical tourism to exacerbate
already existing healthcare inequities in medical tourism destinations
throughout the world, scant scholarly work has actually examined this
empirically. This paper seeks to contribute to filling this gap by presenting
early findings from a study supported by the Penang state government’s think
tank, Penang Institute, that analyses secondary data gathered from a range of
Malaysian ministries in order, first, to identify effects of medical tourism to
Penang on local medical costs and the public/private distribution of healthcare
resources and, second, to estimate the costs and benefits that medical tourism
brings to local economic actors.
Michael Guiry – ‘The Economic Impact of Medical Tourism on Countries’
Travel and Tourism Sectors: An Exploratory Investigation’
- ·
Using Euromonitor Passport Health and Wellness
Tourism industry data, the research will investigate the impact of medical
tourism on countries’ travel and tourism revenue generated through inbound
medical tourism. For the purpose of the research, medical tourism encompasses
inbound travel that has the purpose of some kind of medical treatment
regardless of complexity. The country travel and tourism revenue includes
expenditures for travel and tourism services, such as hotels, travel within the
country, car rental, travel retail etc., by inbound medical tourists and
accompanying persons. Medical expenses are excluded from the data. Countries
that will be investigated over a five-year time period include Australia,
Columbia, Czech Republic, Hong Kong, Indonesia, the Philippines, Poland,
Singapore, Spain, and United Arab Emirates. Similarities and differences in
travel and tourism revenue impact across countries will discussed, explanations
for the findings proffered, and implications for internal and external
destination branding will be explored.
Beth Kangas – ‘Building a Destination around a World-Class Medical
Center: Rochester, Minnesota, the Mayo Clinic, and the Destination Medical
Center’
- ·
Much of the literature on the development of
medical tourism destinations has focused on locations not already known for
their advanced medical services. While replete with attractive tourist
amenities, destinations such as Malaysia, Thailand, Barbados, and Jamaica have
had to – or will have to (in the last two cases) – convince international
travelers that they offer specialized care comparable to (or even exceeding)
that available in the United Kingdom and United States. The literature has
hailed Harley Street in London and the Mayo Clinic and Cleveland Clinic, among
others, in the US as the original destinations of biomedicine-seeking
travelers. While studies acknowledge that the September 11, 2001 terrorist
attacks and ensuing visa restrictions in the US rerouted transnational medical
travelers to destinations in Asia, few if any explore the current efforts of
these original sites to secure their status as global medical destinations. This
paper investigates the collaborative undertakings of the state, county, city,
medical facility, and private partners to make Rochester, Minnesota, home of
the Mayo Clinic, a destination medical center (DMC). In 2013, Minnesota
legislature passed a “DMC law” to position the Mayo Clinic and Rochester as the
world’s premier destination medical center and center for health. This paper
draws on DMC board meetings archived online, legislative documents, newspaper
articles, reports, and local observations to explore the negotiations of a
20-year economic development initiative with community concerns for affordable
housing, respect for existing architecture, improved public infrastructure, and
quality of life. It illustrates place-making as a dynamic process.
Juan
Bosco Gimeno – ‘Impact of tourism on Spain’s private healthcare sector’
- · Spain is working hard to be a prime destination
for healthcare and medical tourism. High quality healthcare with excellent
private clinics, prestigious and worldwide known doctors and treatments, can
match with the leading position of the country in the general tourism market.
Within this frame, the information about what are nowadays the facts and
figures of the impact of tourism in private healthcare sector will result in
relevant information for those -service providers and coordinators- who are involved,
or want to approach, in international patients' treatment to prepare further
activities to accomplish their aims. The object of the study is twofold: 1)
detailed knowledge of the flow of international patients currently treated in
Spain including geographic and demographic aspects (origin, destination,
ages...), healthcare (diseases, treatment, duration...), but also motivational
aspects (expectations, results, satisfaction...), and tourism; and 2) evaluate
the impact in areas of economic significance (employment, training, performance
...) and other relevant areas of healthcare, at strategic level, in resources'
administration, and patients'' management. In addition to plotting a series of
profiles on the state of health tourism focused on health care, it is expected
to identify areas of value to service providers: best practices, strengths and
opportunities.
·
Session 3: Health equity impacts in receiving countries
Johanna Hanefeld – ‘How medical travel affects health systems
- evidence from mixed methods research in South Africa’
Valorie Crooks – ‘Do people in patient's home countries care
about the health equity impacts of medical tourism abroad? An examination of
Canadian stakeholder perspectives’
- ·
The international medical tourism literature
suggests that destination countries can experience both health equity gains and
losses resulting directly and indirectly from the development of a local
medical tourism sector. For example, it is often reported that medical tourism
helps to reverse brain drain and bring in foreign revenue, both of which can
have health equity gains for the local population. At the same time, other
research suggests that there may be a re-direction of local policy resources
and a shifting of health care priorities in order to ramp up a medical tourism
sector, both of which can contribute to health equity losses. After conducting
a large, multi-year study of the observed and potential health equity impacts
of medical tourism in Mexico, Guatemala and Barbados we created vignettes
highlighting the real health equity impacts that emerged from our findings and
shared them in 20 interviews conducted with Canadians we broadly conceive of as
stakeholders in the practice of medical tourism. More specifically, interviews
were conducted with key informants who have expertise in health law and policy,
patient advocacy, health care administration, international patient travel,
patient safety, and other sectors that are directly impacted by the outflow of
patients abroad as medical tourists. In this presentation we share the
vignettes and the perspectives offered by the participants. We show how a
single vignette can be simultaneously interpreted as having negative and
positive health equity impacts and in doing so reflect on the challenges of
assigning responsibility for mitigating the harms associated with this global
health services practice.
Alejandra Giraldo – ‘Health tourism in Spanish public health centres’
- ·
One of the main concerns of Spanish citizens
has been how to maintain the quality of and the universal access to the public
health system (CIS, 2011), therefore one of the issues that has been in the
spotlight is medical care for foreigners. Public opinion and the media assumes
that there is a high volume of tourism in public health centers. This paper
analyzes this phenomenon. The first part of the work quantifies and
characterizes hospital care dispensed to patients who reside abroad but are
treated in Spanish public centers. This descriptive analysis shows that a
percentage of these patients come to Spain because of the difference in quality
between the health systems of their own country and the Spanish health system.
This health gap acts as a catalyst for patient movement. Finally this paper
sets an econometric model which aims to predict how foreign patients will cross
the border in order to be hospitalized in Gynecology and Obstetrics Departments
in Spain because of the differences, in comparison to their home countries, in
two indicators: maternal mortality and public expenditure per capita PPP.
Valorie Crooks – ‘Medical tourism development in Guatemala:
An empirical examination of health human resource impacts’
- ·
Guatemala is a Central American country that is
actively seeking involvement in the international medical tourism market.
Championed by various local groups, health care clinics, and health care
providers, a modest number of clinics and hospitals are taking measures to
expand their private-paying international patient load. While ample scholarly
research suggests that there are both health equity gains and losses to be had
for countries developing medical tourism sectors, there is little on-the-ground
research in these very countries that offers empirical perspectives related to
health equity impacts. In this presentation we report on 50 interviews
conducted with representatives from four stakeholder sectors in Guatemala:
public health care providers, private health care providers, civil society, and
government. Among the issues examined in these interviews, we asked
participants to offer realized and potential (i.e., forward-looking) impacts of
medical tourism sector development on health human resources. Here we examine
these realized and potential impacts and conclude by discussing the complexity
of determining the health equity gains and losses stemming from each.
Session 4: Cross-border care arrangements
Maria Teresa Martinez Almanza – ‘Border medical tourism: The case
of Ciudad Juarez, Mexico’
- Medical attention is one of the key issues of
the 21st century. This is, in part, due to individuals and governments facing
complex problems related to contemporary healthcare, such as cost, access, and
change in needs linked to demographic circumstances. In view of the growth in
demand for medical treatment by American patients in Mexico, this research will
examine medical tourism at the border between two countries, the diaspora, and
more specifically, the distinct phenomenon affecting the social and health
systems at the Juárez, Mexico/El Paso, USA border. This presentation draws on 69
in-depth interviews with key healthcare stakeholders to explore Juárez as a
medical tourism destination. The interviews were performed from 2013 to 2015. Grounded
theory was selected because it uses qualitative analysis to generate
theoretical propositions based on empirical data. The following macro
categories emerged from the analysis: context of the destination, context of
the market, product and commercialization strategies, and the border. The study
describes the reality and particularities of this border medical destination.
Tomas Mainil, David
Botterill, Vincent Platenkamp and Olaf Timmermans – ‘Putting the EU
Cross-Border Health Care Directive into practice: A UK perspective with EU
policy implications’
- ·
The take up by UK patients of the opportunities
under the EU Directive on cross-border health to seek treatment in another
member state is the start point for an analysis of the importance of the
political dimension in the core system dynamics of the EU national health
systems. A case study of patient outflows from Wales adopts a multi-method
approach. It draws upon secondary data in the form of government reports on
waiting lists for health care, collaboration with a health journalist and the
use of FoI requests in an action research project, previously unpublished data
on uptake of the EU directive by UK patients, and an individual patient
experience of negotiating treatment to receive hip replacement surgery in
Belgium. A critical realist analytical frame explores the political realities
of the implementation of the EU directive in the UK. At the macro-political
level In the UK, the political sensibilities that are potentially offended by
seeking cross-border health care implode around 1) the implied rejection of the
NHS concept by UK patients, 2) being seen to favour continued relations between
the UK with the EU at a time when a referendum on the UK's membership is
planned, and 3) to be complacent on migration and border control issues in the
face of persistent, unplanned, increases in population. The diverse political
attitudes of the four different administrations in the UK towards models of
patient choice in health care suggests a further undermining of any expansion
of EU cross-border health care patient mobility. At the micro-political level,
the patient case reports how she had to work against the ignorance of her own
GP. She had to live with the consequences of;
'upsetting' the economic and professional power base of the local
consultant surgeon, rejecting the conditions of the NHS Wales with its undue
waiting times, and having to bear the additional anxiety of dealing with a
complex and fledgling administration system surrounding the Directive. The
study indicates that for a UK patient to exercise her or his rights under the
Directive the patient risks; offending powerful interests, an engagement with
emotive political debates, and financial uncertainty on costs of treatment.
Implications for the EU of the position found in the UK are discussed,
including the importance of building a
framework to deal with these challenging developments at a micro, meso
and macro level that challenges the dominant narratives and power distributions
in national health care systems.
Betty Rouland, Sébastien Fleuret
and Mounir Jarraya – ‘Emergence of a transnational care network: Private
services and Libyan migrants in Sfax, Tunisia’
- ·
This paper shows the interdependence between the
emergence of a transnational health care system and the rise of the number of
Libyan patients in Sfax. The Tunisian private care sector has gone through
different phases over the past two decades: it emerged as "medical
tourism" during the nineties, suffered of the Arab revolution in 2011 to
then be completely overwhelmed by the flows of Libyan wounded soldiers. Today,
the sector manifests a new dynamism related to the geographical position in
Sfax, the southern door of Tunisia. The method combines a survey amongst
Libyans in four clinics and interviews with different actors in the private
health care sector. On the one hand, the results attest that political
instability in Libya has encouraged the proliferation of private polyclinics
and related services. Moreover, it has produced new spatial configurations
around the health facilities (properties, real estate), a transnational
transport network (Libyan ambulances, cross-border taxis) and an informal
economy. On the other hand, the Libyan migrants interviewed display
heterogeneous migratory characteristics related to the political chaos in
Libya, thus "re"-conceptualizing the debate on "medical
tourism" in the region. Despite the problems at the Tunisian-Libyan
border, the proximity of Sfax, the lack of sanitary infrastructures in Libya
and the quality of the services in Tunisia contribute to the construction of a
"transnational" care network.
Both health professionals and Libyan people are actors of such processes
of "bottom-up" globalization, contributing to economic development
and growing south-south migration as well as producing new forms of
"transmobility".
Ricardo Pagan – ‘Health tourism trends in the United Kingdom: Are
they net exporters of health services?’
- ·
The study investigates the inbound and outbound
health tourism in the United Kingdom (UK) to determine if the UK can be
considered as a net exporter of health services. Although there is an
increasing number of studies analysing the phenomenon of health tourism, little
empirical data are available. This paper contributes to reducing this gap by
providing reliable data on health tourism flows for the British case. Using
microdata drawn from the International Passenger Survey (IPS) for the period
2000-2014, we estimate the flows, number of nights and expenditure of tourists
looking for medical treatment who complete international visits of less than 12
months’ duration to and from the UK. In addition, we analyse the main
destinations of UK residents (outbound health tourists), and country of origin
of overseas residents (inbound health tourists). The results show the upward
trend of inbound and outbound patients (163 and 364% during the period
2000-2014, respectively), the strong seasonality in outbound patients (lower
during the summer), and the significant increase in the levels of expenditure
of overseas residents since 2005. Poland, France, India and Hungry are the
chosen countries by UK residents to be treated, whereas Irish Republic, Spain,
United Arab Emirates and Greece are the main countries providing inbound health
patients. Public policy considerations are given.
Session 5: Intermediaries
Meredith Jones - TBA
Jacqueline Sanchez Taylor – ‘Contested tourism: Parallels between
sex tourism and cosmetic surgery tourism’
- ·
This paper will draw on recent research on
cosmetic surgery tourism and my long-standing research interest on sex tourism
to think about the parallels between the two industries. Although tourism made
important economic contribution to some developing countries during the 1980s
and 1990s it has also created social problems. One of these has been the
development of an informal sex industry that operates around tourist
destinations and incorporates local women, men and children. Western male sex
tourists or ‘expatriates’ often act as
mediators who help to shape and market this informal sex industry. They are
sources of information, telling others about opportunities and helping sex
tourists to access sexual services. Cosmetic surgery tourism has also been led
by Western female mediators. Usually patients, who often are one of the first
to have had cosmetic procedures abroad and spotting a gap in the market, use
their experience and knowledge to facilitate the travel and surgery of others. This
paper will pay particular attention to how Western mediators have shaped the
development medical tourism or sex tourism in different destinations by drawing
on aspects of their own identity as well as the tropes about the destination
that allow patients to travel in order to experience cheaper surgery or sexual
services. It will argue that their interests in doing so go beyond the economic
as cultural and social constructions about gender and race also play an
important role in motivating and developing their business.
Lila Skountridaki – ‘Issues of Trust between Medical Tourism
Facilitators and Medical Doctors engaging in the Transnational Healthcare
Market’
- ·
Trust plays a central role in business
relations; more so in emerging fields. Trust works as a connecting tissue
promoting the smooth/efficient function of the markets; whereas high levels of
trust among partners may require long-term efforts, and its absence may inhibit
the development of fruitful commercial arrangements. This paper examines facets
of the developing relationship between two important actors in the
transnational healthcare market: ‘medical tourism’ facilitators and medical
doctors (MDs) engaging in the niche field. The empirical focus is on the
latter, and in particular MDs practicing in Greece and Turkey, an emerging and
an established destination for medical care correspondingly. Study participants
are plastic and dental surgeons who work for or own small medical practices -as
opposed to large organisations- and, as a result, deal with the commercial
aspect of transnational healthcare in addition to the clinical part of patient
care. Rich qualitative data shows that MDs express concerns over the commercial
practices of facilitators, perceived to be undermining the interests of both MDs
and patients. Particularly, concerns over commissions and fees; and
interference in the patient-doctor relationship inhibit the development of high
trust towards facilitators. Interestingly, the comparative study shows that
(despite expressing concerns) Turkish MDs are more open to business with
facilitators; the majority of Greek MDs resist what is perceived to be
facilitators’ pressures to control prices and the ‘rules of the game’, and are
more reluctant to proceed to business arrangements which overall delays the
development of the Greece as an established destination.
Session 6: National strategies
Neil Lunt – ‘Medical
travel: what we know and why we don’t’
- ·
The past decade has witnessed growing academic
and professional interest surrounding patients who travel abroad to receive
medical treatments. There has been much media coverage – of individual
patients, of unusual places, of life-saving and life-changing treatments, and
medical mishaps and the risks travellers face. Discussions have typically involved
a great deal of hyperbole regarding future market development and how it will
benefit or impact detrimentally on systems and patients. In recent years the academic literature on
medical tourism has burgeoned and a first wave of ‘discovery and description’
publications documented the novelty of medical tourism and its broad
characteristics. Something of a second wave of scholarship since 2010 includes
more detailed empirical investigations of particular aspects and local
development. This second wave has drawn from across disciplinary settings,
identifying medical tourism as a complex phenomenon that escapes
straightforward categorisation.
Discussion is organised in three parts: first, highlighting what we know
about medical travel at the level of patient, provision and health system;
second, identifying the continued gaps in knowledge and exploring why such gaps continue; and third,
sketching the likely routes of empirical and theoretical studies of medical
travel given they are emblematic of broader cultural, political, economic and
social changes associated with globalisation.
Jin
Ki Nam – ‘Globalization of healthcare in Korea: Policy and political issues’
- ·
In 2009, Korean government made its blueprint
mapping out 17 new national growth engines, including global healthcare, which
will drive the national economy over the next decades. Since then, Korean
government has pursued the policy for globalizing healthcare and executed many
strategic plans. During the initial phase, the policy focus was on boosting
inbound medical tourism. Since 2012, the strategic weight was shifted toward
developing outbound market, indicating export of hospital system to other countries.
Korea's medical tourism income was just $59 million in 2006, but rose to $500
million in 2014, nearly 10 times over a 8-year period. This policy for
globalizing healthcare requires the revenue and human resources to execute the
strategies. However, Korea is suffering a shortage of medical manpower. In
2012, Korea had two physicians per 1,000 people, much lower than the OECD
average of 3.1. In spite of the financial crisis of some public hospitals,
government has spent a lot of money for supporting the private hospitals or
clinics for medical tourism. In order to penetrate into foreign healthcare
market, Korean hospitals need capital fund. Since Korean hospitals are
not-for-profit organizations, it is very difficult for them to attract capital
fund. Hence, Korean government tried to change the medical law for loosening
the regulation. The opposition party and some NGOs have expressed negative
opinions toward the globalization policy. They are so much concerned about the
negative effect of this policy since the globalization of healthcare would
entail privatization of healthcare. Hence, there has been a political argument
concerning the globalization of healthcare.
The purposes of this presentation are as follows: 1) To explain the
current policy and trend of globalization of healthcare in Korea; 2) To review
the political issues regarding the globalization of healthcare.
Maria Kuklina – ‘Prospects of development of medical tourism and its
informational systems in Russia: The case of the Baikal region’
- Medical tourism is becoming a lucrative
segment of the service economy and more than 50 countries claim state support
for it. In Russia, it is just beginning to develop. Currently, Russia is more often the source of
international patients than the destination. However, the devaluation of
Russian currency has changed these patterns, reducing the number of
tourists going abroad and increasing the number of foreign tourists attracted
by the low cost of tourist services, including medical services. Responding to
this demand, the list of services and the number of hotels is growing, though
not evenly around the country. The post-soviet
legacy of sanatorium resorts across Russia could be developed to attract
international tourists, but they have not been significantly modernized since
the collapse of the Soviet Union and they suffer from a lack of
investment in infrastructure, marketing and collaboration with tourist firms.
Yet their unique balneal resources have been
preserved. In this presentation,
I discuss the challenges facing the development of medical tourism in Russia,
the prospects of combining medical tourism with other tourism offerings in remote regions, and places in which Western and
Eastern medical practices and services encounter one another. I draw on
the example of the Baikal region where, though
recognized as one of Russia’s leading tourist destinations and home to
developed Tibetan medical practices, medical
tourism opportunities are not yet widely known. The presentation is
based on an analysis of four resort areas (Ivolginskii, Arshan, Baikalsk and
Angara) where I conducted interviews with personnel, tourists and local
inhabitants as well as examining medical facilities’ records and medical
tourism websites. Policy implications for the
development of medical tourism in the Baikal region will be given, with emphasis
on the development of information systems that play a crucial role in marketing
strategies, investment and collaboration between tourist firms, resorts, other
healthcare centers, government and tourists themselves.
Daniel
Horsfall – ‘The end of medical tourism?’
- ·
A thorn in the side of any academic researcher
with an interest in medical tourism has long been the issue of numbers. Just
how many people are involved in medical tourism? From early, speculative and
rather fanciful estimates running into tens of millions, more recent headline
figures have settled around the 5 million mark per year, globally. Whilst
arriving at a number that inspires confidence in both academic and industry
sources represents an advance of sorts, in many ways the numbers have become
peripheral to some of the more important emerging issues related to medical
travel. The first of these is that medical tourism is quite simply not what it
was once purported to be. Nearly all of the academic studies of the phenomenon
have sought to capture the commercialisation of healthcare and have often
started with a focus on the advertising of services to individuals who then
travel for treatment. While there is plenty of evidence of such journeys
happening, the bulk of medical tourism involves people travelling across
borders for care, travelling to their countries of birth or places of familial
connection, or care being organised through politio-cultural relationships. The low numbers of ‘typical’ medical tourists
is hidden by and, in turn, hides much wider activity and developments in the
field of healthcare export and transnational or global healthcare. In some
cases, national governments are driving an expansion of domestic health systems
in order to capture this international activity but rarely is this in order to
attract conventional medical tourists.
Presenters’
biographies
(In alphabetical order by surname)
Juan Bosco Gimeno
Juan Bosco Gimeno
holds an MBA from IESE Business School and a law degree from Universidad de
Navarra. He works as a consultant for healthcare and tourism sectors, focused
on quality management and patient safety. Most of his professional life has
been concentrated in the healthcare and tourism sectors holding executive
positions in hospitals as well as in tourism companies. He has significant
experience in promoting, managing and owning hotels; founding Historic Hotels
of Europe, Haciendas y Estancias de México, among other initiatives. He implemented
the landing in Spain of the US healthcare provider company Community Care
Systems; contributed to develop strategic management for private clinics in
Spain. He speaks at national and international congresses and lectures in
postgraduate programmes.
Valorie Crooks
Dr. Valorie Crooks is
a health geographer specializing in health services research and Associate
Professor at Simon Fraser University (Canada). She currently holds a Canada
Research Chair and a Scholar Award from the Michael Smith Foundation for Health
Research.
Alejandra Giraldo
Alejandra Giraldo is
Assistant Professor in the Department of Applied Economics at UNED (Distance
University of Spain).
Michael Guiry
Michael Guiry is an
Associate Professor of Marketing at West Chester University in West Chester,
PA. He earned his Ph.D. in Marketing from the University of Florida, an MBA
from Duke University, and a B.S. in Agricultural Business Management &
Marketing from Cornell University. His research interests include medical
tourism destination branding and positioning, medical tourism service quality,
and cross-cultural consumer behavior. Dr. Guiry’s research has been published
in journals such as the Journal of the
Academy of Marketing Science, Journal of International Consumer Marketing,
International Journal of Behavioral and Healthcare Research, International
Journal of Health Care Quality Assurance, International Journal of Leisure and
Tourism Marketing, and Health
Marketing Quarterly.
Johanna Hanefeld
Johanna Hanefeld is head of the
Anthropology, Politics and Policy Group in the Department of Global Health and
Development, and Senior Lecturer in Health Policy and Systems Research at the
London School of Hygiene and Tropical Medicine (UK). Her work is situated within the field of health policy and systems research
and focuses on the political economy of global health. Current research focuses
on health systems and medical travel and migration, policy analysis of evidence
to policy uptake, trade and health, governance and health inequalities. She recently
co-edited The Handbook of Medical Tourism and Patient
Mobility (Edward Elgar).
Daniel Horsfall
Daniel Horsfall is Lecturer in
Comparative Social Policy at the School of Social Policy and Social Work,
University of York (UK). Author of several publications on international
medical travel, he recently co-edited The Handbook of Medical
Tourism and Patient Mobility (Edward Elgar).
Jin Ki Nam
Jin Ki Nam is
Professor at the Department of Health Administration, Yonsei University (Korea).
He is trained as a medical sociologist, and received his MA and PhD from
University of Illinois at Urbana-Champaign in the US. His research areas are
medical tourism, healthcare service design and U-Healthcare. He has worked with
several government agencies(Korea Health Industry Development Institutes, Korea
Tourism Organization) to promote medical tourism in Korea. He has published in Medical Tourism: Structure & Trends
(2013), Medical Tourism: Service
Marketing (2015), and Handbook on
Medical Tourism & Patient Mobility (2015).
Beth Kangas
Beth Kangas conducted
research in the 1990s in Yemen – and Jordan and India – on patients and their
companions who sought medical care outside of Yemen. This first ethnographic
account of international medical travel highlighted that traveling abroad for
medical care was not limited to the wealthy and elite; patients who lacked
readily available resources sacrificed greatly to seek care abroad. The study
also provided an early example of medical travel occurring from the South to
the South. Kangas now resides in Rochester, Minnesota, where she is studying
the development of the Destination Medical Center.
Maria Kuklina
Maria Kuklina is
Associate Professor in Economics at Irkutsk State Technical University
(Russia). She has worked in the fields of industrial enterprise management and
regional economics and teaches information technology, information technology
innovation and information technology management. Her research interests
include electronic systems of reservation in tourism, tourism development in
the Baikal region, development of the systems of reservation in Baikal region
and medical tourism. She has authored over 15 peer-reviewed articles.
Neil Lunt
Neil Lunt is Reader at the School of Social Policy
and Public Sector Management, University of York (UK). He is currently Director of the MPA (CASPPER) Programme,
Pathway Lead (Social Policy) for the White Rose Doctoral Training Centre, and
contributes towards SPEAX within the Department focussing on East Asian social
policy. Author of several publications on international medical travel, he
recently co-edited The Handbook of Medical
Tourism and Patient Mobility (Edward Elgar).
Tomas Mainil
Dr. Tomas Mainil is Senior
Lecturer at the Academy of Tourism, NHTV Breda University of Applied Sciences,
the Netherlands. His PhD focused on transnational healthcare and medical
tourism and their relation with health region development. He has co-edited a special issue on
transnational care in Social Science
& Medicine and a Palgrave Macmillan volume on medical tourism and
transnational health care.
Maria Teresa Martinez Almanza
Maria Teresa Martinez
Almanza is researcher and professor at the Universidad Autónoma de Ciudad
Juárez, México, located at the Mexico-USA Border. Holds a Bachelor in Business Administration
in Economics, a Masters in Education and a Masters in Foreign Trade. Professor
Martinez has significant experience in international project management for
funding, having managed major international health projects. Her research
interests are related to borders, diaspora, and health tourism. She is
currently completing her doctoral training at the University of Girona in
Spain. Her doctoral thesis is related to the development of medical tourism
destinations. She studies the particular medical tourism case of Ciudad Juarez,
border city between Mexico and the United States.
Meghann Ormond
Meghann Ormond is Assistant
Professor in Cultural Geography at Wageningen University (The Netherlands). A
human geographer, her research is mainly focused on the intersections of
transnational mobility, health and care at a range of scales. She is the author
of Neoliberal Governance and
International Medical Travel in Malaysia (Routledge, 2013) and numerous
journal articles and book chapters on 'medical tourism', migrant health,
cross-border and intra-regional healthcare development, personalised medicine,
and international retirement migration. Her work has appeared in such journals
as Social Science and Medicine, Health
and Place, Globalization and Health, Maturitas and Mobilities.
Ricardo Pagan
Ricardo Pagan is
Professor of Economics at University of Malaga (Spain) and Head of the University’s
Chair "Tourism, Health and Wellbeing".
Zsófia Papp
Zsófia Papp is a
Research Fellow with the Hungarian Academy of Sciences’ Centre for Social
Sciences (Hungary).
Sunita Reddy
Sunita Reddy is an
Anthropologist and Associate Professor at Jawaharlal Nehru University, New
Delhi (India). Her areas of research are women and child health, disaster
studies, medical tourism, surrogacy. She
is the author of Clash of Waves: Post-tsunami
Relief and Rehabilitation in Andaman and Nicobar Islands. She is a founder
member of ‘Anthropos India Foundation’, a trust which promotes visual and
action anthropology and has a dynamic website www.anthroposindiafoundation.com.
She is also a president of an organization called ‘SATAT’ which works for
empowering women and children. She has published extensively in peer-reviewed
journals.
Betty Rouland
Betty Rouland is a
Research Fellow at the Institut für Humangeographie, Goethe-Universität
Frankfurt/Main (Germany).
Jacqueline Sanchez Taylor
Jacqueline Sanchez
Taylor, of the University of Leicester (UK), has undertaken international
ethnographic research on sex tourism, child and adult prostitution and sexual
exploitation with a particular focus on female sex tourism. She is currently conducting qualitative
research on breast augmentations and has contributed to an international ESRC
project on cosmetic surgery tourism entitled ‘Sun, Sea and Silicon: Cosmetic
Surgery Tourism’. She is interested in
the global markets for cosmetic surgery and sex tourism and her publications
focus on theoretical questions about the intersections of class, gender, race,
embodiment.
Lila Skountridaki
Lila Skountridaki is
a Lecturer in Management and Sustainable Practice at the University of
Stirling. She completed her PhD at the Department of Strategy and Organisation,
Strathclyde University Business School, UK. Her PhD examined the role of
medical professionals in the internationalisation of healthcare and the
entrepreneurship of medical doctors. She has studied Economics at the Athens
University of Economics and Business and the University of Amsterdam. Her
research interests include the internationalisation of healthcare, the
professions, and business ethics. Before starting her PhD, Skountridaki worked
for Quality Control and Accounting Departments in the private sector in Germany
and Greece.
Sabina Stan
Sabina Stan is a
Lecturer in Sociology and Anthropology in the School of Nursing and Human
Sciences, DCU, Ireland. Her research has dealt with healthcare reform in
Central and Eastern Europe, European east-west migration, transnational
healthcare practices in Europe, the rising European healthcare system, and
collective action in response to healthcare privatisation and mobility in
Europe. She has published with CNRS Editions (Paris), Routledge and Rowman and
Littlefield, as well as in journals such as Social
Science and Medicine, Journal of the Royal Anthropological Institute, Labor
History and European Journal of
Industrial Relations.
Judit Sulyok
Judit Sulyok is
Senior Lecturer at the University of Pannonia (Hungary). Her courses include
strategic marketing, health tourism, and tourism marketing. She is the
coordinator of the ‘Off to Spas’ project, funded by the EU Cosme programme. She
has significant experience in tourism research and marketing, having worked for
years for Hungarian Tourism Ltd. and gaining international experience as a
member of the ETC Research Group.
Arturo Vargas Bustamante
Arturo Vargas
Bustamante is Associate Professor in the Department of Health Policy and
Management at the UCLA Fielding School of Public Health (USA). He specializes
in health care equity and in the comparative analyses of health care delivery
systems in Latin American countries. His research has been published in
reputable health policy journals such as Health
Affairs, Health Services Research, Social Science and Medicine, among
others. As part of his professional experience, he has worked for the
Inter-American Development Bank, the California Program on Access to Care and
the Health Care Financing Administration of the Mexican Ministry of Health.
Andrea Whittaker
Associate Professor
Andrea Whittaker is ARC Future Fellow and Convenor of Anthropology at the
School of Social Sciences, Monash University, Melbourne, Australia. She is a
medical anthropologist working primarily in the fields of reproductive health,
biotechnologies and medical mobility/ travel with a special interest in
Thailand and SE Asia. She is currently
undertaking research on medical travel in Thailand and Malaysia as well as
reproductive travel in Thailand and the region, funded by the Australian Research
Council. Her major publications include Intimate
Knowledge: Women and their Health in Northeast Thailand (2000), Women’s Health in Mainland South-east Asia
(2002), Abortion, Sin and the State in Thailand (2004), Abortion in Asia: Local dilemmas, global politics (2010) and Thai in vitro: Assisted reproduction in
Thailand (2015).
