Medical Tourism Myopia
posted by Frank Pasquale
The political blogosphere has recently seized on the topic of medical tourism. Andrew Sullivan believes that Britons seeking health care abroad prove the failure of “socialized medicine.” Ezra Klein compares America’s record:
America is actually driving the medical tourism industry that some Britons are taking advantage of. The growth of foreign treatment centers aren’t a result of the failings of the British health care system (of which there are many). They’re a result of the cost of American health care, and the huge numbers of sick individuals we price out. . . . The Brits also have a bad health care system, but theirs is, on the bright side, very, very cheap. Ours isn’t.
Whatever your political spin is, there’s no doubt that medical tourism is increasingly important. One of the best works I’ve found on the topic is Nathan Cortez’s Patients Without Borders. Toward the end of the piece, Cortez frames the matter well:
[M]edical tourism foreshadows the diverse set of issues we will have to confront as health care continues to globalize. How will globalization affect health care costs, quality, and access? Where does the free market fail? When is government regulation futile? How do governments retain the jurisdiction to respond to important legal and ethical questions? How can
multilateralism facilitate trade without eviscerating local authorities’ jurisdiction? How do patients, companies, and policymakers balance the risks?
As I prepare a paper for a Wisconsin conference on the internationalization of health care, I’m taking a global justice angle. I’m particularly interested in how American demand for discretionary procedures affects the health systems of other countries.
For example, as expenditures on cosmetic surgery increase in the U.S., a new standard is set. This increases the pressure to go abroad for medical interventions that are expensive here. Dr. Victoria Pitts-Taylor, associate professor of sociology at City University of New York, argues that:
“What counts as natural changes in every culture and epoch. I believe we are now undergoing a transformation in our conception of the natural to accommodate high-tech surgery and continual, life-long regimens of cosmetic surgery (and beauty procedures).”
With a salary falling well beneath $50K a year, and approximately nineteen rounds of laser treatments averaging around $500 per treatment, [a profiled patient] is a conspicuous example of just how much women sacrifice to achieve what Pitts-Taylor calls the “technological asthetic.” And while it may be hard for some to imagine spending a quarter of their annual income on “bettering” themselves, for many it’s a logical choice.
“Once it was necessary to feel stigmatized, ugly, or abnormal to justify getting cosmetic surgery,” explained Pitts-Taylor. “Now in the United States there is a rhetoric of empowerment surrounding surgeries. One does it to ‘improve’ oneself, for example. People express an interest in using cosmetic surgery as a way to take care of themselves.”
According to Klein’s post, “there are more Americans — 100,000 — traveling abroad for cosmetic surgery alone than there are Britons seeking any type of services in foreign lands.” Cosmetic surgery tourists are also common in East Asia, where South Korea is the destination of choice:
according to the Ministry of Health and Welfare, the number of plastic surgeons [in South Korea] jumped 45 percent between 2000 and 2005, from 926 to 1,344. . . . Medical school officials say high pay is luring more and more young doctors into plastic surgery. “It is quite amazing how many residents are abandoning specialties like internal medicine and pathology to jump on the plastic surgeon bandwagon. . . .” [said one doctor].
So my questions focus on the following: do the cosmetic surgery tourists divert doctors away from the standard health care needed in destination countries? Or do they provide a needed boost of cash to these countries’ health infrastructures? Probably the answer is a mix of both effects, but it seems to me imperative for those analyzing the medical tourism phenomenon to take into account its effect on destination countries (and not merely the degree to which it indicates the deficiencies of health care in the countries from which the tourists are coming).
PS: This podcast is tangentially related, and too interesting to keep from posting:
How could we go wrong . . . by asking Richard Epstein to debate himself? On May 4 he did exactly that. The event was billed as Epstein vs. Epstein, and the topic was “Why should the U.S. subsidize the world with our high prescription drug prices?” Professor Epstein served as moderator as well, of course.