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Ethical considerations associated with the develeopment of medical tourism.

Ethical considerations associated with the develeopment of medical tourism.
Author: Sally Whitlock
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Key words:
niche tourism, medical tourism, medicities, urban, rural, mortality.

Abstract
Medical tourism has become an arguable form of ‘niche tourism’ (Jackson and Barber, 2015). The development of the marketplace for medical tourism can therefore be adapted to suit the needs of the tourists meaning the local residents may be neglected as resources are diverted to the tourists.

Through focusing on the ethical implications in which medical tourists can have on the host environment therefore to the local residents an opinion can be formulated. Specific case studies will be focused upon, to support the opinion of local residents suffering ethically from the development of what is now known as ‘medicities’.

The World Health Organisation (WHO) published a paper (2011) specifically focusing on the implications of medical tourism within Thailand. The paper particularly focused on the amount of time in which residents have with a physician in comparison to that of tourists. By focusing on two separate hospitals the result showed how physicians could spend a day with between 14-16 foreign patients in comparison to 40-48 local residents, within the same time frame (World Health Organisation, 2011). An issue with regards to this is currently the healthcare system within Thailand can already be associated as being under ‘strain’, statistically there is 0.4 physicians per 1,000 patients (World Bank, 2015). Another key issue with regards to the ‘strain’ with resources can be seen through the number of nurses and midwives to patients. This is currently set at 2.1 per 1,000 patients (World Bank, 2015). This statistic for both nurses, midwives, and physicians is meant to be set at 2.5 per 1,000 patients. This is a strong indicator that already the country is having issues within the healthcare system.

The correlation between the amount of physicians, midwives and nurses can be seen through infant mortality rates, and life expectancy. The average life expectancy within Thailand is established at 74 years old. With infant mortality being seen as 11 deaths per 1,000 live births (World Bank, 2013). An issue which local residents may have can be established through the tax system. As currently money which is paid into the tax system pays for both medical treatment, of local residents and medical training for physicians. Therefore with local residents not being able to see a physician may incorporate a feeling of distain to tourists.

When comparing Thailand to another country that being of India certain similarities can be recognised. However issues can also be seen these include the current infant mortality rate within India. This is 43.19 per 1,000 live births (Central Intelligence Agency, 2010). When comparing the amount of local residents who live below or at the poverty line within both countries a difference can be seen. 29.8% of the population in India live below the poverty line whereas in Thailand this is considerably higher being seen at 13.2% (Central Intelligence Agency, 2011).


The infrastructure within India can be arguably ‘lacking’ to currently cope with the 1.2 million residents within the country (Central Intelligence Agency, 2014). However many of the 1.2 million residents currently live in rural India this figure being established at 850,000,000 meaning the access to the healthcare system and facilities within cities may prove inaccessible leading to the increase of urban and rural divide with an increase in mortality rates.
Another key issue can be seen through the development of medical tourism models within countries. An example of that can be seen through the American Medical Association (2008) guidelines which are set to assure both businesses and tourists of what to look for before deciding to use this form of travel. The guidelines reassure tourists of rules they should look for before travel such as accreditations and any issues in which they may have.

However an issue which can be recognised is the privatisation of the medical sector within developing countries such as that of Thailand and India. ‘Medicities’ have been seen as being established such as that of ‘Medanta’. This private medicity located in Gurgaon India focuses on private medical treatments. However issues with this can be seen through the high infant mortality rates within India, the high poverty in the rural areas as this is in an urbanised setting. A main issue can be seen as the income generated may not necessarily help the local residents and may simply benefit the profit made by the business. The website also offers a section specifically for medical tourists which means the local residents who can’t afford the medical care may be infringed upon.

The main key issue which can be recognised is the ‘trickle down’ affect (Robinson et al, 2011). With medical tourism jobs can be created for local residents and a more supportive infrastructure can be created. However if the money stays within these ‘medicities’ many local residents will be impacted this can be seen through the high mortality rates and poverty issues within rural settings.








References
Central Intelligence Agency. (2015) The World Fact Book: India. [online].[Accessed on 27th April 2015] Available at:< https://www.cia.gov/library/publications/the-world-factbook/geos/in.html >

NaRanong., A., NaRanong., V. (2011) The effects of medical tourism: Thailand’s experience. World Health Organisation. [online]. 89 (5) PP.336-344. [Accessed on 15th April 2015] Available at:<http://www.who.int/bulletin/volumes/89/5/09-072249/en/ >

World Bank. (2015) World Development Indicators: Health Systems. [online].[Accessed on 27th April 2015]. Available at:<http://wdi.worldbank.org/table/2.15 >