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      The effects of medical tourism: Thailand's experience Translated title: Les effets du tourisme médical: l'expérience thaïlandaise Translated title: Efectos del turismo médico: el caso de Tailandia

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          Abstract

          OBJECTIVE: To explore the positive and negative effects of medical tourism on the economy, health staff and medical costs in Thailand. METHODS: The financial repercussions of medical tourism were estimated from commerce ministry data, with modifications and extrapolations. Survey data on 4755 foreign and Thai outpatients in two private hospitals were used to explore how medical tourism affects human resources. Trends in the relative prices of caesarean section, appendectomy, hernia repair, cholecystectomy and knee replacement in five private hospitals were examined. Focus groups and in-depth interviews with hospital managers and key informants from the public and private sectors were conducted to better understand stakeholders' motivations and practices in connection with these procedures and learn more about medical tourism. FINDINGS: Medical tourism generates the equivalent of 0.4% of Thailand's gross domestic product but has exacerbated the shortage of medical staff by luring more workers away from the private and public sectors towards hospitals catering to foreigners. This has raised costs in private hospitals substantially and is likely to raise them in public hospitals and in the universal health-care insurance covering most Thais as well. The "brain drain" may also undermine medical training in future. CONCLUSION: Medical tourism in Thailand, despite some benefits, has negative effects that could be mitigated by lifting the restrictions on the importation of qualified foreign physicians and by taxing tourists who visit the country solely for the purpose of seeking medical treatment. The revenue thus generated could then be used to train physicians and retain medical school professors.

          Translated abstract

          OBJECTIF: Examiner les effets positifs et négatifs du tourisme médical sur l'économie, le personnel de santé et les coûts médicaux en Thaïlande. MÉTHODES: Les répercussions financières du tourisme médical ont été estimées à partir de données émanant du ministère du Commerce, avec des modifications et des extrapolations. Les données d'une enquête réalisée auprès de 4 755 patients ambulatoires étrangers et thaïlandais dans deux hôpitaux privés ont été utilisées afin d'étudier l'impact du tourisme médical sur les ressources humaines. Les tendances des tarifs relatifs de la césarienne, de l'appendicectomie, de la réparation de hernies, de la cholécystectomie et de l'arthroplastie du genou dans cinq hôpitaux privés ont été examinées. Des groupes cibles et des entrevues approfondies avec des directeurs d'hôpital et des témoins privilégiés des secteurs public et privé ont été organisés afin de mieux comprendre les motivations et les pratiques des parties prenantes liées à ces interventions et de renforcer les connaissances sur le tourisme médical. RÉSULTATS: Le tourisme médical génère l'équivalent de 0,4% du produit intérieur brut thaïlandais, mais il exacerbe la pénurie de personnel médical en détournant de plus en plus de travailleurs des secteurs privé et public au profit des hôpitaux traitant les étrangers. Cela se traduit par une augmentation substantielle des coûts dans les hôpitaux privés et il est probable qu'il en aille de même au niveau des hôpitaux publics et de l'assurance santé universelle qui prend en charge la plupart des Thaïlandais. La «fuite des cerveaux» est également susceptible de porter atteinte à la formation médicale dans le futur. CONCLUSION: Le tourisme médical en Thaïlande, en dépit de certains avantages, a des effets négatifs qui pourraient être atténués par une levée des restrictions appliquées à l'importation de médecins étrangers qualifiés et par une taxe visant les touristes qui ne visitent le pays qu'en vue de bénéficier d'un traitement médical. Le chiffre d'affaires qui serait ainsi généré pourrait ensuite servir à former des médecins et à retenir les professeurs des facultés de médecine.

          Translated abstract

          OBJETIVO: Analizar los efectos positivos y negativos que tiene el turismo médico en la economía, el personal sanitario y los gastos médicos de Tailandia. MÉTODOS: Las repercusiones económicas del turismo médico se calcularon a partir de los datos del Ministerio de comercio, con diversas modificaciones y extrapolaciones. Para investigar cómo afecta el turismo médico a los recursos humanos se emplearon los datos de una encuesta realizada a 4 755 pacientes ambulatorios tailandeses y extranjeros en dos hospitales privados. Se analizaron las tendencias de los precios relacionados con la cesárea, la apendicectomía, la herniorrafia, la colecistectomía y la artroplastia de rodilla en cinco hospitales privados. Se crearon grupos de investigación cualitativa y se realizaron entrevistas minuciosas a los directores de hospital y a los informadores clave procedentes del sector privado y público para entender mejor los motivos y las prácticas de los interesados relacionados con estos procedimientos y, de este modo, aprender más acerca del turismo médico. RESULTADOS: El turismo médico genera el equivalente al 0,4% del producto interior bruto de Tailandia, si bien ha agravado la falta de personal médico al tentar a muchos trabajadores procedentes de los sectores público y privado para que trabajen en hospitales orientados a los extranjeros. Esto ha provocado un aumento sustancial de los costes en los hospitales privados y probablemente también conllevará un aumento de los mismos en los hospitales públicos y en el seguro sanitario universal del que se benefician la mayoría de los tailandeses. Esta «fuga de cerebros» también podría perjudicar a la formación médica futura. CONCLUSIÓN: El turismo médico en Tailandia, a pesar de ofrecer ciertos beneficios, presenta también efectos negativos que podrían mitigarse reduciendo las restricciones para la importación de personal médico cualificado procedente del extranjero y gravando con impuestos a los turistas que visiten este país con el único propósito de someterse a un tratamiento médico. Los ingresos que se obtuvieran de este modo podrían emplearse en la formación de médicos y para que los catedráticos permanecieran en la Facultad de Medicina.

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          Most cited references 21

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          Patients without borders: the emergence of medical tourism.

          A growing number of patients from the United States and other developed countries are traveling abroad with the express purpose of obtaining health care, including elective surgery and long-term care. This trend is not innocuous. It can lead developing countries to emphasize technology-intensive tertiary care for foreigners at the expense of basic health care for their citizens. Moreover, it can exacerbate the brain drain from the public to the private sector. The examples of Thailand and India suggest the distorting effects of this trend and raise questions of social equity in the distribution of scarce resources.
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            Patients without Borders: The Emergence of Medical Tourism

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              Incoherent policies on universal coverage of health insurance and promotion of international trade in health services in Thailand.

              The Thai government has implemented universal coverage of health insurance since October 2001. Universal access to antiretroviral (ARV) drugs has also been included since October 2003. These two policies have greatly increased the demand for health services and human resources for health, particularly among public health care providers. After the 1997 economic crisis, private health care providers, with the support of the government, embarked on new marketing strategies targeted at attracting foreign patients. Consequently, increasing numbers of foreign patients are visiting Thailand to seek medical care. In addition, the economic recovery since 2001 has greatly increased the demand for private health services among the Thai population. The increasing demand and much higher financial incentives from urban private providers have attracted health personnel, particularly medical doctors, from rural public health care facilities. Responding to this increasing demand and internal brain drain, in mid-2004 the Thai government approved the increased production of medical doctors by 10,678 in the following 15 years. Many additional financial incentives have also been applied. However, the immediate shortage of human resources needs to be addressed competently and urgently. Equity in health care access under this situation of competing demands from dual track policies is a challenge to policy makers and analysts. This paper summarizes the situation and trends as well as the responses by the Thai government. Both supply and demand side responses are described, and some solutions to restore equity in health care access are proposed.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra )
                0042-9686
                May 2011
                : 89
                : 5
                : 336-344
                Affiliations
                [1 ] National Institute of Development Administration Thailand
                [2 ] Thailand Development Research Institute Thailand
                Article
                S0042-96862011000500009
                10.2471/BLT.09.072249
                3089382
                21556301

                http://creativecommons.org/licenses/by/4.0/

                Product
                Product Information: SciELO Public Health
                Categories
                Health Policy & Services

                Public health

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