Speaker 1: I'd like you all to meet Bob. Bob is a 58-year-old factory employee at the Target Corporation here in Minneapolis. He was in overall decent health until recently when he was in the emergency room for chest pains and found out that he has atherosclerosis and has to have a coronary bypass operation as soon as possible. Bob is a contract worker at Target, and that means that he doesn't actually have health insurance. So what should he do at this point? As it stands, he has two options. He could either deplete his life savings and take a loan out for $150,000, or he could do nothing, maybe take some drugs, but basically just hope for the best. Obviously, neither of these options are all that appealing. So Bob goes online and stumbles upon this website called Planet Hospital. Planet Hospital is a website that connects people to private sector medical care facilities in the developing world. So Bob is now looking at going to India after seeing the $10,000 price tag. What he ended up getting was this sun and surgery package, which includes the airfare and a week's stay at a resort overlooking the beach. All that for $10,000. Now, Bob has become what is popularly termed as a medical tourist, somebody who crosses borders to obtain healthcare in an environment outside their own. The concept of medical tourism is not new. It's been around throughout the modern era. However, traditionally speaking, medical tourism involved developing world families pooling their life savings and traveling to the developed world to obtain what they perceive to be superior quality medical care. However, what we've seen now is that healthcare in the developing world has caught up so significantly that you can now get, as medical tourism facilitators claim, first world healthcare at third world prices. Bob's decision to go to India was clearly an economic one. He is among the 48 million uninsured or underinsured Americans that are just seeking high quality and affordable healthcare in lieu of rising medical care costs. For people that live in nations with nationalized healthcare plans, though, they still face rather long wait times to obtain services. But people also go abroad for procedures that they couldn't normally get in their home country due to legal issues, such as in the case of unlicensed and unproven stem cell injections or for procedures that aren't covered by most mainstream medical insurance providers, such as cosmetic surgeries. So, countries in Africa, Asia, and the Americas have all branded themselves as leading medical tourism destinations. Medical tourism has diversified so greatly that you can now cross borders to get dental work done. You can get plastic surgery. You can even sign up for a surrogacy program where you can pay somebody to have a child for you. It all kind of falls under this umbrella. Now, medical tourism is generally framed as this activity that's hugely beneficial for economic development as it creates more healthcare jobs, it creates more healthcare facilities, and you get access to the latest and the greatest in healthcare technologies, and that's supposed to improve the quality of life for everybody involved. However, the empirical data seems to suggest otherwise that medical tourism does have unintended consequences for nations. Medical tourism has demonstrated a huge shift in the way that healthcare is both accessed and delivered in our world today. It's contributed significantly to the growth of health disparities in our world today. Health disparities, as defined by the National Institutes of Health, are differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups. So how can medical tourism contribute to health disparities? Well, let's go back to Bob. So Bob has, there's certain consequences that Bob doesn't know about as he embarks on this journey to India. Let's take his surgeon, for example. His surgeon spoke fluent English and was educated in the United Kingdom. Upon returning back to his home country, though, he started out his career in the public sector treating the masses. But over time, he was able to transition out of the public sector and into a private sector position where he can treat medical tourists like Bob. The problem is not with him, per se, but that there are several healthcare workers that migrate from public to private sectors. And this creates the phenomenon known as brain drain, where the density of healthcare workers is so low that diseases such as tuberculosis or AIDS or malaria become very challenging to control and treat in these countries. So not only has the private sector been draining medical staffing from the public sector, but it's also draining funds. The hospital that Bob is staying at is most likely being maintained through tax breaks and land subsidies by the Indian government. Now, this is especially alarming when you consider countries like India that have large segments of the population that lack access to basic medical care or sanitation or family planning services due to large-scale private sector investment. But when we look at things like private sector investment and brain drain, we can see that there are more indirect causes of health disparities in the developing world. But let's just say that Bob is not getting bypass surgery. Let's say that he has renal failure and has to get a kidney transplant, but has been put on a waiting list to get one, which could take years to obtain. So again, he can go contact a broker, and they can connect him to a hospital in another country, and he can get his kidney immediately. The issue, though, is that this donor for the kidney is most likely an impoverished and or illiterate person that was promised a large sum of money in exchange for their organ. But when all the medical procedures have taken place and the follow-up have, this donor person has going to only receive a very nominal payment for their organ and could very likely end up in worse health than before. Bob, as the recipient, though, has zero contact with his donor, and so he has no clue how this donor was reimbursed or what the donor's health status was prior to the donation. So this is a clear-cut case of a lack of transparency, and that contributes significantly to the exploitation of vulnerable populations in the developing world, and ultimately the propagation of health disparities as a whole. It's important to keep in mind, though, that exploitation, vulnerable populations, and transparency, or lack thereof, is not exclusive to the developing world. There are situations in the developed world where the same sort of practice does still apply. For example, because there are no international regulations in place for medical tourism activities as it stands, these brokerages lack the sufficient information regarding the risks and the benefits of these procedures that they're marketing so heavily as sun and surgery and vacations. So people like Bob, who are desperate for medical care and have exhausted all the options in their home countries, are often left to face the choice and to perhaps gamble with their life on this matter. So let's also just say, for the sake of argument, that Bob did go to India, and he got his bypass done. He came back to the United States, and he found out that he had acquired an infection from a hospital in India. Now, these hospitals are really upscale, but complications like infections can and still do arise. The difference, though, is that in the United States, Bob could file a malpractice lawsuit and sue for punitive damages if he did not receive competent medical care. If he goes abroad, though, his legal recourse is less clear. Could he sue the doctor? Could he sue the hospital? Could he sue the nurses? Could he sue the brokerage? It's not entirely clear what would happen as far as the malpractice and indemnification laws, because they're so variable around the world. So the parties that need to be held accountable may not necessarily be. There's also the issue about if Bob does go abroad and comes back with complications, the burden of the financials related to his post-operative care would ultimately be covered by Bob himself, probably the taxpayers of the U.S., and even the hospital may have to absorb the cost of providing this care for him. So Bob is looking at this sort of gamble on his life by going abroad for care. But moving beyond Bob, let's look at the consequences that medical tourism has for U.S. healthcare. When Bob is an uninsured American, and so he is using a public sector hospital to address his medical care needs along with millions of other people, when he's taking his money to go abroad to get treatment, he's not contributing to the system that he uses. And these hospitals are highly dependent on revenue from people like Bob that are relatively middle class to subsidize care for people who have even lower income statuses. So that's also something to think about as far as how medical tourism could easily affect the origin countries as well. So today we're discussing where do we go from here. There have been a number of solutions that have been proposed for the issue of medical tourism and health disparities. But they all have their benefits and their drawbacks. And a number of schools of thought have come about. One of them being taking the taxes from medical tourism procedures in the private sector and putting them back into the public sector in the same way that a trickle-down Reaganomics sort of situation would have worked. But we all know that that didn't work especially well in the 1980s, and the chances of it being successful now aren't very high either. People have also talked about setting up an international governing body for regulating medical tourism activities. But that also becomes an issue about how to go about doing that and who would set up these rules and regulations and on what grounds. People have also suggested that they should just pay healthcare providers in the public sector more money to stay. But that begs the question about where would the money come from? And is it really a long-term fix to healthcare brain drain? I would suspect it's probably not because the career opportunities just aren't that great in the public sector versus the private sector. There's also been talk of using a quota system to regulate how medical tourism traffic goes in developing countries. In South Korea, they have allocated 5% of hospital beds for medical tourists, but that might become an ethical issue when you consider that if the demand overshadows the amount allocated by the quota, can you really turn somebody away who is in dire need of medical care? So, obviously, all of these have been put forth as ideas on how to tackle this issue, but it's important to realize that medical tourism is such a complex thing. It affects so many people in really, really good ways, but it also has really, really adverse effects as well. You can't blame Bob for going abroad to get his procedure done, and you can't blame his doctor for going from public to private sectors. Everybody is trying to seek a higher quality of life for themselves and their loved ones, but the World Health Organization points out that healthcare is a human right, and so it's now really undeniable that healthcare equity for everybody has to be addressed on a global scale. Now, I myself really don't know what the answer is as far as what to do about medical tourism, but I do know that the first and very crucial step is to raise awareness about this so that we can have a global dialogue about it. The world is significantly smaller than it once was, and so things that happen on one side of the earth could drastically affect things on the other side. So, we have to be aware of what our actions are and the world around us. Now, it's really hard to say what the future of medical tourism is going to be. In the U.S., the Affordable Care Act was recently passed, and so that could mean either an increase or a decrease in the demand for overseas health services, but that would depend on many factors within the system as well. Regardless, though, the popularity of medical tourism signifies that people have become much more creative problem solvers. Like, take our friend Bob, for instance. He couldn't afford $150,000 for a bypass in the U.S., and so he got online and found out that he can get this operation done and a pretty sweet vacation for a fraction of the cost. Where there's a will, there's a way. But medical tourism is both an international problem and an international solution, and therefore, it has to be addressed on that scale. As we have seen throughout history, though, anything that has a global impact has started out with a local conversation. So, let's talk. Where do we go from here? Thanks. Thanks. Thank you.