Event Title
Justice across borders: The case of medical tourism
Start Date
28-6-2010 10:45 AM
End Date
28-6-2010 12:15 PM
Description
This presentation is part of the Science and Values: Global Perspectives track.
Analyses of migration and trafficking focus on the flow of persons from poorer to wealthier countries. In relation to health care, these accounts emphasize either the drain of resources from poorer countries, as skilled medical personnel migrate to developed economies, or the burden placed on developed economies by the immigration of disadvantaged populations. Medical tourism, in which the flow of persons is reversed, raises a different and even more critical set of ethical difficulties at the juncture of medicine, mobility, and justice.
Typically, medical tourists travel from a wealthy country to a poorer one to obtain medical care at a substantially discounted rate. Agencies market package tours combining medical services in a hospital or clinic with convalescence in a hotel or resort style accommodation. Historically, medical tourism consisted largely of female patient/tourists seeking elective plastic surgeries at a discount. Recently, the numbers of patient/tourists traveling for organ transplants has surged. Reproductive services constitute a booming part of the industry.
Bioethics rarely reflects on medical tourism; yet, annually, more than a million Americans alone travel as patient/tourists. Some conventional health insurance companies have begun to market package tours. A growing genre of private companies specializes in medical tourism, matching patients with providers, and arranging travel, accommodation, translation services, and recreational or tourist activities. Studies suggest that the marketing of medical tourism is even more advanced in the UK, than in the US.
Health care analysts in the US predict that medical tourism will soon become a structurally integrated part of the delivery system, encouraged as a means of reducing costs. An operation costing $30k in the US costs $6k in Costa Rica, including recuperation on the beach. India’s first for-profit hospital promotes “First-World Health Care at Emerging Market Prices” to an international clientele. Some employers and insurance providers in the US are exploring medical tourism as a low-cost alternative to local care. The government of India, in conjunction with for-profit providers, is now actively pursuing a “subcontracting” relationship with the British National Health Service for the outsourcing of medical care, that is, for shipping British patients to India to receive care. Thus, medical tourism not only shifts resources within the “host” country, from the local population to profit-generating foreigners, but also threatens to undermine guarantees of care in the tourist’s home country.
At the same time, countries in Asia, South America, and Eastern Europe have embraced medical tourism as a key element of economic development. In 2003, the Singapore Ministry of Health launched Singapore-Medicine, a “multi-agency government-industry partnership committed to promoting Singapore as a world-class destination for advanced patient care.” Through Singapore-Medicine, the government’s Economic Development Board collaborates with its Tourism Board to “brand and market” Singapore’s health care services internationally. Singapore plans to attract 1 million medical tourists annually by 2012 and to become a major competitor to well-established markets in South Africa, Thailand, and South America. Recent amendments to Singapore’s Human Organ Transplant Act eliminated the prohibition against payments to living donors. Despite laws against organ trading, Singapore has engaged the worldwide advertising firm DDB to “handle all marketing and advertising communication for its Human Organ Transplant Act (HOTA) campaign,” and is already attracting foreign clients.
Following a similar strategy, the government of India actively promotes collaboration between for-profit health care providers and the tourism industry. Finance Minister Jaswant Singhi’s 2003 budget made the development of India as a “global health destination” official government policy. Medical tourism is frequently identified as India’s most important growth industry.
India’s development policy for medical tourism specifically targets “reproductive outsourcing” as a key sector of economic growth. Surrogacy produces nearly $500 million a year in revenue in for-profit clinics. Under guidelines issued by the Indian Council of Medical Research, women recruited as surrogates, who are almost invariably poor and frequently illiterate, sign away, often with a thumbprint, any relation to the children they bear. Policies actively isolate the surrogates from both donors and clients, while children are immediately removed from the surrogate at birth. These practices insure the alienation of the surrogates from the social and generative aspects of pregnancy, reducing them to the status of rented wombs.
Marketing strategies in the industry specifically contrast the conditions of surrogacy in the West with the practices of surveillance and confinement to which Indian surrogates are subjected. Frequently, surrogates are housed in hostels attached to for-profit medical clinics, where they are constantly monitored. Clinics advertise the regimens of exercise and diet and the “supervision” by medical personnel to which surrogates submit. One American client remarked, “[In the U.S.] You have no idea if your surrogate mother is smoking, drinking alcohol, doing drugs. You don’t know what she’s doing. You have a third-party agency as a mediator between the two of you, but there’s no one policing her.”
The ethical difficulties of medical tourism arise from the exploitation of inequities of wealth and power, both between the home and “host” countries and within the “host” country itself. Efforts to employ medical tourism as a form of cost-containment in the US and Britain exemplify the exploitation of social inequity within the home country as well.
These policies differentially aggravate the subjection of women, reinforcing their poverty and powerlessness, as well as their status as property. Policies that alienate the surrogate from pregnancy and birth, subject her to surveillance and discipline, and reduce her social relations to an economic calculus constitute a paradigm of the commodification of the body to benefit governmental power and wealth.
Some argue that prohibiting or even criticizing payments to poor women in India who serve as surrogates constitutes paternalism, if not imperialism. This argument ignores the effect of these practices in reinforcing the very structural inequities of power and wealth that subject women in the first place. The collaboration of governmental power and economic privilege in the aggressive marketing of the wombs of poor women may provide an isolated, marginal economic gain for a particular woman, but it systematically secures and consolidates her status as property. Similarly, structural inequities are reinforced when medical tourists buy organs in poorer countries, just as gender inequities are intensified when medical tourists travel to Turkey to practice sex selection.
My paper argues that medical tourism not only constitutes an “internal drain” on the “host” country’s health care system, comparable to the external drain of personnel and wealth due to immigration, but also that it depends on and reinforces structures of subjection, as well as the systematic disparities of wealth and power that they produce. Whatever wealth results from this industry, there is little, if any, evidence that it ameliorates existing economic and social inequities, while it clearly depends not only on the commodification of the body and the rendering of persons as property, but also on entrenched and historically determined inequities that differentially affect women.
Justice across borders: The case of medical tourism
This presentation is part of the Science and Values: Global Perspectives track.
Analyses of migration and trafficking focus on the flow of persons from poorer to wealthier countries. In relation to health care, these accounts emphasize either the drain of resources from poorer countries, as skilled medical personnel migrate to developed economies, or the burden placed on developed economies by the immigration of disadvantaged populations. Medical tourism, in which the flow of persons is reversed, raises a different and even more critical set of ethical difficulties at the juncture of medicine, mobility, and justice.
Typically, medical tourists travel from a wealthy country to a poorer one to obtain medical care at a substantially discounted rate. Agencies market package tours combining medical services in a hospital or clinic with convalescence in a hotel or resort style accommodation. Historically, medical tourism consisted largely of female patient/tourists seeking elective plastic surgeries at a discount. Recently, the numbers of patient/tourists traveling for organ transplants has surged. Reproductive services constitute a booming part of the industry.
Bioethics rarely reflects on medical tourism; yet, annually, more than a million Americans alone travel as patient/tourists. Some conventional health insurance companies have begun to market package tours. A growing genre of private companies specializes in medical tourism, matching patients with providers, and arranging travel, accommodation, translation services, and recreational or tourist activities. Studies suggest that the marketing of medical tourism is even more advanced in the UK, than in the US.
Health care analysts in the US predict that medical tourism will soon become a structurally integrated part of the delivery system, encouraged as a means of reducing costs. An operation costing $30k in the US costs $6k in Costa Rica, including recuperation on the beach. India’s first for-profit hospital promotes “First-World Health Care at Emerging Market Prices” to an international clientele. Some employers and insurance providers in the US are exploring medical tourism as a low-cost alternative to local care. The government of India, in conjunction with for-profit providers, is now actively pursuing a “subcontracting” relationship with the British National Health Service for the outsourcing of medical care, that is, for shipping British patients to India to receive care. Thus, medical tourism not only shifts resources within the “host” country, from the local population to profit-generating foreigners, but also threatens to undermine guarantees of care in the tourist’s home country.
At the same time, countries in Asia, South America, and Eastern Europe have embraced medical tourism as a key element of economic development. In 2003, the Singapore Ministry of Health launched Singapore-Medicine, a “multi-agency government-industry partnership committed to promoting Singapore as a world-class destination for advanced patient care.” Through Singapore-Medicine, the government’s Economic Development Board collaborates with its Tourism Board to “brand and market” Singapore’s health care services internationally. Singapore plans to attract 1 million medical tourists annually by 2012 and to become a major competitor to well-established markets in South Africa, Thailand, and South America. Recent amendments to Singapore’s Human Organ Transplant Act eliminated the prohibition against payments to living donors. Despite laws against organ trading, Singapore has engaged the worldwide advertising firm DDB to “handle all marketing and advertising communication for its Human Organ Transplant Act (HOTA) campaign,” and is already attracting foreign clients.
Following a similar strategy, the government of India actively promotes collaboration between for-profit health care providers and the tourism industry. Finance Minister Jaswant Singhi’s 2003 budget made the development of India as a “global health destination” official government policy. Medical tourism is frequently identified as India’s most important growth industry.
India’s development policy for medical tourism specifically targets “reproductive outsourcing” as a key sector of economic growth. Surrogacy produces nearly $500 million a year in revenue in for-profit clinics. Under guidelines issued by the Indian Council of Medical Research, women recruited as surrogates, who are almost invariably poor and frequently illiterate, sign away, often with a thumbprint, any relation to the children they bear. Policies actively isolate the surrogates from both donors and clients, while children are immediately removed from the surrogate at birth. These practices insure the alienation of the surrogates from the social and generative aspects of pregnancy, reducing them to the status of rented wombs.
Marketing strategies in the industry specifically contrast the conditions of surrogacy in the West with the practices of surveillance and confinement to which Indian surrogates are subjected. Frequently, surrogates are housed in hostels attached to for-profit medical clinics, where they are constantly monitored. Clinics advertise the regimens of exercise and diet and the “supervision” by medical personnel to which surrogates submit. One American client remarked, “[In the U.S.] You have no idea if your surrogate mother is smoking, drinking alcohol, doing drugs. You don’t know what she’s doing. You have a third-party agency as a mediator between the two of you, but there’s no one policing her.”
The ethical difficulties of medical tourism arise from the exploitation of inequities of wealth and power, both between the home and “host” countries and within the “host” country itself. Efforts to employ medical tourism as a form of cost-containment in the US and Britain exemplify the exploitation of social inequity within the home country as well.
These policies differentially aggravate the subjection of women, reinforcing their poverty and powerlessness, as well as their status as property. Policies that alienate the surrogate from pregnancy and birth, subject her to surveillance and discipline, and reduce her social relations to an economic calculus constitute a paradigm of the commodification of the body to benefit governmental power and wealth.
Some argue that prohibiting or even criticizing payments to poor women in India who serve as surrogates constitutes paternalism, if not imperialism. This argument ignores the effect of these practices in reinforcing the very structural inequities of power and wealth that subject women in the first place. The collaboration of governmental power and economic privilege in the aggressive marketing of the wombs of poor women may provide an isolated, marginal economic gain for a particular woman, but it systematically secures and consolidates her status as property. Similarly, structural inequities are reinforced when medical tourists buy organs in poorer countries, just as gender inequities are intensified when medical tourists travel to Turkey to practice sex selection.
My paper argues that medical tourism not only constitutes an “internal drain” on the “host” country’s health care system, comparable to the external drain of personnel and wealth due to immigration, but also that it depends on and reinforces structures of subjection, as well as the systematic disparities of wealth and power that they produce. Whatever wealth results from this industry, there is little, if any, evidence that it ameliorates existing economic and social inequities, while it clearly depends not only on the commodification of the body and the rendering of persons as property, but also on entrenched and historically determined inequities that differentially affect women.