The purpose of this paper is to disseminate among concerned professionals its certain operational aspects, including some possible implications on health and medical care practices.
It is written on the basis of the author’s special study of a diverse source of information, as well as on author’s practical experience and observation in this particular area.
Special attention is paid to possible public health impacts within a broad social and economic framework, as well as to its impacts on the existing national health care systems in countries, that would possibly lead to certain degree of inequity in health at national level as an important consequence of health development progress.
Knowledge and understanding gained from this paper might be useful in the efforts to develop and manage national health care systems to ensure a reasonable balance in health status of people of all groups.
Introduction
Economic globalization deals with the integrated development of networks or linkages between and among various sectors of global economy, which has three main important features, i.e. free trade, flow of capital, and exploitation of cheap labor market[1]. It primarily concerns international trade and investment that uses information and communication technology as an overriding strategy in the development and management of policy and plan of such networks or linkages. Globalization arose from the need for international collaboration in economic development and the development in other sectors[2], which refers to the collaboration ideas and other aspects of culture that improves economic well-being. Numbers of issues were identified to underline the development of globalization as follows:
equal distribution of world resources for development;
narrowing the gap in terms of development between rich and poor countries; and
promotion of inter-connectedness and inter-dependence among countries through the use of information and communication technology as a main approach.
Demonstration of the contemporary perspective that there would be no country that would be able to pursue its development in isolation without inter-country collaboration.
Health globalization
Health is basically related to the humanitarian issues; but at the same time, health industry significantly contributes to the progress of economic development. Health development activities lead to the production of both goods/commodity (drugs, vaccines, biologicals, medical supplies, and equipment) and health services in both medical and public health areas commercially provided by international firms. Huge investment involved with medical supplies, equipment, management, and health services has been continuously processed to enhance overall health industry.
Health care may be viewed in two main areas of development, i.e.:
Medical care which places particular emphasis on treatment of the sick and rehabilitation of the disabled, it is largely carried out on individual basis (one at the time).
Public health services focus on health promotion and disease prevention, through organized efforts and informed choices of organization, society, communities and individual, and public and private international collaboration facilitates health technology assessment and evaluation; standardization of medical procedures and practice to ensure high quality of services; and facilitation of flow across international boundaries of patients and medical practitioners and specialists. Moreover, the spread of dangerous infectious disease from one country to other geographical areas is an overriding public health concern that needs international collaboration and action in its prevention and control. The epidemic and spread of infectious diseases with a serious public health impact in the affected countries or areas usually take place also during the occurrence of big and devastating disasters, natural and man-made. It may be seen in this context that health industry as a consequence leading to health and medical care globalization that significantly contributes to globalization of world economy and humanitarianism activities[3].
Health in economic globalization
Health globalization pays special attention to medical services that render treatment and care to patients, and rehabilitation services. Economic or financial gain from these care and services is visibly evident and tangible, particularly for a short-term benefit. This is in opposition to the service in public health area of which its financial benefit is not economically attractive to financial investment. At the same time, there has been an attempt to develop a more complete cycle health care encompassing more comprehensively diagnosis of disease, treatment of the sick, disease prevention, and rehabilitation of the disabled, as well as several aspects of health protection, such as nutrition education as well as physical and mental care, these services are provided to people largely on individual basis. For effective economic gain purpose, medical care services may have to be promoted through advertisement, calling public attention by emphasizing especially desirable qualities of medical products or services so as to arouse a desire to purchase or patronize. Morally, the advertisement needs to be on the basis of facts, the quality of products and services being advertised has to be truly genuine, not purposefully overstated, and would be wrongly guiding people to misunderstand the information on such qualities. The advertisement must be carried out within the appropriate ethical and moral framework. Advertising to promote medical products and services must be treated with strict social responsibility, well balanced between the two main purposes, of economic and humanitarian gains. Most important aspect of this issue is the inherent ethical and moral quality of those who are promoting and providing medical care and services to clients. It is the issue related to the need for strict measures to be undertaken to ensure adequate consumers’ protection of their right to health gain. The consumers of health care and services must be fairly treated by the service and care providers.
Tourism is the practice of traveling for recreation, dealing primarily with the guidance or management of tourists, the promotion or encouragement of touring, and the accommodation arrangement for tourists, and equally important, tourism promotes seeking new knowledge and experience in new places, in addition to recreation dominant purpose of individuals or groups. It is an industry with emphasis on providing a wide range of services to tourists’ travel plan and arrangement of guidance and accommodation, including room and board; not less important the arrangement for places to be visited; and providing other facilitating facilities for tourists’ convenience and comfort. Tourism today is the main source of income for many countries, both developed and developing.
Medical tourism is a part of medical care globalization, the particular attention of which is to economic and financial gain. People may travel from their own countries to other places for medical services, which may not be available in their countries; usually it is the travel from less developed to more developed ones where needed medical care is available[4]. However, patients from more developed countries may opt to travel to less developed countries for good quality health service for cost saving reason.
There is a situation whereby some medical care may not be available or legally allowed in their own countries, such as laboratory assisting pregnancy, abortion, certain procedures of cosmetic surgery, and sex change surgical operation. At certain places, there may be an arrangement offered for mental health care, availability of alternative medicine, and in particular case, the arrangement for funeral function. There are some health risks from medical tourism, such as contracting the locally prevailing communicable diseases, especially when the visit is in the less developed countries; contracting infectious diseases in hospitals or other medical facilities (Nosocomial infection); deep vein thrombosis due to long-haul travel and the travelers may already have blood or blood vessel conditions as a predisposing cause.
Health tourism and wellness tourism
People may travel to an institution to seek certain health care from a complete set of individual health services, consisting broadly of health promotion and protection, disease prevention, medical treatment and care, rehabilitation, and other health interventions. People on wellness tour are looking for preferable options from an arrangement of a holistic health care and service, which may be in the form of health club that arranges for even spa, massage, fitness, weight loss, beauty, yoga, meditation, and other treatment for relaxation and enjoyment[5]. In a way, medical tour and wellness tour are practically similar and may be inclusive in their arrangement for tourists.
To promote health tourism and wellness tourism, there is need to develop medical centers at national and regional levels. The network of those medical centers in a region may be call medical hub, such as ASEAN medical hub, Asian medical hub, or even world medical hub. Usually the strongest medical center may be assigned the task of coordinating the work of other medical centers in the region (center of regional medical hub). In reality, it is not difficult to identify medical centers, in a country or region, but shape/organization and function of regional medical hub or network may be difficult to define or delineate. Individual medical centers choose to work independently. However, they may cooperate with each other in certain specific areas, such as referral of sick or in juried persons, training of medical staff, and exchange of technical information and know how.
Medical center is the necessity of medical tourism, countries interested in medical tourism must first develop medical centers of high performance in ensuring the quality of medical care and efficiency in the management of services, the services of exceptional courtesy and hospitality provided. The medical centers must have full and complete medical staff for all medical specialties with the required number and types of medical specialists; there must always be availability of drugs, vaccines and other biologicals, medical supplies, and equipment that are needed for the most efficient and effective operation of the centers. The centers must have completely functioning infrastructure and facilities at the level of international standard in their operation to serve tourists, Consideration may be specially directed toward the appropriate application of international standard of hotel management, emphasizing the services for the highest level of client’s comfort and satisfaction.
In purchasing or receiving medical care services from medical centers, the availability of reliable medical or health insurance is absolutely essential. Private health insurance firms may play an important role in helping or facilitating financing of such services, ensuring or guaranteeing to a certain extent financial security of the tourists as far as cost of medical care and service is concerned.
Medical or health tourism in the globalization world is largely conceptualized and realized by private sector that can afford a very high cost investment in the development and maintenance of infrastructure and services. That situation leads to the very high cost of health or medical treatment and care, which the ordinary people have no mean or power to purchase such service and treatment.
Therefore, health or medical insurance is necessary indeed when people, especially those who are medically indigent, have to resort to these services in the private hospitals of high standard.
Impact of medical tourism on public health
Public health mostly focus on medical care and treatment that can provide adequate financial incentive, rather than health promotion and disease prevention which are not attractive in term of financial gain.
Private health facilities offer higher financial incentive to health practitioners; as a result, doctors, nurses, and pharmacists prefer to be employed by private health facilities.
This situation leads to widening health gap among groups of people in long term, the poor cannot get quality medical treatment due mainly to their inability to pay high cost of care.
Bigger financial investment, including better pay of salary in particular and more efficient management of infrastructure and facilities in private sector adversely impact on the opportunity to develop high standard medical centers in public sector. Among other reasons, people with high capability, good staff, and personnel tend to go and work with the private agencies, which offer much better incentive.
However, it should also be understood that investment in the development and management of private medical care and service facilities comes from private fund (capital form shareholders or from their own wealth), not public fund (budget from public taxation by government); therefore, earning or benefiting from their practice is the most important consideration in their investment for their financial gain, survival, and progress.
