Policy implications of medical tourism development in destination countries: revisiting and revising an existing framework by examining the case of Jamaica

Abstract

BackgroundMedical tourism is now targeted by many hospitals and governments worldwide for further growth and investment. Southeast Asia provides what is perhaps the best documented example of medical tourism development and promotion on a regional scale, but interest in the practice is growing in locations where it is not yet established. Numerous governments and private hospitals in the Caribbean have recently identified medical tourism as a priority for economic development. We explore here the projects, activities, and outlooks surrounding medical tourism and their anticipated economic and health sector policy implications in the Caribbean country of Jamaica. Specifically, we apply Pocock and Phua’s previously-published conceptual framework of policy implications raised by medical tourism to explore its relevance in this new context and to identify additional considerations raised by the Jamaican context.MethodsEmploying case study methodology, we conducted six weeks of qualitative fieldwork in Jamaica between October 2012 and July 2013. Semi-structured interviews with health, tourism, and trade sector stakeholders, on-site visits to health and tourism infrastructure, and reflexive journaling were all used to collect a comprehensive dataset of how medical tourism in Jamaica is being developed. Our analytic strategy involved organizing our data within Pocock and Phua’s framework to identify overlapping and divergent issues.ResultsMany of the issues identified in Pocock and Phua’s policy implications framework are echoed in the planning and development of medical tourism in Jamaica. However, a number of additional implications, such as the involvement of international development agencies in facilitating interest in the sector, cyclical mobility of international health human resources, and the significance of health insurance portability in driving the growth of international hospital accreditation, arise from this new context and further enrich the original framework.ConclusionsThe framework developed by Pocock and Phua is a flexible common reference point with which to document issues raised by medical tourism in established and emerging destinations. However, the framework’s design does not lend itself to explaining how the underlying health system factors it identifies work to facilitate medical tourism’s development or how the specific impacts of the practice are likely to unfold.

Providers’ perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications

“…In the CAC region, medical tourism is understood to be a solution to address unused capacity in the private health sector (21, 22). For Guatemala and Mexico, this capacity already exists and is seeking utilization; for Barbados, the demonstrated viability of tapping into the international market to reach a sufficient catchment of private patients is facilitating planning for new private facilities.…”

“…While existing discussion of international hospital accreditation focuses on its role as a marketable credential and means to improve and standardize quality of care, many participants emphasized international hospital accreditation as a precursor to accessing private insurance funds outside of their countries. International hospital accreditation should thus be understood not only as an emerging standard of care, but also as a precursor to scaling up flows of international patients into the future (21, 26). …”

“…While instances of medical tourism being coordinated and promoted by government agencies are found in the literature (2–5, 21), the parallel roles of the public export and investments promotions corporations in all three countries are striking in their formulaic recurrence and its consequent implications for health policy in each country and across the region. As the most visible government organizations driving medical tourism in CAC are both removed from health systems planning and approaching medical tourism solely as an economic development project, the risk of the sector developing with only cursory consideration of the many health equity concerns medical tourism raises (2–8, 27) is significantly heightened.…”

Government roles in regulating medical tourism: evidence from Guatemala

“…Guatemala is not alone in this regard. Findings from our other studies exploring medical tourism sector development in the LAC region have demonstrated similar tension between the potential for regulation and the will to actually regulate, including in Barbados [ 14 ], Jamaica [ 38 ], St. Lucia [ 39 ], and Cayman Islands [ 40 ]. Although our Guatemalan informants generally recognized the need for governments to regulate public health care, opinions on regulation of medical tourism were mixed.…”

A Sustainable Medical Tourism FrameworkBased on the Enterprise ArchitectureDesign:The Case in Thailand

“…The healthcare provider and staff are a significant factor in Malaysia [15]. In the same way, the healthcare workforce, health insurance and the international accreditation have been confirmed to have great impact on medical tourism in Jamaica [16].…”