Dental Vacation

I’ve not been a big fan of the state of American dental care on this blog, and I’ve had some worries about medical tourism. But a story in the NYT today describes what may be a promising development: the dental vacation:

Roughly half a million Americans sought medical care abroad in 2006, of which 40 percent were dental tourists, according to the National Coalition on Health Care, an alliance of more than 70 organizations. That’s up from an estimated 150,000 in 2004, said Renee-Marie Stephano, the chief operating officer for the Medical Tourism Association, a nonprofit organization that researches global health care.

From cosmetic surgery safari to tooth-trips, what are the legal and social implications of medical tourism? A few thoughts beneath the fold.

First, as Milica Bookman notes, this type of tourism can be a real boon for developing countries’ economies:

There’s something called the multiplier which works itself through the economy which means that, you know, every dollar that comes in to the country can have several dollars’ worth of effect throughout the country as people have jobs and then they spend their income that they earned and then there’s more demand for other secondary goods and tertiary goods. So, those countries such as Malaysia, India, Thailand, they really do expect and we do expect that there will be huge economic benefit.

The existence of medical tourism actually helps public health in a country because it might improve and expand access to high tech facilities that poor or non-paying poor would otherwise not have. It might give them access to doctors and physicians and technology that they otherwise might not have. And of course, the most important thing about the crowding in effect is that medical tourism brings in profit and taxable income. And governments can tax that income and then redistribute it into the public health system.

But Bookman worries about the immediate economic effects on the relevant countries.

[There is an] effect of decreasing resources for the poor population, decreasing the facilities that are available for the poor population because hospitals and doctors and everybody involved in the medical field is going to want to go into the more lucrative medicine namely medicine for foreigners, for cash-paying foreigners. The government might also experience distortion of its priorities because here’s this possibility of bringing in a lot of foreign currency which they would want to do and maybe they will favor the private medicine that caters to foreigners over the public health.

So in that way, we could say that medical tourism, which is flashy and lucrative will crowd out public health which is, you know, not very interesting. So, what you can have with the crowding out effect is the emergence of a dual medical structure. And let me just give you one example that we talked about in the book. In Malaysia, private hospitals have about 20% of the overall bed capacity in the country but they hire 54% of the doctors. And this is an example of how medical staff prefers to work in the private sector that caters to the foreigners rather than the public sector. So, that’s the negative crowding out effect.

Interestingly, that “dual effect” within Malaysia mirrors a tiering that may be beginning in the U.S. Unable (or perhaps unwilling) to buy their way into the U.S. dental system, the dental tourists travel abroad. Perhaps eventually as inequality rises, we will see a majority of U.S. dentists catering to, say, the wealthiest quintile of the population, with the bottom 80% scrambling for the remainder, or traveling abroad for care.

What about the possibility of substandard care abroad? Philip Mirrer-Singer has an interesting article entitled Medical Malpractice Overseas: The Legal Uncertainty Surrounding Medical Tourism (Law and Contemporary Problems, Vol. 70:211, Spring 2007). Here’s the bottom line:

Part II [of this article] explains why courts probably lack jurisdiction over foreign physicians who have allegedly committed malpractice and discusses theories under which U.S. firms in the medical-tourism business could be held liable for the foreign provider’s negligence. Part III discusses additional barriers to malpractice actions against firms, such as forum non conveniens and conflict-of-law issues. Part IV presents the arguments for and against holding firms vicariously liable for the negligence of foreign providers. The article concludes by noting that legislation may be necessary to deal with the complex policy issues medical tourism presents.

Nathan Cortez’s article Patients Without Borders has some sensible recommendations on some possible “next steps” here. He argues that we should “build on existing consumer protection laws, expand licensing regimes, and recalibrate existing schemes that may unfairly allocate the risks and benefits.” And perhaps a new focus on “global health care finance” is in order?

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