“Best care on home ground” versus “elitist healthcare”: concerns and competing expectations for medical tourism development in Barbados

International Journal for Equity in Health

Jeremy Snyder³  Valorie A Crooks²  Lisa Bishop¹  Krystyna Adams³  Rory Johnston² 

[1] Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados;Department of Geography, Simon Fraser University, Burnaby, Canada;Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

关键词: Qualitative methods;    Caribbean;    International medical travel;    Health services;    Thematic analysis;    Focus groups;    Barbados;    Health equity;    Medical tourism;   

Others  :  1133627
DOI  :  10.1186/s12939-015-0147-1

 received in 2014-06-03, accepted in 2015-01-21,  发布年份 2015

【 摘 要 】

Introduction

Many countries have demonstrated interest in expanding their medical tourism sectors because of its potential economic and health system benefits. However, medical tourism poses challenges to the equitable distribution of health resources between international and local patients and private and public medical facilities. Currently, very little is known about how medical tourism is perceived among front line workers and users of health systems in medical tourism ‘destinations’. Barbados is one such country currently seeking to expand its medical tourism sector. Barbadian nurses and health care users were consulted about the challenges and benefits posed by ongoing medical tourism development there.

Methods

Focus groups were held with two stakeholder groups in May, 2013. Nine (n = 9) citizens who use the public health system participated in the first focus group and seven (n = 7) nurses participated in the second. Each focus group ran for 1.5 hours and was digitally recorded. Following transcription, thematic analysis of the digitally coded focus group data was conducted to identify cross-cutting themes and issues.

Results

Three core concerns regarding medical tourism’s health equity impacts were raised; its potential to 1) incentivize migration of health workers from public to private facilities, 2) burden Barbados’ lone tertiary health care centre, and 3) produce different tiers of quality of care within the same health system. These concerns were informed and tempered by the existing a) health system structure that incorporates both universal public healthcare and a significant private medical sector, b) international mobility among patients and health workers, and c) Barbados’ large recreational tourism sector, which served as the main reference in discussions about medical tourism’s impacts. Incorporating these concerns and contextual influences, participants’ shared their expectations of how medical tourism should locally develop and operate.

Conclusions

By engaging with local health workers and users, we begin to unpack how potential health equity impacts of medical tourism in an emerging destination are understood by local stakeholders who are not directing sector development. This further outlines how these groups employ knowledge from their home context to ground and reconcile their hopes and concerns for the impacts posed by medical tourism.

【 授权许可】

   
2015 Johnston et al.; licensee BioMed Central.

【 参考文献 】

• [1]Lunt N, Carrera P: Medical tourism: assessing the evidence on treatment abroad. Maturitas 2010, 66(1):27-32.
• [2]Smith R, Martínez Álvarez M, Chanda R: Medical tourism: a review of the literature and analysis of a role for bi-lateral trade. Health Policy 2011, 103(2–3):276-82.
• [3]Connell J: A new inequality? Privatisation, urban bias, migration and medical tourism. Asia Pac Viewp 2011, 52:260-71.
• [4]Turner L: “First world health care at third world prices”: globalization, bioethics and medical tourism. Biosocieties 2007, 2(3):303-25.
• [5]Snyder J, Crooks VA, Turner L, Johnston R, Fraser H, Kadowaki L, et al.: Caring for non-residents in Barbados: examining the implications of inbound transnational medical care for public and private health care. In Medical tourism and transnational health care. Edited by Botterill D, Pennings G, Mainil T. Palgrave Macmillan, Basingstoke; 2013:41-62.
• [6]Johnston R, Crooks VA, Snyder J, Dharamsi S: Canadian family doctors’ roles and responsibilities toward outbound medical tourists “Our true role is … within the confines of our system”. Can Fam Physician 2013, 59(12):1314-9.
• [7]Johnston R, Crooks VA, Snyder J: “I didn’t even know what I was looking for”: a qualitative study of the decision-making processes of Canadian medical tourists. Global Health 2012, 8(1):23. BioMed Central Full Text
• [8]Casey V, Crooks VA, Snyder J, Turner L: “Knowledge brokers, companions, and navigators: qualitatively examining informal caregivers’ roles in medical tourism. Int J Equity Health 2013, 12:94. BioMed Central Full Text
• [9]Connell J: Medical tourism in the Caribbean islands: a cure for economies in crisis? Island Stud J 2013, 8(1):115-30.
• [10]Ramirez de Arellano AB: Medical tourism in the Caribbean. Signs 2011, 36(2):289-96.
• [11]Zappino V. Caribbean tourism and development: An overview [http://ecdpm.org/publications/caribbean-tourism-development/]
• [12]Chambers D, McIntosh B: Using authenticity to achieve competitive in medical tourism in the English-speaking Caribbean. Third World Q 2008, 29(5):919-37.
• [13]BVI Beacon. Low-cost health centre opens in Cayman Islands [http://www.bvibeacon.com/1/index.php/news-articles-2/1569-march-20-2014/business-march-20-2014/4733-low-cost-health-centre-opens-in-cayman-islands]
• [14]International Medical Travel Journal. Bahamas, Bermuda, Caymans, Jamaica, Turks and Caicos: Developments in medical tourism in the Caribbean [http://www.imtj.com/news/?entryid82=420236]
• [15]Collinder, A. Physicians to develop Jamaica’s first “five-star” medical tourism centre. [http://jamaica-gleaner.com/latest/article.php?id=42876]
• [16]Horowitz MD, Rosensweig JA, Jones CA: Medical tourism: globalization of the healthcare marketplace. Med Gen Med 2007, 9(4):33.
• [17]Hopkins L, Labonté R, Runnels V, Packer C: Medical tourism today: What is the state of existing knowledge? J Public Health Policy 2010, 31(2):185-98.
• [18]Johnston R, Crooks VA, Snyder J, Kingsbury P: What is known about the effects of medical tourism in destination and departure countries? A scoping review. Int J Equity Health 2010, 9:24. BioMed Central Full Text
• [19]Scheyvens R, Momsen JH: Tourism and poverty reduction: issues for small island states. Tourism Geog 2008, 10(1):22-41.
• [20]PAHO. Health Systems Profile: Barbados [http://new.paho.org/hq/dmdocuments/2010/Health-System-Profile-Barbados-2008.pdf]
• [21]World Travel and Tourism Council. Travel & Tourism: Economic Impact 2014 Barbados. [http://www.wttc.org/-/media/files/reports/economic%20impact%20research/country%20reports/barbados2014.pdf]
• [22]Johnston R, Crooks VA, Snyder J, Fraser H, Labonté R, Adams K. An Overview of Barbados’ Medical Tourism Industry [http://www.sfu.ca/medicaltourism/An%20Overview%20of%20Barbados'%20Medical%20Tourism%20Industry%20-%20Version%202.0.pdf]
• [23]Eckhert NL: Perspective: private schools of the Caribbean: outsourcing medical education. Acad Med 2010, 85(4):622-30.
• [24]Mullings B: Globalization and the territorialization of the new Caribbean service economy. J Econ Geog 2004, 4(3):275-98.
• [25]Angelchik P. Medical Tourism: Barbados’ Next Big Export Services Opportunity [http://businessbarbados.com/industries/tourism/medical-tourism-barbados-export-opportunity/]
• [26]Cumberbatch S. New hospital waiting for Gov’t approval [http://www.barbadostoday.bb/2013/04/22/new-hospital-waiting-for-govt-approval/]
• [27]Ministry of Health: The health of the nation is the wealth of the nation: Barbados strategic plan for health 2002–2012. Ministry of Health, Barbados; 2003.
• [28]Ministry of Health: Draft renewed primary health care policy of Barbados 2010–2015. Ministry of Health, Barbados; 2010.
• [29]PAHO. Report of the Caribbean Commission on Health and Development [http://www.who.int/macrohealth/action/PAHO_Report.pdf]
• [30]Parker A, Tritter J: Focus group method and methodology: current practice and recent debate. Int J Res Method Educ 2006, 29(1):23-37.
• [31]Sim J: Collecting and analysing qualitative data: issues raised by the focus group. J Adv Nurs 1998, 28(2):345-52.
• [32]QSR International. NVivo Version 8.0 [Software]. [http://www.qsrinternational.com/default.aspx]
• [33]Blouin C: Trade policy and health: from conflicting interests to policy coherence. Bull World Health Organ 2007, 85:169-73.
• [34]Hanefeld J, Horsfall D, Lunt N, Smith R: Medical tourism: a cost or benefit to the NHS? PLoS One 2013, 8(10):e70406.
• [35]NaRanong A, NaRanong V: The effects of medical tourism: Thailand’s experience. Bull World Health Organ 2011, 89(5):336-44.
• [36]Ormond M: Shifting subjects of health-care: Placing “medical tourism” in the context of Malaysian domestic health-care reform. Asia Pac Viewp 2011, 52(3):247-59.
• [37]Alleyne K. Making strides in the medical tourism field [http://www.barbadosadvocate.com/newsitem.asp?more=local&NewsID=13821]
• [38]Barbados Advocate. Barbados seeking to become health care capital of the Caribbean [http://www.barbadosadvocate.com/newsitem.asp?more=3Dlocal&NewsID=24703]
• [39]Kirton W. The medical tourism niche [http://www.nationnews.com/nationnews/news/26420/medical-tourism-niche]
• [40]Sen Gupta A: Medical tourism: reverse subsidy for the elite. Signs 2011, 36(2):312-9.
• [41]Lautier M: Export of health services from developing countries: the case of Tunisia. Soc Sci Med 2008, 67(1):101-10.
• [42]Koplan JP, Bond TC, Merson MH, Reddy KS, Rodriguez MH, Sewankambo NK, et al.: Towards a common definition of global health. Lancet 2009, 373(9679):1993-5.
• [43]Rowson M, Willott C, Hughes R, Maini A, Martin S, Miranda JJ, et al.: Conceptualising global health: theoretical issues and their relevance for teaching. Global Health 2012, 8(1):36. BioMed Central Full Text
• [44]Runnels V, Turner L: Bioethics and transnational medical travel: India, “medical tourism”, and the globalisation of healthcare. Indian J Med Ethics 2011, 8(1):42-4.
• [45]Kangas B: Travel for medical care in a global world. Med Anthropol 2010, 29(4):344-62.