Medical tourism in India – in whose interest?

• Date: 20 June 2016
• Published date: 20 June 2016
• Pages: 115-133
• DOI: https://doi.org/10.1108/JITLP-01-2016-0005
• Author: Swati Gola
• Subject Matter: Strategy,International business,International business law,Economics,International economics,International trade

Medical tourism in India – in

whose interest?

Swati Gola

School of Law, University of Manchester, Manchester, UK

Abstract

Purpose – The present paper aims to analyse who actually benets from the policies to promote

international trade in healthcare services through medical tourism in India. It also assesses the

implications of unfettered and unchecked medical tourism for public health policy-making.

Design/methodology/approach – The research methodology adopted in this paper is

inter-disciplinary (socioeconomic and legal) and includes a mix of doctrinal and empirical qualitative

research.

Findings – The present paper argues that in the absence of any baseline data in the public domain on

inbound trafc of tourists visiting India on medical tourism, it is difcult to assess and evaluate the

private sector claims and that the absence of any format for data collection, management and analysis

results in questionable accountability and institutional fragmentation and non-coordination.

Furthermore, it results in asymmetrical policy-making in areas like international trade, which may have

unintended negative effects for public health.

Research limitations/implications – The research ndings of the present paper will also assist

other developing countries considering to promote medical tourism to learn lessons from India’s

experiences.

Originality/value – The present paper uses the qualitative empirical research conducted by the

author to analyse the state of affair of medical tourism in India.

Keywords Medical tourism, Adaptive governance, GATS, Public health

Paper type Research paper

Introduction

Medical tourism, also known as health tourism, refers to situations where the patients

from one country travel to another country to receive medical treatment. Although

medical tourism has been around during much of the twentieth century as a “novelty”,

the inclusion of services within the auspices of the World Trade Organisation (WTO)

made it a global phenomenon (McLean, 2008). Medical tourism corresponds to the

“consumption of healthcare services abroad” under Mode 2 of the General Agreement on

Trade in Services (GATS). This mode relates to the export of healthcare services, like

specialised, high-quality treatments or diagnostics, to the afuent and privileged

patients who travel to the country of the service provider to use these services, which

may either not be available in their home countries or, if available, may not be of a

sufciently good standard (Chanda, 2002). Thus, medical tourism merges two aspects of

international trade in service, i.e. tourism and healthcare services, as these are exported

by the host country within its own boundaries to the patients travelling there to

purchase and consume the same (Medhekar, 2013).

A number of industry studies have claimed the potential of medical tourism for

revenue generation in India (Confederation of Indian Industry & McKinsey, 2002;

The current issue and full text archive of this journal is available on Emerald Insight at:

www.emeraldinsight.com/1477-0024.htm

Medical

tourism in

India

115

Received 27 January 2016

Revised 4 April 2016

Accepted 18 May 2016

Journalof International Trade Law

andPolicy

Vol.15 No. 2/3, 2016

pp.115-133

©Emerald Group Publishing Limited

1477-0024

DOI 10.1108/JITLP-01-2016-0005

RNCOS Business Consultancy Services, 2013). However, the present paper argues that

in the absence of any baseline data in the public domain on inbound trafc of tourists

visiting India on medical tourism, it is not only difcult to assess and evaluate the

private sector claims but also that the absence of any format for data collection,

management and analysis results in questionable accountability and institutional

fragmentation and non-coordination. This further results in asymmetrical

policy-making in areas like trade in healthcare services which may have unintended

negative effects for public health. The paper concludes with recommending

evidence-based adaptive health governance model in public health governance to

monitor outcomes and enable institutions, laws and policies to be appropriately exible.

Such models of health governance will help developing countries formulate trade in

healthcare policies that ensure reversibility in light of evolving learning and evidence.

Method

The research method adopted in this paper is inter-disciplinary (socioeconomic and

legal) and includes a mix of doctrinal and empirical qualitative research. Using the

empirical, reality testing approach to knowledge, socioeconomics recognises the

pervasive and powerful inuence of the neo-classical paradigm on contemporary

thought (Ashford, 2004). It thus seeks to examine and test assumptions and predictions

of the neoclassical economic paradigm, develop a rigorous understanding of its

limitations, improve upon its application and develop alternative approaches (Ashford,

1997). With the objective to test the neoliberal assumption that economic gains of trade

liberalisation will “trickle down” to the lowest segment of the society, the present paper,

using the case study method, examines and evaluates the effectiveness of medical

tourism in light of the industry and the government’s claims in India. The case study

method is concerned with the complexity and particular nature of a case and entails the

detailed and intensive analysis of a single case (Bryman, 2008). The term “case”

associates the case study with a location, community or organisation, which, in the

present case, is India.

Given that there are hardly any data on medical tourists in the public domain, an

attempt was made to gather as much information on medical tourism as possible,

including both primary and secondary data sources, to assess the ground realities and

implications of medical tourism in India. This process included collection of

administrative and policy information related to medical tourism from the relevant

ministries, using the Right to Information Act (RTI) 2005. Freedom of information is

increasingly recognised as a powerful research tool in academic investigations,

especially when studying agencies that are data-rich but reluctant to publicise (Brown,

2009). Written enquiries were then made with regard to foreign visitors visiting India on

medical/medical attendant visas between June 2005 and December 2011, policies related

to medical tourism, foreign exchange earned through medical tourism or other touristic

activities undertaken by these visitors and other policies on public and private

initiatives in hospital services. In addition, administrative data were collated via various

sources of secondary data that include reports of the various Union and State Ministries,

the National Planning Commission, National Health Policies, Ministries’ responses to

questions asked in Parliament, studies carried out for the government agencies and the

publications of independent agencies. Applying the documentary content analysis

method, all the ofcial responses, policy documents and administrative reports were

JITLP

15,2/3

116