Policy Implications of Medical Tourism Development in Destination Countries: Revisiting and Revising an Existing Framework by Examining the Case of Jamaica

Background: Medical 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\u27s 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.   Methods: Employing 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\u27s framework to identify overlapping and divergent issues.   Results: Many of the issues identified in Pocock and Phua\u27s 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.   Conclusions: The 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\u27s design does not lend itself to explaining how the underlying health system factors it identifies work to facilitate medical tourism\u27s development or how the specific impacts of the practice are likely to unfold. &nbsp

Medical tourism from the UK to Poland : how the market masks migration

Much medical travel happens, but it is misleading to label it as ‘medical tourism’. Rather, patterns of travel reflect a range of drivers: from longstanding cultural, economic and political ties to the country providing treatment, to word-of-mouth networks. Poland provides a particularly interesting case, as it has been touted as the leading medical tourism destination for UK medical travellers in Europe; marketing by Polish providers is advanced and there is strong government support for the industry. In this paper examining data from the UK's International Passenger Survey for the past 15 years, we demonstrate that, while travel to Poland has indeed increased dramatically, much of this actually reflects a wider pattern of Polish migrants living in the UK and returning to Poland for medical care rather than increased ‘medical tourism’ consumer activity by Britons in Poland

Risk entrepreneurship and the construction of healthcare deservingness for ‘desirable’, ‘acceptable’ and ‘disposable’ migrants in Malaysia

In recent years, scholars have focused on the concept of healthcare deservingness, observing that healthcare professionals, state authorities and the broader public make moral judgements about which migrants are deserving of health care and which are not. This literature tends to focus on migrants with irregular status. This article examines how state calculations of healthcare deservingness have also been applied to authorised migrants. Focusing on Malaysia, we examine the ways in which state authorities construct migrants as ‘desirable’, ‘acceptable’ and ‘disposable’, differentiated through calculations of their biological and economic risks and potential contribution to ‘the nation’. To do this, we analyse recent government and commercial policies, plans and practices to reflect on how such biopolitical orderings create the conditions for risk entrepreneurship – where public and private actors capitalise on profit-making opportunities that emerge from the construction of risky subjects and risky scenarios – while reinforcing hierarchies of healthcare deservingness that exacerbate health inequalities by privileging migrants with greater economic capital and legitimising the exclusion of poor migrants

International medical travel and the politics of therapeutic place-making in Malaysia

Electronic version excludes material for which permission has not been granted by the rights holderThis thesis examines the shifting relationship between the state and its subjects with regard to responsibility for and entitlement to care. Using Malaysia as a case study the research engages with international medical travel (IMT) as an outcome of the neoliberal retrenchment of the welfare state. I offer a critical reading of postcolonial development strategies that negotiate the benefits and challenges of extending care to non-national subjects. The research draws from relevant media, private-sector and governmental documents and 49 semi-structured, in-depth interviews with IMT proponents and critics representing federal, state and urban governmental authorities, professional associations, civil society, private medical facilities and medical travel agencies in Malaysia’s principal IMT regions (Klang Valley, Penang and Malacca). Across four empirical chapters, the thesis demonstrates how ‘Malaysia’ gets positioned as a destination within a range of imagined geographies of care through a strategic-relational logic of care and hospitality. I argue that this positioning places ‘Malaysian’ subjects and spaces into lucrative global networks in ways that underscore particular narratives of postcolonial hybridity that draw from Malaysia’s ‘developing country’, ‘progressive, moderate Islamic’ and ‘multiethnic’ credentials. In considering the political logics of care-giving, I explore how the extension of care can serve as a place-making technology to re-imagine the state as a provider and protector within a globalising marketplace in which care, increasingly commodified, is tied to the production of new political, social, cultural and economic geographies

Adoption, genealogical bewilderment and biological heritage bricolage

Closed adoptions – where birth and adoption records are legally sealed to obscure adoptees’ biological parentage – were once the norm in many Western Anglophone countries. Grassroots resistance to closed adoption relied upon the belief that deprivation of knowledge of their true biological origins could lead to psychological trauma among adoptees. In this chapter, the author reflects on her own mother’s sense of deprivation, her desire for a coherent origin story and her consequent process of cobbling together disparate analogue, digital and biotechnical fragments of legally, religiously, scientifically, commercially and familiarly authorised and authorising heritages from among diverse resources rendered intelligible, relevant and truthful by societal and (bio)technological transformations over time. In so doing, the author calls attention to complicated power relations in everyday personal heritage practices that challenge the simplistic pitting of ‘heritage from below’ (Iain Robertson, Heritage from Below, 2012) against ‘Authorised Heritage Discourse’ (AHD) (Laurajane Smith, Uses of Heritage, 2006)

Transnational medical travel: : Patient mobility, shifting health system entitlements and attachments

Transnational medical travel -- the temporary movement by patients across national borders in order to address medical concerns abroad that are unable to be sufficiently met within their countries of residence -- is an important therapeutic coping strategy used by growing proportions of peoples with a diverse range of mobility profiles and intensities of global moorings. Studying this phenomenon provides useful insight into the rapidly globalising era of health governance, where an ever-wider array of state and non-state actors are transcending the increasingly restrictive national containerisations of health care and engaging in cross-border action to effectively address contemporary health challenges at both individual and collective levels. In our introduction to this special issue on transnational medical travel, we draw on both ‘medical tourism’ and migrant health scholarship to acknowledge the diversity of motivations among migrant and non-migrant patients alike and the complex nature of mobile patients’ attachments to the multiple places in which they seek care. We then bring attention to how dynamic structural issues in mobile patients’ countries of residence and destination shape their attachments to places and health systems over time, examining the linkages between vitality of the political and social systems in these places to which they are differently attached and their dis/satisfaction and dis/enfranchisement with them