President Biden's Africa policy

Joe Biden’s administration has committed to transforming America’s relationships across the globe. This period of reform presents the opportunity for a long-overdue reimagination of America’s policy in Sub-Saharan Africa. In this Strategic Update, Rebecca Rattner and Bjorn Whitmore argue a successful new relationship between America and Sub-Saharan Africa must rely on genuine partnership, support to local actors, and strong regional institutions. Their piece considers how to apply these principles in practice by examining the nuanced socio-political realities in East, West, Central, and Southern Africa

A Qualitative Exploration of how Canadian Informal Caregivers in Medical Tourism use Experiential Resources to Cope with Providing Transnational Care

Canadians travelling abroad for privately arranged surgeries paid for out-of-pocket are engaging in what  has come to be known as medical tourism. They are often accompanied by friends or family members, who we call caregiver-companions. Caregiver-companions provide care in and across a variety of formal and informal settings, such as in hotels, airplanes and at home. This qualitative study examines the experiences  of informal caregivers in medical tourism to learn more about the lived experiences or ‘experiential  resources’ they draw upon to cope with providing care and avoiding caregiver burden. The care-giving literature has demonstrated that such burden can negatively impact caregivers’ well-being. The unique, transnational context of care-giving in medical tourism and recent growth in popularity of this practice means that there are few supports or resources currently in place to assist informal caregivers. In this article, we report on an analysis that sought to detail how caregiver-companions draw upon their previous lived experiences to cope with providing transnational care and to minimise or avoid the onset of caregiver burden. We conducted semi-structured telephone interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery between September 2013 and January 2014. Thematic analysis revealed the ways that participants had developed practical strategies to deal with the challenges they faced in medical tourism. The interviews revealed three important experiential resources drawn upon by participants: (i) previous experiences of international travel; (ii) previous experiences of informal care-giving; and (iii) dimensions of the existing relationship with the care recipient. Differences in access to and use of these experiential resources related to participants’ perspectives on medical tourism and the outcomes of the trip. By identifying the experiential resources drawn upon by informal caregivers in medical tourism, we  can more effectively identify supportive interventions

Ethics of Care in Medical Tourism: Informal Caregivers\u27 Narratives of Responsibility, Vulnerability and Mutuality

This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists

Exploring Informal Caregivers’ Roles in Medical Tourism through Qualitative Data Triangulation

When Canadian medical tourists go abroad, they are often accompanied by friends and family, referred to as caregiver-companions, who provide informal care. These individuals play a role in patient decision-making and are stakeholders in medical tourism, yet little is known about their participation in this consumer health practice. To examine the roles that Canadian caregiver-companions play while accompanying medical tourists abroad, and to identify how multi-perspective qualitative data can augment our understanding of these roles, primary and secondary analysis was undertaken on datasets generated from multiple qualitative studies: semi-structured interviews with medical tourists, caregiver-companions, and international patient coordinators, and a survey with medical tourism facilitators. The findings from the triangulated analysis of these qualitative datasets serve to better understand the multiple, overlapping perspectives of different stakeholders in medical tourism. Results show that medical tourism caregivers act as companions, providing physical and emotional care; navigators, providing logistical assistance; and knowledge brokers, participating in decision-making and information exchange between medical tourists and professionals. Using data triangulation to examine the narratives of multiple stakeholders confirmed, altered, and augmented our knowledge of caregiver-companion roles. The unique perspectives offered by each participant group augment our understanding of caregiver roles and the practice of medical tourism

“The Major Forces that Need to Back Medical Tourism Were ... in Alignment”: Championing Development of Barbados’s Medical Tourism Sector

Governments around the world have expressed interest in developing local medical tourism sectors, framing the industry as an opportunity for economic growth and health system improvement. This article addresses questions about how the desire to develop a medical tourism sector in a country emerges and which stakeholders are involved in both creating momentum and informing its progress. Presenting a thematic analysis of 19 key informant interviews conducted with domestic and inter-national stakeholders in Barbados’s medical tourism sector in 2011, we examine the roles that “actors” and “champions” at home and abroad have played in the sector’s development. Physicians and the Barbadian government, along with international investors, the Medical Tourism Association, and development agencies, have promoted the industry, while actors such as medical tourists and international hospital accreditation companies are passively framing the terms of how medical tourism is unfolding in Barbados. Within this context, we seek to better understand the roles and relationships of various actors and champions implicated in the development of medical tourism in order to provide a more nuanced understanding of how the sector is emerging in Barbados and elsewhere and how its development might impact equitable health system development.&nbsp

Medical Tourism in the Tropics: New Regulation is Needed to Tackle Equity and Quality Concerns in Barbados

Medical tourism is on the rise as many patients travel overseas to seek private medical care that is either more expensive, unavailable or requires long waiting periods in their home country. Barbados, a small Caribbean island actively planning for medical tourism industry development, faces common challenges affecting destination countries such as degraded local access to healthcare, and possible brain drain of domestic medical workers. To address such concerns, the government must navigate both legal and ethical obstacles to develop effective regulatory mechanisms for their emerging medical tourism sector.  &nbsp

Medical Tourism\u27s Impacts on Health Worker Migration in the Caribbean: Five Examples and Their Implications for Global Justice

Medical tourism is a practice where individuals cross international borders in order to access medical care. This practice can impact the global distribution of health workers by potentially reducing the emigration of health workers from destination countries for medical tourists and affecting the internal distribution of these workers. Little has been said, however, about the impacts of medical tourism on the immigration of health workers to medical tourism destinations. We discuss five patterns of medical tourism-driven health worker migration to medical tourism destinations: 1) long-term international migration; 2) long-term diasporic migration; 3) long-term migration and ‘black sheep’; 4) short-term migration via time share; and 5) short-term migration via patient-provider dyad. These patterns of health worker migration have repercussions for global justice that include potential negative impacts on the following: 1) health worker training; 2) health worker distributions; 3) local provision of care; and 4) local economies. In order to address these potential negative impacts, policy makers in destination countries should work to ensure that changes in health worker training and licensure aimed at promoting the medical tourism sector are also supportive of the health needs of the domestic population. Policy makers in both source and destination countries should be aware of the effects of medical tourism on health worker flows both into and out of medical tourism destinations and work to ensure that the potential harms of these worker flows to both groups are mitigated

Consumer Cost-Sharing in Marketplace vs. Employer Health Insurance Plans, 2015

Using data from 49 states and Washington, D.C., we analyzed changes in costsharing under health plans offered to individuals and families through state and federal exchanges from 2014 to 2015. We examined eight vehicles for cost-sharing, including deductibles, copayments, coinsurance, and out-of-pocket limits, and compared findings with cost-sharing under employer-based insurance. We found cost-sharing under marketplace plans remained essentially unchanged from 2014 to 2015. Stable premiums during that period do not reflect greater costs borne by enrollees. Further, 56 percent of enrollees in marketplace plans attained cost-sharing reductions in 2015. However, for people without cost-sharing reductions, average copayments, deductibles, and out-of-pocket limits under catastrophic, bronze, and silver plans are considerably higher than under employerbased plans on average, while cost-sharing under gold plans is similar employer-based plans on average. Marketplace plans are far more likely than employer-based plans to require enrollees to meet deductibles before they receive coverage for prescription drugs

Optically pure heterobimetallic helicates from self-assembly and click strategies

Single diastereomer, diamagnetic, octahedral Fe(II) tris chelate complexes are synthesised that contain three pendant pyridine proligands pre-organised for coordination to a second metal. They bind Cu(I) and Ag(I) with coordination geometry depending on the identity of the metal and the detail of the ligand structure, but for example homohelical (ΔFe,ΔCu) configured systems with unusual trigonal planar Cu cations are formed exclusively in solution as shown by VT-NMR and supported by DFT calculations. Similar heterobimetallic tris(triazole) complexes are synthesised via clean CuAAC reactions at a tris(alkynyl) complex, although here the configurations of the two metals differ (ΔFe,ΛCu), leading to the first optically pure heterohelicates. A second series of Fe complexes perform less well in either strategy as a result of lack of preorganisation

Inbound Medical Tourism to Barbados: A Qualitative Examination of Local Lawyers’ Prospective Legal and Regulatory Concerns

Background Enabled by globalizing processes such as trade liberalization, medical tourism is a practice that involves patients’ intentional travel to privately obtain medical care in another country. Empirical legal research on this issue is limited and seldom based on the perspectives of destination countries receiving medical tourists. We consulted with diverse lawyers from across Barbados to explore their views on the prospective legal and regulatory implications of the developing medical tourism industry in the country. Methods We held a focus group in February 2014 in Barbados with lawyers from across the country. Nine lawyers with diverse legal backgrounds participated. Focus group moderators summarized the study objective and engaged participants in identifying the local implications of medical tourism and the anticipated legal and regulatory concerns. The focus group was transcribed verbatim and analyzed thematically. Results Five dominant legal and regulatory themes were identified through analysis: (1) liability; (2) immigration law; (3) physician licensing; (4) corporate ownership; and (5) reputational protection. Conclusions Two predominant legal and ethical concerns associated with medical tourism in Barbados were raised by participants and are reflected in the literature: the ability of medical tourists to recover medical malpractice for adverse events; and the effects of medical tourism on access to health care in the destination country. However, the participants also identified several topics that have received much less attention in the legal and ethical literature. Overall this analysis reveals that lawyers, at least in Barbados, have an important role to play in the medical tourism sector beyond litigation – particularly in transactional and gatekeeper capacities. It remains to be seen whether these findings are specific to the ecology of Barbados or can be extrapolated to the legal climate of other medical tourism destination countries