Published in The Daily Star on Monday, 24 August 2015.
Better health for South Asia
Dr Fahmida Khatun
Bangladeshi patients travel now more than ever before. And this is not a trend only among the affluent section, but also across middle and even lower middle class patients. India, Thailand, Singapore, the UK and the USA are common destinations for check-ups and treatment. On account of cost and geographical distance, India stands at the top not only for Bangladesh, but also for other South Asian neighbours in regards to medical and wellness tourism.
The shortage of medical facilities in these countries has led to such cross-border trade in health services in the region. But healthcare tourism is only one component of trade in health services. Telemedicine, cross border investment in health infrastructure and movement of health personnel are the other areas where collaboration amongst the South Asian countries can be strengthened.
But the prospect for higher volume of trade in health services is constrained by several factors. These relate to infrastructural, regulatory, perception-related, logistical, and cultural problems. Among various e-health tools, telemedicine is showing significant results in developed countries. Of course, implementation of these services requires high initial cost for the necessary infrastructure to be in place. Protecting the privacy and confidentiality of patient information through a legal framework is also an issue. There may be resistance from local healthcare providers for telemedicine due to apprehension of increased competition from medical professionals abroad through telemedicine.
Visa and airline connectivity problems restrict the mobility of patients to a large extent. Due to complications with visas, many patients travel on tourist visas. As a result, actual patient movement within the region is underestimated. More importantly, patients could also face complications with regard to financing and obtaining approval for treatment. Medical tourism has to be facilitated also for the movement of health personnel, physicians and specialists from one country to another. Strict policies and complicated systems for granting visas restrict mobility of health professionals in the region, limiting their attendance in seminars and conferences.
Easy regional payment arrangements and hassle free settlement of financial matters are pre-conditions for encouraging medical tourism. There must be a common health insurance product in the region. A framework for the portability of health insurance needs to be developed so that patients can use an insurance policy for treatment anywhere in the region. The other issue is the modality of bill payment. For the convenience of patients, rates for different treatments and procedures at various hospitals in the region should be fixed. The possibility of reimbursing bills through hospitals, banks and insurance companies in the region may be explored. Promotion of medical tourism also requires the availability of related services, such as accommodation and transportation, at an affordable price.
Commercial presence through building of establishments such as hospitals, clinics, diagnostics and treatment centres, and nursing homes is another area for collaboration in health services. There are, of course, risks attached to such initiatives. Domestic healthcare providers fear that FDI inflow in the health sector could stifle demand for their services and lead to capital flight and profit outflow. This could reduce net income from abroad and lead to a negative impact on the balance-of-payments situation of countries. Since governments of the region have limited resources for the development of the health sector, investments through public-private-partnerships could be an option too. However, the gap between the two-tier health care system, where the poor rely on government hospitals which traditionally provide low quality service, while the rich avail modern health care facilities provided by the private sector, should be minimised through measures by respective governments. The poor should be provided with basic healthcare services at free or low cost by governments to reduce the inequality.
For improved health services, investment is also required on capacity building of health professionals. Regional cooperation and skills transfer issues such as visa and harmonisation of professional standards are needed for capacity building. Understandably, there is political sensitivity in making SAARC a visa free region. But visa requirements for travelling patients can, at least, be minimised. The reputation of health services in the region can be improved by harmonisation of professional standards and recognition of qualifications as well as accreditation of hospitals and other medical establishments. This could potentially increase health tourism in the region from other countries as well.
In the end, it is of course dependent on how the leaders of the South Asian countries envision the health sector of the region as a whole. First and foremost, countries have to commit to liberalise their health sectors under the General Agreement of Trade in Services of the WTO. Only India, Nepal and Pakistan have made commitments in a few sub-sectors of health services. The SAARC Agreement on Trade in Services, adopted during the 16th SAARC Summit, is a leap forward towards progressive liberalisation of trade in services.
The world, by 2030, wants to “ensure healthy lives and promote well-being for all at all ages”. South Asia, which scores poorly in case of Human Development Index, with high infant mortality and low average life expectancy, should gear up its efforts towards achieving this ambitious objective under Sustainable Development Goals through increased regional integration in the health sector.
The writer is Research Director at the Centre for Policy Dialogue, currently a Visiting Scholar at the Centre for Study of Science, Technology & Policy, India.