In my news feed I noticed an item posted today from the International Medical Travel Journal about some new visa exemptions for medical tourists. The story says “The new regulations allow nationals from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE, to stay in Thailand for medical treatment up to 90 days without a visa.” It also says that up to three people many acompany the patient and receive the same visa exemption.

That sounded familiar to me. In fact, I thought this already existed. So I searched a little and yes indeed, this “new” visa exemption was approved back in August of last year. There is a story about it in The Nation (link). That story says four relatives can travel with the patient and receive the same exemption.

So, not news. It’s been in place for a while. It will be interesting to see if the number of arrivals from those countries jumps.

I couldn’t pass up posting about this subject when I saw it in my Yahoo news feed. In addition to the increase of all types of medical tourism around the world there are also some specialized combinations of vacations and medical services. The idea is to enable people with chronic medical conditions who would not otherwise be able to travel to enjoy the same vacations as healthy people. Take dialysis patients, for example. You would need to do a lot of planning and be very confident in your connections for dialysis treatment at your destinations before you committed to an extended trip. An enterprising company called Holiday Dialysis International is addressing this issue.

The dialysis cruise concept is one of their packages. They also arrange other vacations to popular destinations where dialysis can be arranged reliably. A spokesperson for the company said they have arranged dialysis in Philippines, Senegal, Kenya and Thailand. We know that Thailand is a high quality and popular medical tourism destination so that is not a big surprise. But Kenya and Senegal? Very interesting. For their cruises the company sets up dialysis wards and a specialist doctor on board.

One could envision an extension of this concept to medical tourism centers located on ships in international waters, similar to the idea of the ship-based entrepreneurial center being contemplated by some Silicon Valley people. The advantage is that the centers, whether engineering or medical, are located in international waters and not subject to the things that drive costs through the roof, like excessive regulation, politically motivated barriers to competition, immigration barriers, etc. I think this idea has legs and could be a boon for people who want to get medical treatment overseas but feel it is just too far to go and too costly. Instead, a short boat ride and it’s as if you are in a far away country in terms of instantly available medical treatments and their costs.

There have been numerous discussions on the possible impact of medical care on a country’s public medical services. Of particular concern to some people is the possibility that the residents of poor countries could face shortages of doctors and hospital beds due to “rich” foreign patients utlizing them. The presumed mechanism is that the lucractive medical tourism trade will draw doctors and nurses to private hospitals, leaving public hospitals understaffed. Detractors are not yet certain if the extra revenue foreign patients bring into a country helps or hurts public medicine – the funds flows are hard to analyze but certainly there are increased tax revenues. Those increased tax funds could be used to boost public health care systems but could also be spent on further promoting medical tourism to a country so the benefits can accrue in either area.

But it isn’t just poor countries that may face issues exacerbated by medical tourist inflows. Singapore, for example, has been experiencing some shortages of hospital beds at public medical facilities. According to an article in the Straits Times on Februay 18, 70% of foreign patients utilize private hospitals in Singapore while the other 30% go to public hospitals. If there is already overcrowding at public facilities then this is certainly contributing to the problem. What I don’t know is if the foreign patients, who are presumably paying out of pocket since they would not be covered by national health insurance, are getting priority treatment and negatively impacting the locals.

I am wondering if the public hospitals in Singapore have something similar to the “private clinic hours” like Thailand public hospitals. Siriraj Hospital, Thailand’s national hospital and the country’s oldest and largest, has these private clinic hours at many of it’s specialty centers. These are usually evening hours for patients who pay out of pocket. During the day the clinics receive Thais who are covered under the national health plan. The cost is nearly nil so the demand is naturally large and therefore the crowds huge and wait times are long. During the private clinic hours the crowds and wait times are smaller. The staff is also different, at least in the clinic’s I have visited. The doctors and nurses from the day shift leave and a new team comes in for the evening. The question would be if medical tourists use these private clinic hours and if that detracts from the public’s health care. Based on what I saw the answer is no – other than myself there were no other foreigners any of the times I visited.

Singapore may be quite different. The language barrier keeps non-Thai speakers away from the public hospitals in Thailand. The staff don’t speak much English. Even learning about the availability of the special clinic hours is unlikely since the hospital don’t advertise it in English. Public hospitals in Singapore are probably much more accessible to English speakers so that alone makes a big difference.

Two news stories that I have been meaning to write about for some time that deal with the issue of governments interfering with people traveling for medical care. In one case a poor country with inadequate medical facilities at home is moving to prevent outbound medical tourism. In another a detailed study was published that considers why and how rich countries might introduce obstacles to outbound medical tourism.

In the first case, Nigeria is moving to stop the practice of paying for government officials to obtain medical treatment in other countries. The Nigerian finance minister says up to $200 million could be saved annually if Nigerians sought medical care in their home country. That substantial sum would be instead invested in improving local hospitals, doctors and patient care. South Africa and India have been the preferred choices for Nigerians traveling abroad for medical care. But the House of Representatives has become increasing vocal about preventing the flow of government funds abroad, resulting in depletion of foreign reserves and stagnation of the countries healthcare infrastructure.

In the other case, a study looks at outbound medical tourism’s effect on rich countries and although the impact is less than in Nigeria due to these being “rich” (ignoring their overwhelming debt for the moment) they are still out for a money grab to trap their citizens into their home countries’ bloated, inefficient and overpriced medical care systems. With the continued onslaught against personal freedoms in the “free” world it will be no surprise when some sort of restrictions are attempted. While some people are positive on medical tourism as a free market alternative to the ruinous Obamacare legislation I think they underestimate the determination of government to trap it’s citizen.