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Tourist Attraction

Health tourism seems to be the topic of the hour. Various politicians, and now even surgeons, in the UK have complained that patients from abroad – both legal and illegal – are queue-jumping and demanding treatment before those already on surgeons’ lists. On the other hand, we have various UK health authorities floating the possibility of sending their patients abroad, especially to the Indian subcontinent, for treatment which is regarded as comparable to that in the UK and significantly cheaper. Thus, these authorities feel that they will be able to save money while cutting down waiting lists. This seems to me to be a rather contradictory state of affairs, with patients from outside the UK displacing British patients, who will in turn be sent to hospitals outside the UK for their treatment.

Living in France, as I do, I am accused light-heartedly by friends of health tourism myself, since I take advantage of the French healthcare system when necessary. I point out to them that for every British person who seeks treatment in France there is, in all probability, a French person who seeks treatment in the UK. I had thought there was some sort of cross-charging mechanism between French and UK healthcare systems, but apparently there is not, and it is left to individual hospitals to try and recover the costs of treatment from the country of origin of patients within the European Union (EU) – a process which seems to be convoluted and inefficient.

Nobody actually seems to know with any accuracy how many citizens of any given EU country live in another country. For example, The Guardian newspaper has recently reported that in the UK there may be 123,000 French inhabitants, whereas in France there are 150,000 UK citizens. Spain still holds a draw for many Brits, as 390,880 are said to inhabit the country, whereas the Spanish, it seems, prefer to settle in France. With over 550,000 Italian people, Germany seems a popular choice for their European friends. However, in France and many other countries, it is not a requirement for foreign residents to register and so, at best, these figures must be approximations. Indeed, estimates of UK citizens living in Nord Pas de Calais range from 200 to 20,000.

The Guardian’s figures indicate that there are up to 1.5 million EU foreigners living in France, Germany or the UK – probably no more than two per cent of the total population. Although, in specific cases, these foreigners may be regarded as a drain on local resources, their numbers – however large – make very little impact on the overall health budget. So perhaps we should not worry about health tourism within the EU.

This issue of EPC contains articles on conducting clinical research in non- Western countries, notably non-EU Eastern Europe and the Middle East. I have commented earlier on studies being carried out in China and India, and although this is not strictly health tourism, it is clinical research tourism, where those in the West are looking for Third World or developing country citizens to act as guinea pigs in investigating new medicines. I recall a US Drug Information Association meeting where clinical research in women was being discussed; one female activist complained vigorously that medicines were disproportionately tested on men but, when challenged on her viewpoint, she said that she did not want US women to be put at risk by such “dangerous experimental medicines” – clearly, you can’t have it both ways.

The British like to think that the National Health Service is the envy of the world, but it is notable that no other country which has been in a position to has emulated it. When Eastern European countries emerged from communism they all instituted a compulsory insurance system which paid the full cost of medical treatment and, in many cases, these regimes now have superior survival rates in diseases such as cancer and heart disease. I must say I rather like the old-fashioned Chinese system where you paid the doctor when you were well, and if you were ill you received free treatment on the assumption that the physician had failed to keep you well. So health tourism is probably, in the grand scheme of things, a minor issue – unless, of course, you are affected by it individually and your place in the queue is taken by a Somali asylum seeker and you are subsequently sent to a clinic in southern India to have your cataract removed.

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Graham Hughes
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