Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Global Health. 2011 May 3;7:11. doi: 10.1186/1744-8603-7-11.
Globalisation has prompted countries to evaluate their position on trade in health services. However, this is often done from a multi-lateral, rather than a regional or bi-lateral perspective. In a previous review, we concluded that most of the issues raised could be better addressed from a bi-lateral relationship. We report here the results of a qualitative exercise to assess stakeholders' perceptions on the prospects for such a bi-lateral system, and its ability to address concerns associated with medical tourism.
30 semi-structured interviews were carried out with stakeholders, 20 in India and 10 in the UK, to assess their views on the potential offered by a bi-lateral relationship on medical tourism between both countries. Issues discussed include data availability, origin of medical tourists, quality and continuity of care, regulation and litigation, barriers to medical tourism, policy changes needed, and prospects for such a bi-lateral relationship.
The majority of stakeholders were concerned about the quality of health services patients would receive abroad, regulation and litigation procedures, lack of continuity of care, and the effect of such trade on the healthcare available to the local population in India. However, when considering trade from a bi-lateral point of view, there was disagreement on how these issues would apply. There was further disagreement on the importance of the Diaspora and the validity of the UK's 'rule' that patients should not fly more than three hours to obtain care. Although the opinion on the prospects for an India-UK bi-lateral relationship was varied, there was no consensus on what policy changes would be needed for such a relationship to take place.
Whilst the literature review previously carried out suggested that a bi-lateral relationship would be best-placed to address the concerns regarding medical tourism, there was scepticism from the analysis provided in this paper based on the over-riding feeling that the political 'cost' involved was likely to be the major impediment. This makes the need for better evidence even more acute, as much of the current policy process could well be based on entrenched ideological positions, rather than secure evidence of impact.
全球化促使各国对其在卫生服务贸易方面的立场进行评估。然而，这通常是从多边角度进行的，而不是从区域或双边角度进行的。在之前的一次审查中，我们得出结论，大多数提出的问题可以从双边关系中得到更好的解决。我们在此报告一项定性研究的结果，评估利益相关者对建立这样一个双边体系的前景及其解决与医疗旅游相关的问题的能力的看法。
在印度和英国各进行了 30 次半结构化访谈，与利益相关者评估两国之间医疗旅游双边关系的潜力及其解决医疗旅游相关问题的能力。讨论的问题包括数据可用性、医疗游客来源、医疗质量和连续性、监管和诉讼、医疗旅游障碍、政策变化的必要性以及这种双边关系的前景。
大多数利益相关者都对患者在国外接受的医疗服务质量、监管和诉讼程序、缺乏医疗连续性以及这种贸易对印度当地人口获得的医疗保健的影响表示担忧。然而，从双边角度考虑贸易时，对这些问题的适用情况存在分歧。对于侨民的重要性以及英国的“规则”（即患者不应飞行超过三个小时接受治疗）的有效性，也存在分歧。尽管对印英双边关系的前景存在不同意见，但对于建立这种关系需要进行哪些政策变革，没有达成共识。
虽然之前进行的文献综述表明，双边关系最适合解决医疗旅游相关的问题，但从本文提供的分析来看，存在怀疑，主要障碍很可能是涉及的政治“成本”。这使得对更好证据的需求更加迫切，因为当前的政策制定过程很可能是基于既定的意识形态立场，而不是对影响的可靠证据。
