Qadeer Imrana, Reddy Sunita
Center of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, New Delhi 110067, India.
Philos Ethics Humanit Med. 2013 Dec 17;8:20. doi: 10.1186/1747-5341-8-20.
Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.
印度现代医学的资深医生在政策制定、舆论引导和机构管理方面发挥着关键作用。本文探讨了他们对印度国内医疗旅游（MT）的看法，这是一个复杂的过程，涉及国际需求以及从医疗服务到医疗保健商业化的政策转变，目的是实现贸易、国内生产总值增长和外汇收入。通过对印度三个城市三级护理医院的91名医生进行访谈，本文探讨了四个关注点：他们对医疗旅游的理解、对所在医院的看法、对医疗旅游在其医院中的价值和地位的认知，以及他们对医疗旅游对该国医疗保健影响的看法。绝大多数（90%）私立三级医疗部门的医生以及74.3%公立三级医疗部门的医生认为印度私立三级医疗部门在医疗旅游方面有巨大潜力。私立三级医疗部门的医生只关心自己的病人，认为穷人的健康是国家的责任。然而，公立三级医疗部门的医生对普通人的问题很敏感，并感到有责任。尽管与医疗旅游相关的高科技魅力让他们眼花缭乱，但只有35.8%的人希望在自己的医院开展医疗旅游，总共有56%的人表示医疗旅游不能成为公共部门的优先事项。10%的私立部门医生对医疗旅游表示保留意见，其余的则要求国家对医疗旅游提供补贴。他们对普通人的关注与专业人士对医疗旅游的看法之间的脱节，是由于对商业化、公立医院资源匮乏以及补贴转向私立部门之间的连续性缺乏认识。本文强调了两组医生看法和背景的异同，提出了质疑对医疗旅游支持的证据，最后分析了医疗旅游对印度医疗服务的一些关键影响、由此产生的伦理问题，以及理解公私部门之间联系以制定更有效的公平医疗政策干预措施的必要性。
