Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
School of Epidemiology and Public Health, University of Ottawa, Alta Vista Campus, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
Hum Resour Health. 2019 Jul 12;17(1):53. doi: 10.1186/s12960-019-0395-z.
Medical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The commodification and export of private health services is often promoted due to perceived economic benefits. Research indicates growing concern for health inequities caused by medical tourism, which includes its impact on health human resources, yet little research addresses the impacts of medical tourism on health human resources in destination countries and the subsequent impacts for health equity. To address this gap, we use a case study approach to identify anticipated impacts of medical tourism sector development on health human resources and the implications for health equity in Guatemala.
After undertaking an extensive review of media and policy discussions in Guatemala's medical tourism sector and site visits observing first-hand the complex dynamics of this sector, in-depth key informant interviews were conducted with 50 purposefully selected medical tourism stakeholders in representing five key sectors: public health care, private health care, health human resources, civil society, and government. Participants were identified using multiple recruitment methods. Interviews were transcribed in English. Transcripts were reviewed to identify emerging themes and were coded accordingly. The coding scheme was tested for integrity and thematic analysis ensued. Data were analysed thematically.
Findings revealed five areas of concern that relate to Guatemala's nascent medical tourism sector development and its anticipated impacts on health human resources: the impetus to meet international training and practice standards; opportunities and demand for English language training and competency among health workers; health worker migration from public to private sector; job creation and labour market augmentation as a result of medical tourism; and the demand for specialist care. These thematic areas present opportunities and challenges for health workers and the health care system.
From a health equity perspective, the results question the responsibility of Guatemala's medical education system for supporting an enhanced medical tourism sector, particularly with an increasing focus on the demand for private clinics, specific specialities, English-language training, and international standards. Further, significant health inequalities and barriers to care for Indigenous populations are unlikely to benefit from the impacts identified from participants, as is true for rural-urban and public-private health human resource migration.
在许多拉丁美洲和加勒比国家，医疗旅游呈增长趋势，涉及跨境旅行以获取私人的非紧急医疗干预措施。由于预期的经济利益，私人卫生服务的商品化和出口经常得到推动。研究表明，人们越来越关注医疗旅游带来的健康不平等问题，其中包括其对卫生人力资源的影响，但很少有研究涉及医疗旅游对目的地国家卫生人力资源的影响及其对健康公平的后续影响。为了解决这一差距，我们采用案例研究方法，确定医疗旅游部门发展对卫生人力资源的预期影响，以及对危地马拉卫生公平的影响。
在对危地马拉医疗旅游部门的媒体和政策讨论进行广泛审查，并实地考察该部门的复杂动态之后，我们对 50 名有目的地选择的医疗旅游利益相关者进行了深入的关键知情人访谈，这些利益相关者代表五个关键部门：公共医疗保健、私人医疗保健、卫生人力资源、民间社会和政府。参与者是通过多种招聘方法确定的。访谈内容以英文记录。对记录进行审查以确定出现的主题，并相应地进行编码。测试编码方案的完整性，然后进行主题分析。对数据进行主题分析。
调查结果揭示了与危地马拉新兴医疗旅游部门发展及其对卫生人力资源的预期影响相关的五个关注领域：达到国际培训和实践标准的动力；卫生工作者英语培训和能力的机会和需求；卫生工作者从公共部门向私营部门的迁移；医疗旅游带来的就业机会和劳动力市场增加；以及对专科护理的需求。这些主题领域为卫生工作者和医疗保健系统带来了机遇和挑战。
从健康公平的角度来看，调查结果对危地马拉医学教育系统支持增强的医疗旅游部门的责任提出了质疑，特别是越来越关注对私人诊所、特定专业、英语培训和国际标准的需求。此外，参与者认为，土著人口的巨大健康不平等和获得医疗保健的障碍不太可能受益于所确定的影响，农村-城市和公共-私人卫生人力资源迁移也是如此。
