Saturday, December 22, 2018

Medical care as a U.S. export

Travel for medical care is sometimes viewed with some repugnance, as the names "transplant tourism" and "fertility tourism" suggest.  (In the case of transplants, particularly from deceased donors, there is sometimes the suggestion that scarce national resources shouldn't be squandered on foreign patients.)  But of course a lot of travel for medical care has to do with going where care is available, and the U.S. hosts many foreign patients. (The availability of pain medicine for palliative end of life care is apparently an issue for some.)  Here's a story from the NY Times that reflects that even travel for ordinary medical care is complex, and can be viewed with some suspicion:

International Patients, Seeking Cures in the States
Are they taking up beds that could be used for vulnerable domestic patients or are they bringing money that could be used toward other programs?

"Each year, tens of thousands of seriously ill people come to the United States hoping to access our acclaimed care. While we do not have exact figures, an economist from the United States International Trade Commission estimated in a 2015 report that between 100,000 and 200,000 international patients per year make this journey. They come with cancer, heart disease and a host of other medical conditions. Most are incredibly sick and see us as their last beacon of hope.
But these patients are not just showing up. Many of our largest and most elite health care institutions seek them out. This is a multimillion-dollar industry, and it is growing. With millions of uninsured and underinsured patients and uncertainty in the domestic health care markets, hospitals are increasingly reliant on patients from abroad to stabilize their bottom line.
"Is an international patient “taking up a bed” that could otherwise be used for a vulnerable domestic patient? Or is the international patient providing funds that can be used toward other clinical and research programs?
"While many international patients are wealthy, they too are a vulnerable population. They enter a foreign medical culture, which may have different standards and expectations for doctor-patient communication, especially around sensitive issues like serious illness and death.
"Furthermore, international patients, particularly those from the Middle East, are frequently members of cultural, ethnic and religious minorities. In an age of rising American xenophobia and cultural protectionism, patients and families expose themselves to considerable risk coming to the United States. On a more practical level, recent travel bans have limited families from visiting sick or dying relatives who are already here.
"in American hospitals, patients and their families have access to advanced palliative and end-of-life care, which may not be the case in their home countries. For instance, opioids, which can be critical to alleviating suffering in the dying process, are not widely available in some countries.

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