Thursday 6 September 2012

Legislating Medical Tourism

It has been in the news recently that the First Lady, Patience Jonathan, is hospitalised abroad.   The reports about what ails her have been varied.  Almost as interesting, but not quite as fascinating as the exact cause of her illness, is the fact that she is being treated abroad. This is interesting, but not particularly surprising.

Many public officials and their families frequently go outside the country for medical treatment and check-ups. Even regular people outside of government, who can afford it, seek treatment outside Nigeria, including in other developing countries. India has been one major beneficiary of our distrust of our health care system.

There are several angles from which to consider our utilisation of health facilities and health care delivery in other countries. The most obvious is the state of our own health care delivery system, including our health facilities, and health personnel. To state that the functioning of our health care system is grossly inadequate, or that our record of patient safety is extremely poor, is certainly to repeat a well-worn cliché. The result is a grave distrust of the health care system by many. Our leaders feel this same distrust apparently as evidenced by their patronisation of health care facilities in other countries, including for the most easily treatable illnesses.  

Medical tourism has become a symbol of continued and deepening inequality between certain classes of people in the country. On one hand, you have the leadership, the wealthy, the top civil servants who have available to them treatment paid for by public monies, those who work for certain companies who provide at least partial funding for treatment abroad, those who can afford treatment abroad because they are able to beg and borrow from friends and family, and those who have the good fortune of having children abroad who can pay for treatments from salaries and credit cards.

On the other hand, you have those who have no choice but to seek treatment in the facilities at home, or if they are lucky, become the fortunate recipients of treatments provided by foreign medical missions arranged by kind-hearted individuals and organisations, or by forward-thinking towns and villages. The latter are, of course, in the majority.  

The capital flight, which is significant going by the figures cited by different sources, is another concern. Further, there have been allegations of fraud in which doctors in Nigeria have been accused of colluding with health professionals and facilities abroad, and providing them with Nigerian patients for both necessary and unnecessary procedures, for a fee.

Allegations of mistreatment and instances of being taken advantage of that some have faced in some countries abroad pose another crucial concern.   There is often little or no remedy available to them both in the country in which they have sought treatment and in their own country. Moreover, even for those who are able to seek such treatment, follow-up as required, especially in the case of chronic illnesses, can become a major problem. This is particularly so in the cases of those categories of persons who resorted to begging and borrowing or relying on relatives in the Diaspora to access treatment abroad.  

With all of these concerns, one must wonder whether it has not occurred to the leadership of our country, that we can increase budgetary allocations and spend a little more on health care; use existing resources more effectively and fully; implement more effective and comprehensive health insurance schemes; investigate and improve the state of our tertiary hospitals; provide better working environments for health personnel to prevent the ubiquitous brain drain in the healthcare sector; and invest more in addressing the inadequacies that adversely affect patient safety and patient outcomes?

Not long ago, the Minister of Health stated that the federal government is in the process of preparing a policy that would require public servants to undergo treatment in Nigeria where available, or otherwise use their private monies should they insist on treatment in countries outside Nigeria. The policy remains under development.  

But we need to go further than that.  We need legislation that prevents politicians and civil servants at all levels of government, and their families from patronising health facilities abroad during their period of service, whether with public or private funds. Since it can be difficult to ascertain what consists of public or private funds when people work in government in Nigeria, private funds would provide no exception to this rule. This would act as an effective deterrent to running for office to persons who do not have the best interests of the country at heart and are thus unprepared to make such a sacrifice.

It would also help channel more energies and resources to rebuilding our dilapidated health care system, a step that would benefit all Nigerians. This proposition may be considered harsh from public office holders’ right to medicare anywhere with their own private funds. But certain strict measures might help encourage more active steps to improving our healthcare and to lessening existing inequities.

Is such legislation likely to be enacted any time soon? Most likely not. But it is time that different advocacy groups began to champion such a cause, especially as news of public officials and their families seeking treatment abroad continues to trickle out.

Legislating medical tourism
Daily Times Nigeria
Medical tourism has become a symbol of continued and deepening inequality between certain classes of people in the country. On one hand, you have the leadership, the wealthy, the top civil servants who have available to them treatment paid for by ...
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Passport to health
China Daily
Li works for Lavion, a Beijing-based travel agent focusing on private medical tourism. The growth of the company's membership, which went from zero to more than 1,000 in fewer than five years, is demonstrative of the business opportunity in the sector.
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China Daily
For harsher punishment
Himalayan Times
The country is trying to promote medical tourism in the country, but the country's so-called life-saving medical doctors are deeply involved in medical corruptions. All the doctors are certainly not bad, but like a proverb 'a certain bad fish can spoil ...
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