Previously limited to manufacturing, outsourcing now includes services whose range is growing daily. For example, American law fi rms are hiring Indian attorneys to do simple legal work and even hiring doctors to provide medical expert witness services in real time. American high school students work with online math tutors thousands of miles away. Outsourcing is so prevalent that one-third of American software engineers are expected to lose their jobs to it in the next six years. In the early twenty-fi rst century, few multinationals have not engaged in outsourcing: over 125 Fortune 500 fi rms have R&D bases in India. In the medical sector, developing countries (with India at the helm) are moving into medical outsourcing, according to which subcontractors provide services to overburdened Western medical systems (for example, American hospitals e-mail x-rays to India for reading). The Western medical sector is drawn to developing countries that supply high-quality services whose range is very broad, including finance, biotech, information techno logy, et cetera. To the extent that businesses are profi ting from the new possibilities offered by the global economy, consumers are not far behind. They have been buying goods from all over the world; they have also been buying services. One of these is medical care at the point of production. In other words, they travel in order to consume the service at the point of sale. In medical tourism, it is the doctor and the hospital that are being outsourced. As with tangible products, outsourcing occurs because of price and availability considerations.
As a result of the internationalization of health-care providers in the more developed countries, medical staff at all levels, from the highly specialized brain surgeon to the unskilled hospital janitor, come from developing countries. Whether they trained in the more developed countries and then opted to stay, or whether they trained at home and then were attracted by lucrative employment opportunities, the fact is that an increasing number of medical personnel are from developing countries. Indeed, the Philippines exports 15,000 nurses a year, and it’s estimated that one in ten Filipinos now works abroad. A study by Gupta, Goldar, and Mitra showed that of the Indian doctors trained abroad, only 48 percent returned, and the rest remained to work in the country of training. Moreover, one out of five doctors in the world is Indian. Under those conditions, Western patients are used to being treated by a doctor from China and by a nurse from the Philippines. It is just one step further to buy health services in the country of the doctor who provides them at home.
Medical Tourism and a New National Revenue for the Developing Countries
