They hail from countries at different levels of development and with different political systems. Such characteristics of international patients are largely irrelevant for the development of medical tourism. There is one characteristic of patients that lends itself for a useful classifi cation: income. A binary division into rich and poor patients enables us to link, albeit roughly, consumption of medical services to personal resources under the assumption that, at the extreme, the rich and the poor consume different health care. There is no clear demarcation marking the boundary between rich and poor, and the boundaries between the services consumed by each are fuzzy at best. Still, one might say that the rich international patients demand high-tech services accompanied by an exotic vacation (luxury medicine), while the poor international patients tend to just barely cross the border to use another country’s medical services (border medicine). This simple difference enables us to distinguish between luxury medicine and border medicine (see table 3.1). In theory, both offer invasive, diagnostic, and lifestyle services. In reality, however, border medicine tends not to be lifestyle oriented, and to the extent that it is invasive, the procedures are rarely elective. Both rich and poor foreigners are consumers of traditional medicine, although its packaging differs according to the budget it caters to.
Poor medical tourists do not consume the high-tech medical services but rather purchase basic services through the public health system. They use the closest facilities, immediately across the border from their homes. They also do not vacation before or after their medical treatment. Their demand is for nonelective medical care, as they have neither the time nor the inclination for elective or lifestyle medicine. While all countries under study have border medicine, Thailand’s border regions are inundated by poor patients from neighboring countries.27 Chile also has ample border medical tourism and is bracing for more when the international highway connecting northern Argentina, eastern Bolivia, and western Brazil is completed.
Two clarifi cations are in order. First, while border medicine tends to attract the poor in neighboring countries, this does not imply that the rich in those neighboring countries do not travel to the same destination for medical care. To the contrary, there is evidence of luxury medical travel from neighbors of all the countries under study. Indeed, India receives patients from the Gulf States as well as nearby Bangladesh, Mauritius, Nepal, and Sri Lanka. Chile and Argentina both provide medical services to neighboring residents, as their medical systems are more sophisticated and modern. Most of the demand for fi rst-rate medical centers in Chile comes from upper income and upper-middle income patients from Bolivia and Peru, and to a lesser extent, from Ecuador.28 However, the wealthy patients will rarely receive medical care in the border areas, but will instead be drawn to the large medical centers that tend to be urban or resort based.
Second, not all border medicine is demanded by residents of developing countries. A study of trade in health services in Tijuana in 1994 notes that on average, there were 300,000 health related border crossings per month.29 Only 50,000 were people going to San Diego for health care while the remaining 250,000 went from the United States to Tijuana. In fact, tens of thousands of California workers get their medical and dental checkups, as well as major treatment and surgeries, in Mexico, where health care is cheaper.30 Also, Americans have been going to Mexico for medical services and cheap drugs for a long time.
Incidental Medical Tourists
