Frequently asked questions
Medical tourism
How does one treat expenditures associated with “medical tourism”? Consider two situations:
1. An individual (Person X) from Country A is a resident in Country B. How should expenditures on health in Country B for this person be treated?
2. Person X from Country A goes to Country B for a medical procedure. How should expenditures in Country B for that person be treated?
In some countries medical tourism can be a major issue and hence Country B would like to count expenditures by foreigners (temporarily visiting their country) against their overall health expenditures. For example it has been suggested that in one of the countries in the MENA region total health expenditures excluding medical tourism was $800 million and medical tourism was estimated to be $600 million.
In situation 1, the health expenditures of Person X should be counted in the NHA of Country B because X is a resident in that country. This is a fairly easy situation to handle from a health accounts perspective.
Situation 2 requires more work from the health accountants. This case involves what is essentially a matter of export and import. Country B clearly produced the medical care but it is treated as an export to Country A. For Country A it is a clear case of imported health care, and should be included in Country A’s final consumption.
Thus, health accountants in Country B (the exporters) ought to make an estimate of the amount spent to treat Person X and deduct that amount from their NHA figure. Further, they should deduct that spending from the total payments by Country B financing agents (FAs) on behalf of Person X. For example, if X received free treatment at a municipal clinic, the value of that treatment should be deducted from the total expenditures made through the clinic. To preserve the total expenditure figure, Country B health accountants may wish to present an exhibit table or addendum table showing the value of medical tourism and known financing agents.
Health accountants in Country A (the importers) should include this expenditure in their health accounts. This would be done using the regular classification schedules for health functions and financing agents. The appropriate provider classification is HP.9 (rest of world), and any payments made by Country B financing agents would show as HF.3 (rest of world). The amounts expended would be expressed in currency units of Country A.
However, data limitations may preclude the treatment from being implemented – in either or both countries. Thus a default treatment of leaving the expenditure on person X in Country B's accounts is the result of "flawed" implementation rather than flawed concept. How much time and effort is spent to identify these expenditures depends upon the resources available to the health accounts team and upon the estimated magnitude of medical tourism (either from the perspective of importation or exportation).