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Business Recorder

Published Date: Sep 6, 2016

Medical tourism: wishful thinking or real potential

"Medical tourism happens to be a $100 billion industry. It has immense potential in Pakistan and should be promoted to earn precious foreign exchange." This is the short version of Sustainable Development Policy Institutes (SDPI) plenary on Regional Cooperation in Health Services, held last week in Islamabad. 

Why not? Our exports in goods arent doing any better. And in the service sector, its much worse; service exports have remained largely ignored throughout history, never really pursued in spirit, mentioned only in letter in trade policy documents. This column has highlighted the poor numbers, which have largely thrived on CSF disbursements from the US (Read: "A disservice to services," published June 29, 2015). Last week, the countrys services trade posted a deficit of $290 million in July 2016 compared to a surplus in July 2015, now that there werent any CSF inflows. 

Regarding medical tourism, there were a slew of creative policy recommendations that were discussed by the panellists. These included, inter alia: expediting visa processes for surgeons and physicians; cross-country mutual recognition of degrees/qualifications; promotion of video-conferencing/telemedicine; coordination in research and development; health sector joining the Services Trade Development Council; promoting public-private healthcare partnerships; and intensive marketing to attract foreign patients. The matter is even being pushed by the stakeholders into becoming part of the SAARC agenda. 

Coordinating on research and development with our hostile neighbour could prove especially beneficial and earn billions in savings. After all, we share similar genetics, obesity patterns, and diseases, said one doctor. All medical research has shifted to India. Pakistan, on the other hand, has plenty of medical colleges but not nearly enough research. The tale is as old as the country itself; what could have been, were India our friend. 

All that aside, there are also moral arguments to be made here. Theres the consumer argument – that openness in trade in healthcare gives the patient the option of obtaining better and/or cheaper treatment. As per SDPIs presentation, Pakistan is experiencing a shortage of both, specialized medical advice and essential medicine, particularly in rural areas. Vaccines and lifesaving drugs are not available at hospitals or private vendors. Moreover, the shortage of medical services and pharmaceutical items has given rise to quacks and spurious drugs. So, to the end of benefiting the consumer, the red tape needs to be torn apart. 

These are all great points, and this column agrees with the need for bringing Pakistan onto the medical-tourism map. However, realistically speaking, it might be an insurmountable task.

First and foremost, there is a gaping void where the data is supposed to be – something highlighted by the speakers themselves. When advocating healthcare-service exports, one would like to put a number to it – what are healthcare exports right now, what is the potential for it? Unfortunately, there are none. There are issues of definition when it comes to trade in services. Services-trade data is with the SBP, where medical tourism is marked as travel, said the Commerce Ministry spokesperson at the event. In value terms, it is estimated that we have more than double the size of the service sector on the informal side, claimed the SDPI presentation. Moreover, there is limited data on the actual volume and value of health-services trade, including the flow of patients and doctors in South Asia. So, crunching the numbers is a bit difficult. 

Secondly, the security paradigm: if policymakers were able to look beyond the security lens and not politicise trade, regional trade in goods alone would be something else entirely, let alone services. Yet in the case of trade in services such as medical tourism, where the policy recommendations are to grant special visas to doctors and patients to expedite their movement to and from the country, there is going to be much more resistance.

Last but not the least; it comes down to a qualitative and quantitative assessment of Pakistans healthcare industry. There is little understanding of the quality of medical hospitals in Pakistan. Quantity too may be a matter of concern: for instance, when a full-fledged private or public hospital was last set up in Karachi; remember that we are not talking about box-styled hospitals the size of houses, but a full service hospital. 

When one thinks of attracting patients from abroad, one would think that improving the dilapidated conditions of existing healthcare facilities would be a talking point. Why would anyone show up for treatment in a country where, given the choice of any medical institution in the whole country, the honourable Prime Minister chose to go to London for a routine procedure?

Still, theres no denying what we know; Pakistan already gets a number of patients from Afghanistan, and while there are bad facilities, there are also good ones. So yes, medical tourism should be promoted in Pakistan, the benefits are obvious, but were not going to hold our breath. Who knows, maybe medical exports will increase the economies of scale to the extent that it helps improve quality and quantity of medical service in the local market too.