The economic burden of overseas medical treatment: a cross sectional study of Maldivian medical travelers

Abstract

BackgroundAccess to tertiary care is a problem common to many small states, especially island ones. Although medical treatment overseas (MTO) may result in cost savings to high income countries, it can be a relatively high cost for low and middle income source countries. The purpose of this study was to estimate the costs of overseas medical treatment incurred by the households of medical travelers from Maldives and assess the burden of medical treatment overseas on the government and on households.MethodsA survey was conducted of inbound Maldivian medical travelers who traveled during the period June – December 2013. Participants were stratified by the source of funds used for treatment abroad. Three hundred and forty four government-subsidized and 471 privately funded Maldivians were interviewed. Self-reported data on the utilization and expenses incurred during the last visit abroad, including both expenses covered by the government and borne by the household, were collected using a researcher administered structured questionnaire.ResultsThe median per capita total cost of a medical travel episode amounted to $1,470. Forty eight percent of the cost was spent on travel. Twenty six percent was spent on direct medical costs, which were markedly higher among patients subsidized by the government than self-funded patients (p = <0.001). The two highest areas of spending for public funds were neoplasms and diseases of the circulatory system in contrast to diseases of the musculoskeletal system and nervous system for privately funded patients. Medical treatment overseas imposed a considerable burden on households as 43 % of the households of medical travelers suffered from catastrophic health spending. Annually, an estimated $68.9 million was spent to obtain treatment for Maldivians in overseas health facilities ($204 per capita), representing 4.8 % of the country’s GDP.ConclusionsOverseas medical treatment represents a substantial economic burden to the Maldives in terms of lost consumer spending in the local economy and catastrophic health spending by households. Geographical inequality in access to public funds for MTO and the disproportionate travel cost borne by travelers from rural areas need to be addressed in the existing Universal Health Care programme to minimize the burden of MTO. Increased investment to create more capacity in the domestic health infrastructure either through government, private or by foreign direct investment can help divert the outflow on MTO.

Reducing the scale? From global images to border crossings in medical tourism

“…Medical travellers from Chile, Bolivia, and Paraguay access nearby regional hospitals in Argentina (Vindrola-Padros 2015). Mongolians travel to China (Snyder et al 2015), and Maldivians to India and Sri Lanka (Suzana et al 2015). Many Rwandans travel to Burundi, where the costs are lower (aided by an exchange rate that favours them), and the service is faster and more efficient.…”

“…Sri Lanka, with only a limited modern healthcare system, has successfully targeted patients from the Maldives (Anon. 2014d;Suzana et al 2015). Thailand has increasingly oriented itself to neighbouring Cambodia, Laos, Myanmar, Vietnam, and Bhutan, where Buddhism is dominant.…”

Economic analysis of dengue prevention and case management in the Maldives

“…This is in line with the previously reported average cost of $1,470 to obtain treatment of any kind in overseas health facilities from the Maldives. [ 27 ] The aggregate cost of overseas hospitalizations for dengue in 2015 ($15,926), however, forms only a small part of the estimated $68.9 million spent on overseas hospitalization for all conditions for Maldivian citizens. [ 27 ]…”

Archipelagic genes: Medical travel as a creative response to limitations and remoteness in the Maldives

“…Compared with other countries of the region, this was an ‘extremely high’ spending of US$277 per capita (MoFT and UNDP, : 82). A 2013 survey estimated US$204 per capita (Suzana et al, : 7). By May 2015, medical travel to more than 20 hospitals in India and Sri Lanka is eligible for public funding by Aasandha on the condition that the treatment is not available in the Maldives and is prescribed by a certified specialist.…”

“…Mobility within and beyond the archipelago's border is the islanders' creative strategy to tackle these challenges. The inevitability, tribulations and economic burdens of Maldivian medical travel (Suzana et al, ) have been mastered in the past and in the present by this seafaring Muslim society with centuries of experience in long‐distance monsoon trade and pilgrimage. Leaving the archipelago for health issues has long been the elite's solution in view of the limitations or complete absence of biomedical services and infrastructure until the mid to late 20th century.…”