"Medical tourism will obligate physicians to elevate their level so that they can compete": a qualitative exploration of the anticipated impacts of inbound medical tourism on health human resources in Guatemala.

BACKGROUND: Medical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The commodification and export of private health services is often promoted due to perceived economic benefits. Research indicates growing concern for health inequities caused by medical tourism, which includes its impact on health human resources, yet little research addresses the impacts of medical tourism on health human resources in destination countries and the subsequent impacts for health equity. To address this gap, we use a case study approach to identify anticipated impacts of medical tourism sector development on health human resources and the implications for health equity in Guatemala. METHODS: After undertaking an extensive review of media and policy discussions in Guatemala's medical tourism sector and site visits observing first-hand the complex dynamics of this sector, in-depth key informant interviews were conducted with 50 purposefully selected medical tourism stakeholders in representing five key sectors: public health care, private health care, health human resources, civil society, and government. Participants were identified using multiple recruitment methods. Interviews were transcribed in English. Transcripts were reviewed to identify emerging themes and were coded accordingly. The coding scheme was tested for integrity and thematic analysis ensued. Data were analysed thematically. RESULTS: Findings revealed five areas of concern that relate to Guatemala's nascent medical tourism sector development and its anticipated impacts on health human resources: the impetus to meet international training and practice standards; opportunities and demand for English language training and competency among health workers; health worker migration from public to private sector; job creation and labour market augmentation as a result of medical tourism; and the demand for specialist care. These thematic areas present opportunities and challenges for health workers and the health care system. CONCLUSION: From a health equity perspective, the results question the responsibility of Guatemala's medical education system for supporting an enhanced medical tourism sector, particularly with an increasing focus on the demand for private clinics, specific specialities, English-language training, and international standards. Further, significant health inequalities and barriers to care for Indigenous populations are unlikely to benefit from the impacts identified from participants, as is true for rural-urban and public-private health human resource migration.

Medical Travel Helps Unions, Employers Improve Cost and Quality of Care.

Not all medical travel programs are created equal, so employers should shop with a discerning eye. Most programs use a "proprietary" method to evaluate and select high-quality providers for their networks. It is important to ask questions.

Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services.

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues.

[Dentists' workforce in Hungary and international migration]. / Fogorvosi munkaero-helyzetünk és a nemzetközi migráció.

In Hungary, cross-national migration in dental care was performed rather by patients from abroad instead of the domestic dentists' migration for working abroad. Actually, this tacitly realized and so-called dental tourism experienced two basic changes. The National Medical Tourism Ltd. arranged the First Conference for Development of Dental Tourism on 21 April 2011. Hungary's prime minister addressed the meeting and finally signed an agreement with the organizing Ltd. about governmental financial support for development of dental tourism. On the other hand, Germany and Austria deleted all restrictions against the free cross-national workforce migration since 1 May this year. For understanding and prognosis of dentists' future migration, it is inevitable to collect and analyse relevant data of the previous years. This study is presenting data obtained from January 1, 2006 to December 31, 2010. According to the net outcome, the dentists' human resource system was balanced down to the end of 2010. However, this state is unsure even for the near future, thus preventing the deficit of dentists all necessary measures must be taken to keep up the present level of the domestic dentral service.

Dental tourists: treat, re-treat or do not treat?

Many UK patients in the search for their perfect smile have now decided to have their dental treatment abroad, the main reasons being that they believe they can have the same treatment but at a much lower price. With many overseas clinics offering treatment packages that also include a holiday, dental tourism seems an opportunity not to be missed. Although not always the case, some treatments unfortunately do not go to plan, often leaving distraught patients and their apprehensive dentists in a difficult situation. This article will discuss the reasons behind dental tourism and if the health system has contributed to the increasing demand for dental tourism. We will touch on the impact dental tourism has had on UK dentistry and if the NHS should be responsible for handling the consequences of any failed or incomplete dental treatment carried out abroad. It will also put the spotlight on dentists' responsibilities and to what extent they should treat these patients, as these cases can leave clinicians in primary and secondary care in a challenging predicament, not only clinically but also ethically and medico-legally.

Emprendimiento médico y turismo de salud en Bucaramanga (Colombia) / Medical Enterprise and Health Tourism in Bucaramanga (Colombia) / Empreendedorismo em medicina e turismo de saúde em Bucaramanga (Colômbia)

Introducción. Los indicadores económicos y las perspectivas comerciales han promovido al turismo de salud sin considerar las perspectivas de desarrollo, mejora e internacionalización del sistema de salud por los médicos-empresarios de Bucaramanga. Objetivo. Identificar las perspectivas médico-empresariales de las instituciones hospitalarias de Bucaramanga que promueven el turismo de salud y bienestar como segmento de desarrollo empresarial y crecimiento socioeconómico. Método. Interpretación deductiva de los textos seleccionados a partir de la técnica de contraste documental, presentando un estado general del turismo de salud hasta precisar la experiencia en turismo médico de Bucaramanga. Temas tratados. En las perspectivas sectoriales se identifican las principales tipologías turísticas asociadas con la salud; en las perspectivas médicas se reafirman las tendencias históricas de atención en salud en las zonas francas de Bucaramanga. Conclusiones. El turismo de salud y bienestar antes que un producto estratégico de clase mundial es una alternativa de desarrollo para los profesionales de la salud, internacionalización de sus centros hospitalarios, adopción de estándares y protocolos estrictos para atender pacientes extranjeros y, oferta de innovaciones o servicios para el mejoramiento del sistema de salud pública de Colombia. Cómo citar: Pérez-Pinzón LR. Emprendimiento médico y turismo de salud en Bucaramanga (Colombia). MedUNAB. 2020;23(2): 307-315. doi: 10.29375/01237047.3499

Introduction: Economic indicators and commercial perspectives have promoted health tourism without considering the local health care system's development, improvement and internationalization perspectives of Bucaramanga's doctor-entrepreneurs. Objective: To identify the medical-entrepreneurial perspectives of Bucaramanga's hospitals that promote well-being and health tourism as a business development and socioeconomic growth segment. Methodology: This is a deductive interpretation of the selected texts based on the documentary comparison technique, showing the general state of health tourism until Bucaramanga's medical tourism experience is specified. Topics Discussed: The main types of tourism associated with health are identified in sectorial perspectives. The historical health care trends in Bucaramanga's free trade zones are reaffirmed through medical perspectives. Conclusions: Well-being and health tourism, apart from being a world-class strategic product, it is an alternative for health care professionals' development, their hospitals' internationalization, adopting strict standards and protocols to attend foreign patients and offering innovations or services to improve Colombia's public health care system. Cómo citar: Pérez-Pinzón LR. Emprendimiento médico y turismo de salud en Bucaramanga (Colombia). MedUNAB. 2020;23(2): 307-315. doi: 10.29375/01237047.3499

Introdução. Os indicadores econômicos e as perspectivas comerciais promoveram o turismo de saúde sem considerar as perspectivas de desenvolvimento, melhoria e internacionalização do sistema de saúde pelos médicos-empresários de Bucaramanga. Objetivo. Identificar as perspectivas da medicina empresarial nas instituições hospitalares de Bucaramanga que promovem o turismo de saúde e bem-estar como um segmento de desenvolvimento empresarial e crescimento socioeconômico. Métodos. Interpretação dedutiva dos textos selecionados a partir da técnica de análise documental, apresentando um estado geral de turismo de saúde até explicitar a experiência em turismo de saúde de Bucaramanga. Tópicos discutidos. Nas perspectivas setoriais foram identificadas as principais tipologias turísticas associadas à saúde; nas perspectivas da medicina foram reafirmadas as tendências históricas de atenção em saúde nas áreas francas de Bucaramanga. Conclusão. O turismo de saúde e bem-estar, além de ser um produto estratégico de classe mundial, é uma alternativa de desenvolvimento para os profissionais de saúde, para a internacionalização de seus centros hospitalares, a adopção de padrões e protocolos rígidos de atendimento a pacientes estrangeiros e para a oferta de inovações ou serviços para o melhoramento do sistema de saúde pública da Colômbia. Cómo citar: Pérez-Pinzón LR. Emprendimiento médico y turismo de salud en Bucaramanga (Colombia). MedUNAB. 2020;23(2): 307-315. doi: 10.29375/01237047.3499

Ethics of care in medical tourism: Informal caregivers' narratives of responsibility, vulnerability and mutuality.

This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists.

International migration of health professionals and the marketization and privatization of health education in India: from push-pull to global political economy.

Health worker migration theories have tended to focus on labour market conditions as principal push or pull factors. The role of education systems in producing internationally oriented health workers has been less explored. In place of the traditional conceptual approaches to understanding health worker, especially nurse, migration, I advocate global political economy (GPE) as a perspective that can highlight how educational investment and global migration tendencies are increasing interlinked. The Indian case illustrates the globally oriented nature of health care training, and informs a broader understanding of both the process of health worker migration, and how it reflects wider marketization tendencies evident in India's education and health systems. The Indian case also demonstrates how the global orientation of education systems in source regions is increasingly central to comprehending the place of health workers in the global and Asian rise in migration. The paper concludes that Indian corporate health care training systems are increasingly aligned with the production of professionals orientated to globally integrated health human resource labour markets, and our conceptual analysis of such processes must effectively reflect these tendencies.

International medical migration: a critical conceptual review of the global movements of doctors and nurses.

This paper critically appraises the discourse around international medical migration at the turn of the 21st century. A critical narrative review of a range of English-language sources, including grey literature, books and research reports, traces the development and spread of specific causative models. The attribution of causative relations between the movement of skilled medical workers, the provision of health care and population health outcomes illustrates how the global reach of biomedicine has to be understood in the context of local conditions. The need to understand migration as an aspect of uneven global development, rather than a delimited issue of manpower services management, is illustrated with reference to debates about 'brain drain' of Africa's health-care professionals, task-shifting and the crisis in health-care human resources. The widespread presumed cause of shortages of skilled health-care staff in sub-Saharan Africa was overdetermined by a compelling narrative of rich countries stealing poor countries' trained health-care professionals. This narrative promotes medical professional interests and ignores historical patterns of underinvestment in health-care systems and structures. Sociological theories of medicalization suggest that the international marketization of medical recruitment is a key site where the uneven global development of capital is at work. A radical reconfiguration of medical staffing along the lines of 'task-shifting' in rich and poor countries' health-care systems alike offers one means of thinking about global equity in access to quality care.

Evaluación del nivel de inglés en los programas de enfermería en Colombia: 2011-2016 / Evaluation of the English level in Colombian nursing programs: 2011-2016

Objetivo: evaluar si se cumplió la meta del Gobierno de Colombia para el 2014 de que el 20 % de los graduandos de programas de enfermería de las instituciones colombianas de educación superior se clasifiquen en nivel intermedio o superior en inglés. Metodología: se emplearon los resultados del módulo de inglés de la base de datos de las pruebas Saber Pro del Instituto Colombiano para la Evaluación de la Educación (2011-2016). Los niveles de calificación de este módulo son adaptados del Marco Común Europeo de Referencia. Para inferir respecto al logro de la meta de la política se realizaron pruebas de proporciones paramétricas y no paramétricas. Adicionalmente, se hicieron ajustes sobre el valor p. Resultados: ningún programa cumplió estadísticamente con la meta. Sin embargo, cuando solo se realizó la prueba de comparación de proporciones paramétrica y no paramétrica (sin corrección por hacer múltiples comparaciones), el programa de la Universidad del Valle, sede Cali, sí la cumplió. Conclusión: la meta propuesta por el Programa de Fortalecimiento al Desarrollo de Competencias en Lenguas Extranjeras para el 2014 no se cumplió en el caso de los estudiantes de enfermería evaluados; solo el 2,36 % alcanzó el nivel B+ ese año. Además, se encuentran rezagados respecto a los programas de medicina, economía y administración de empresas

Objective: To determine if universities' nursing programs reached the goal established in 2014 by the Colombian government of having 20% of higher education graduates reaching an intermediate or superior level in English. Methods: The research used a descriptive and statistical approach (parametric and non-parametric tests) using the data of nursing students in Higher Education Institutions who took Saber Pro test (2011 -2016). The grades of this module are adapted to the Common European Framework of Reference for Languages. In order to make inferences in respect to the achievement of the government's goal, parametric and non-parametric proportionality tests were carried out. Additionally, adjustments were made to the p-value to avoid the bias that results from generating a joint conclusion from joining results of an individual test. Results: No nursery program met the statis-tical goal. However, Universidad del Valle's nursing program met the goal if only the parametric and non-parametric proportion comparison tests (without correction for multiple comparisons) are considered. Conclusion: Overall, the goal of the Program for the Strengthening of the Development of Competency in Foreign Languages by 2014 was not met by nursing students: just 2.36% of them achieved an intermediate or higher level of English in 2014. In addition, nursing students fall behind student in medicine, economics and business administration programs

Worrying about the wrong thing: patient mobility versus mobility of health care professionals.

Patients and health care professionals in the European Union (EU) benefit from legislation on the freedom of movement between Member States. In relative terms, many more doctors and nurses move within the EU than patients. Despite this, patient mobility has attracted more attention from policy-makers and the public while workforce mobility remains largely ignored. This is paradoxical and imprudent. On the one hand, the scope of patient mobility is narrow and self-limited. On the other hand, current and forecasted health care workforce shortages across the EU, global competition for health care professionals, and current economic pressures are all good reasons to start worrying about the mobility of health care professionals and its implications for health systems.