The development of medical tourism in Barbados

Krystyna Adams, a member of the Medical Tourism Research Group at Simon Fraser University, Canada provides an update on current medical tourism initiatives in Barbados and future plans for the sector.

The island of Barbados is the most easterly Caribbean island with a dense population that nearly doubles in peak tourist seasons. Tourism is the largest industry in Barbados with most tourists arriving from the United Kingdom, the United States, neighbouring Caribbean islands, and Canada. With tourism representing approximately 25% of the nation’s GDP, the government has devoted much attention to diversifying its economy by expanding the medical tourism sector. ¹

Existing facilities for medical tourists

Barbados developed a universally accessible public health care system in the 1960’s to provide care free of charge to all citizens. Parallel to this public system are private health care services provided through family physician clinics, emergency clinics/hospitals, cardiac clinics, and other facilities. The users of these facilities may include middle to high income Barbadians, non-Barbadian residents that are not permitted access to non-emergency care within the public sector, as well as tourists seeking care while visiting the island. Private financing for health care is growing with approximately 70% of health care spending coming from private sources. This has resulted in an expansion of private facilities in recent years. At the same time, the government is exploring expanding the medical tourism industry on the island.^¹

While most of the existing private facilities cater to tourists already on the island, facilities specifically targeting international patients are limited. The Barbados Fertility Centre has been most successful at recruiting medical tourists. This clinic was founded in 2002 and employs one gynecologist who is also the owner, and five nurses to provide fertility treatments. The clinic was developed with the specific purpose of attracting patients from outside Barbados to the site, recognizing the appeal of relaxing on the beach while undergoing treatment. The original establishment of the clinic was assisted by numerous government benefits, such as the waiving of customs duties for medical equipment. Along with an internationally trained staff, the clinic is accredited by the Joint Commission International, an international hospital accreditation agency, to appeal to international patients. While approximately 80% of the patients are medical tourists, locals have identical access to the Centre’s services and are provided treatments at a discounted rate. Overall, the clinic has proven the potential success of medical tourism businesses in Barbados. ¹

Stakeholder perspectives

Despite past failed attempts to develop facilities catering to international patients, the government of Barbados has shown consistent interest in developing this sector. Stakeholders within the tourism and economic development sector are generally positive about potential growth of this sector as a means of spurring the economy through job creation, increased training opportunities for health workers, and enhanced quality and accessibility to medical offerings on the island. However, stakeholders in the public health sector are wearier of potential negative impacts on local access to health care if health workers are enticed to shift from the public to private system with further health care privatization as a result of medical tourism.²

Of particular concern to stakeholders in the public sector are the potential impacts on health human resources. Health human resource shortages have been a concern on the island, particularly nursing shortages caused by out migration (Snyder et al). The high level of nurse migration from the island has negative impacts on the public system’s ability to provide care. Furthermore, increasing privatization of health care may entice physicians to work in the private sector, resulting in a loss of health care providers in the public sector. This shift from public to private along with the outmigration of nurses represents a loss of public investment that supports the training of these workers.^²

In response to these concerns about health human resources on the island, some stakeholders have suggested that medical tourism may improve health worker retention. First of all, development of the medical tourism sector may allow for an expansion in training opportunities for health workers due to increased demand for specialized procedures. This might appeal to health workers that would otherwise leave for additional training and might then continue practicing out of country. As a result, this could increase the number of specialists and increase access to these specialized procedures for locals. Furthermore, by providing high cost and more specialized care to foreign patients at medical tourism facilities, this may entice health workers to stay in Barbados to benefit financially from the provision of medical care to foreign patients while still being able to treat local patients. Some stakeholders indicate that an improved working environment may encourage workers, including nurses, to remain locally which would overall increase the number of health human resources on the island. ^²

However, some stakeholders are less optimistic about the impacts of medical tourism on health human resource retention and local access to health human resources. While the development of medical tourism facilities may provide financial incentives for health workers, health care providers may be enticed to shift from the public to private sector resulting in reduced access and increased wait times for care amongst the local population. Furthermore, while medical tourism may increase training opportunities for health care providers, these opportunities may shift planning and training priorities away from local health care needs and towards the needs of foreign patients resulting in increasingly inequitable access to medical care on the island.²

Future plans for medical tourism

These considerations may be important to the development of policy and regulation related to medical tourism, particularly in light of plans to develop a new medical tourism facility at the site of an abandoned hospital. The company American World Clinics (AWC) has recently started construction on a 70 bed facility which will primarily cater to medical tourists. The company plans to recruit international surgeons to treat patients on a part-time basis through a time-share model.¹ Besides surgeons, the plan indicates the facility would hire local nurses, technicians and other hospital staff to increase employment opportunities to Barbadians. Interest from at least 15 investors in this particular site and project indicates the potential for growth in the medical tourism industry in Barbados. However, given that this project would greatly increase the amount of medical tourism on the island, it is unknown whether this may impact local access to health care in the public sector and what provisions the government may take to mitigate any potential negative impacts. If the new facility hires local health care workers, it is unknown what the impacts of this might be on health human resources on the island.^²

This project represents an important moment in the development of the medical tourism industry in Barbados. With the industry set to expand, the development of policies and regulations must go hand in hand with this expansion to avoid potential problematic impacts on public sector health resources. In this way, Barbados has the opportunity to serve as a model for the many other countries in the Caribbean and elsewhere that are exploring expanding their medical tourism sectors.

References:

1. Johnston, R., Crooks, V.A., Snyder, J., Fraser, H., Labonté, R, and Adams, K. (2012). An Overview of Barbados’ Medical Tourism Industry. Department of Geography, Simon Fraser University.

2. Snyder, J., Crooks, V.A., Turner, L. & Johnston, R. (2013). Understanding the impacts of medical tourism on health human resources in Barbados: a prospective, qualitative study of stakeholder perceptions. International Journal for Equity in Health.

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Profile of the author

Krystyna Adams is a Master’s of Public Health (Global Health) candidate in the Faculty of Health Sciences at Simon Fraser University. She is a member of the Medical Tourism Research Group based out of Simon Fraser University. Her research interests include impacts of globalization on health equity. She has a particular interest in exploring medical tourism with a focus on the communication of risks and potential impacts of medical tourism to promote ethical decision-making and sustainability in destination communities.