The government of the Turks and Caicos Islands has followed Dubai and Nigeria with a public declaration of the need to drastically cut government funded outbound medical tourism. While for Dubai and Nigeria it is a point of principle to improve local healthcare so patients do not have to be sent abroad, for the Turks and Caicos it is matter of dire economic necessity. Other countries that pay for citizens to go overseas for treatment either have economic problems or a desire to spend the money on improving local healthcare. This could well be the beginning of the end for government paid outbound medical tourism in these countries.
Nigeria loses an estimated £10 million annually to medical tourism to India, says Henry Mojekwu of medical tourism agency New Horizon Healthcare Nigeria Limited. He says that the trend is due to India's ready availability of relatively cheaper healthcare, and accepts that when Nigeria has quality hospitals, the country will benefit financially. At present, patients go to India to avoid the long waiting times that patients experience in Nigeria.
The Turks and Caicos Islands interim government is seeking public input on how to reduce the cost of a two-year-old health care system that the country now cannot afford. Among a raft of budget measures that include renegotiating contracts with InterHealth Canada for operating the two local hospitals, is the intention to limit services for temporary residents.
The local economy hit the system hard by reducing the number of foreign workers who left when jobs dried up; reducing insurance contributions that help pay for the nation’s health care, according to the government’s “Health Care Funding Challenge
”. The total annual cost of healthcare is $61.5 million. NHIP contributions pay for only $19 million, while the government picks up the $42 million difference. Costs include $44 million to InterHealth Canada for infrastructure, equipment and clinical services to operate the hospitals
A key target for cuts is the $9 million that the health insurance pays to get locals treated overseas. Because of tight budget constraints, the Ministry of Health has had to suspend or downsize a number of its programmes, including closing a hospice and care home.
Part of the problem is that much of the healthcare plan of the previous elected government was never implemented. A Health Regulatory Authority to govern and monitor many aspects of the healthcare delivery process has never been created, neither has primary health care been upgraded or a healthy lifestyles initiative developed. Also, a clinical services review board has been appointed but has not met, and a contract management board to deal with InterHealth Canada has been ineffective.
Although blaming their predecessors makes political points, the government needs to reduce the high cost for medical treatment overseas. While NHIP reduced the cost from $36 million for 10,000 Turks and Caicos Islanders in 2008 to $9 million for more than 30,000 beneficiaries, the cost is threatened by what the review calls “an open door, no limit policy as required by current legislation.” Also increasing costs is unlimited funding for medical care overseas for migrant workers who do not permanently reside in the TCI and unlimited funding for their dependents, regardless of the number of dependents. Illegal immigrants do not make any contributions, but they get treatment on humanitarian grounds and under international accords and agreements. Only those who are employed contribute, so 11,000 dependants are being supported by 18,000 contributors. The government suggests dramatic increases in contributions and allowing long-term residents not currently eligible for cover, such as retired persons and winter visitors, to join the program to increase contributions.
Other ways to increase income would be applying high healthcare taxes on tobacco, alcohol and high sugar content products, and encouraging health and medical tourism, although the suggestion that the government receive 50 % of revenues may not go down well.