BELIZE: Local doctors oppose medical tourism plans for Belize

There is growing controversy over the potential development of medical tourism in Belize.? The policies are currently being drafted and could open up the market to new medical facilities that may offer health care exclusively to foreigners. The problem is that the government is working with investors, but refusing to include local medical professionals in any debate or discussion. Medical tourism could hurt the pockets of local doctors, as it seems that American medical professionals will provide exclusive health services that are already being offered by locals.

In a radio interview, Joel Cervantes, president of the Belize Medical and Dental Association said that removal of medical tourism services offered by local doctors could seriously affect the viability of well-established institutions,“ What is very important to realize is that medical tourism, at this point for Belize, poses a threat as there are a lot of interest both inside Belize?powerful businessmen, very politically aligned?and also foreign interests with a lot of money and they are interested in opening up medical tourism. In fact, there are a lot of advanced plans; we know that there is a place in the Free Zone; we know that there are plans for something to go on in San Pedro, and also down in Placencia. The only problem, in our view is that medical tourism should first and foremost be a national industry whereby we, as Belizeans, local doctors, dentists, nurses and all health allied personnel, should be the ones that are leading. But we have been left out of the picture.”

Most available medical procedures are cheaper in Belize than in the USA, but many residents head north into Mexico for treatment, where costs are lower, facilities are better and more procedures are available. Facilities, equipment and doctors in Belize are in extremely short supply, so the range of available treatments is limited.

Belizean doctors generally come from abroad and the vast majority work in publicly funded clinics or hospitals. A few run their own private medical and dental practices, with some advertising to foreigners. A few people have visited Belize as medical tourists, often enjoying Belize's laid-back atmosphere as a great place to recover.

The Placencia Group wants to promote the country as a health and wellness destination for Canadians, Americans and Europeans. The five star therapeutic and wellness resort will be part of an acute care hospital at The Placencia, 10 minutes from Placencia International Airport. The company claims it has government support for the venture that will also offer stem cell treatment.

It seems that the politicians are planning to develop medical tourism, without involving local healthcare professionals. Mike Singh of the Caribbean Export Development Agency reports, “The policies are currently being drafted and will open up the market to new medical facilities that may offer health care exclusively to foreigners. It was discussed at a forum spearheaded by the Caribbean Export Development Agency and the Inter-American Development Bank. There are inquiries coming in from medical professionals abroad that are interested in setting up facilities. It is an area that has quite a huge scope for development.”

The reason that local hospitals are not happy is that under current proposals, overseas organisations flying doctors in from the USA would get preferable tax treatment to Belize clinics promoting medical tourism.

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EUROPE : A French view on the EU cross-border healthcare plans

Presenting to fellow European members of parliament her recommendations on cross-border health care for a second reading, French rapporteur Francoise Grossetete insisted she would be uncompromising on the issue of prior authorisation. While she does not question this principle, she rejects the quality and security criteria added by the Council, which would make it possible for a member state to arbitrarily refuse to grant authorisation to a patient, “I believe that this criterion is unacceptable because it would make it possible for prior authorisation to be refused at any time without explanation. It is inconceivable and would, in the end, lead to new appeals before the European Court of Justice”.

The objective of the proposal for a directive is to standardise case law of the Court of Justice of the European Union and avoid the ambiguity faced by patients. The Commission is attempting to clarify the rights of patients treated in another member state, including the issue of the reimbursement of care. As a general principle, it establishes that patients treated in another member state will receive the same level of reimbursement anticipated for the same treatment or for a similar treatment in their national health system, if they are entitled to this treatment in their country of affiliation.

Grossetete is an influential MEP and her stance could help influence changes in the Second Reading later this year. Her worry is that the latest version still enables member states to limit the application of rules relating to the reimbursement of cross-border health care by demanding prior authorisation for certain treatments. According to the rapporteur, prior authorisation must be based on the need for health care planning and rationalisation, but cannot be abused in order to deny patients the right to travel for treatment. She therefore proposes even tougher restrictions- limiting prior authorisation to hospital treatment (a stay of more than one night in hospital), specialised care or treatment that poses a particular risk to the patient or the population.

Grossetete believes that this text must be urgently concluded under the best possible conditions because the question has been open for too long. She makes a valid point that less than one per cent of the European population would even consider state paid healthcare in another country, as most people prefer to be treated at home. Her argument is that if states are offered the opportunity for prior authorisation and reimbursement, unless carefully controlled, the practice in some member states will make the whole concept unmanageable.

Grossetete will be intransigent on the issue of rare diseases, as she wants patients suffering from rare diseases to have access to care in another member state and be reimbursed, particularly if the treatment is not provided in their member state. She joins an increasing number of MEPs arguing that rare diseases must not be subject to prior authorisation. She points out an area that was not resolved in the latest version from Council, but appears to be yet another get out clause agreed earlier this year by health ministers. This is the stipulation that patients who have obtained prior authorisation must provide advance payment to the hospital .Her argument is that this makes a nonsense of the whole agreement and the logic must be that if any advance payment is allowed, then this should only be in those few countries where at home, the patient has to pay an advance fee to the hospital before reclaiming from the state after the treatment.

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