The globalization of health care is reflected in at least two trends that are arguably good for the United States, but bad for other countries. The first is the tendency for shortages of health professionals in the US to create large flows of emigration of such professionals from their home countries, which incurred the costs of training them, but get nothing from their investment, except perhaps for money sent home by well-paid immigrants who share their wealth with family left at home.

Huge numbers of nurses and physicians have emigrated in the past, and though visas are tougher to get with homeland security regulations, they continue to emigrate in large numbers. Over half of the primary physicians in this country came from other countries, for example. This necessarily causes shortages of physicians and nurses in the countries that trained them, while enabling the US to get by at least. And while arguably the immigrants and America both gain from this phenomenon, the residents of the countries from which they came clearly do not, rather lose both taxpayer investments that don’t pay off, and sources of care that they need as well.

While we “repay” many such countries to some extent by sending Americans overseas, often to many of the same countries that supplied needed manpower, even that is adding a cost as well. While “medical tourism” is responsible for delivering millions of dollars to foreign countries, such as India, Brazil, and Thailand, for example, it is also using homegrown healthcare resources, and depriving citizens of these countries of sources of care they need as well.

With millions of medical tourists coming to Thailand, for example, from many countries, not merely the US, Thai physicians can make so much more money working for private hospitals that serve this lucrative market that few are willing to work in public hospitals, upon which most Thais depend for their own medical care. Often the “best and brightest” of Thai physicians “defect” from the public system in order to enjoy far better working conditions and incomes in the private sector. [J. Hamilton “Medical Tourism Creates Thai Doctor Shortage” All Things Considered Nov 29, 2007]

To some extent, this may keep physicians at home who would otherwise emigrate, but even if they are at home, they are not necessarily treating local residents. The combination of our becoming an attractive place for trained health professionals to emigrate to, while sending our own citizens overseas where they use local providers to the detriment of local citizens, is a major problem for underdeveloped countries, along with their lack of financial resources to pay for necessary medical care for their citizens. While the revenue impact of both immigrants sending money home and US residents bringing their money with them to such countries may partially mitigate the total impact, it is clear that the net effect on the underdeveloped world is negative.

While we have lots to do in order to solve our own healthcare crisis, it is possible that the efforts and resources we invest to improve the health of Americans will help in both these problems. The fewer sick Americans there are, the fewer immigrant health professionals there will be needed from other countries, and the fewer patients we need send elsewhere to occupy the time of professionals in other countries.