Scot MacStravic takes  an unduly negative view of the impact of medical tourism on the countries providing the care (The Downside of Globalizing Health Care). He cites the example of Thailand, where physicians are defecting from the public to private sector to take care of medical tourists and private-pay Thais. Obviously when a public clinic loses a doctor it’s a bad thing for the clinic and its patients. However, I’d argue that there’s more upside than downside to medical tourism when looked at broadly and that the Thai (and other foreign) governments have remedies available to them to correct specific problems.

• As Milica Bookman has argued, medical tourism can be a good development strategy for a country. Compared with other economic development activities it is cleaner, more profitable, and provides jobs for both well-educated and less educated people. For every gleaming hospital that is built there are many jobs for nurses, technicians, administrators, janitors, builders, launderers, taxi drivers, and so on. Few alternatives have such a broad, positive impact. This is the way that people are lifted out of poverty and can afford better food, shelter, and yes, even medical care.
• Medical tourism has the potential to reverse the brain drain. Instead of Thai/Indian/Filipino/Mexican/etc. doctors and nurses emigrating, they can find jobs in their home countries or return from abroad. Rather than focusing just on the shift of health care professionals within a country, we should take account of those who are coming back and potentially adding to the number of professionals available to spend at least some of their time in the public sector
• MacStravic laments the loss of investment by countries who invest in medical education and then lose out on the return on investment when medical professionals emigrate or work in the private sector. If you accept (which I don’t) that governments don’t get a return from professionals who emigrate or work in the private sector, there are some straightforward policy changes that can be made. For example, physicians could be required to work in the public sector for a few (more) years after graduating and/or they could be required to pay back some or all of the cost of their education if they emigrate or work in the private sector

Poverty sucks. There’s no way around it. But what we’re witnessing in medical tourism countries is rapid economic growth, which is quickly lifting the populations of these countries into the middle class. The globalization of health care is part of this process.

Rather than taking pity on developing countries, we should work on making the US more attractive for hard-working, well-educated immigrants. In recent years the country has taken a more negative, restrictive view toward immigration at the same time that immigrants are finding more opportunities in their home countries. The United States’ leadership in innovation is in deep trouble if this trend continues, as it looks set to do.