Critical thinking paper

St. Petersburg College Applied Ethics Program

Critical Thinking & Application Paper

Instructions: Read the case and answer the questions your instructor provided. Instead of writing one, long traditional essay based on the questions, reflect on and answer the questions individually, giving a detailed and thorough answer for each.

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Medical Outsourcing

As the cost of U.S. health care continues to rise to stratospheric levels, Americans have begun to shop around for medical treatment in foreign countries. While medical tourism is hardly novel (for years Americans have sought discounted cosmetic surgery in places like Mexico, Thailand and India), the interest in foreign medical treatment among uninsured (or underinsured) individuals is, indeed, a burgeoning trend.

Amy Smith is one such American considering the possibility of going abroad for an elective cosmetic medical procedure. Despite the fact that Amy has a bachelor's degree in fine art, she works as an exotic dancer. Her true passion is photography and she hopes one day to open a photography studio. Dancing is a means to that end, though truthfully she enjoys the money and flexible schedule which allows her to travel. Exploring other parts of the world is another of her personal delights. Though Amy's income is not insignificant she is uninsured, and it is unlikely that insurance would cover her elective procedure anyway. Given her inquisitive nature, Amy decides to do a little research into the pros and cons of medical tourism.

The main incentive for outsourcing health care procedures is the relatively low cost and the high quality of care. Surgical services in places like India and Thailand cost 70 to 80 percent less than in the United States. For example, heart bypass surgery, which can cost more than $130,000 in the United States, can be performed for $10,000 in India and $19,000 in Turkey. Patients receive high-quality care in luxurious hospitals exclusively designed for tourists. As one recuperates from mitral valve surgery in a luxurious Indian hospital suite (fully-equipped with TV, computer, and mini-fridge), one can rest assured that all of one's needs will be catered to – from diet and galling skin rash to one's craving for ice cream. Furthermore, according to John Lancaster of The Washington Post, Indian private hospitals have a better mortality rate for heart surgery than American hospitals.

Individual patients are not the only ones taking advantage of the overseas medical market. Some companies (like Blue Ridge Paper Products of North Carolina), faced with the hard choice between providing health coverage and staying solvent, have tried sending their employees overseas for medical treatment. Companies are not alone in considering this alternative. For example, a West Virginia legislator has been developing a bill that “would encourage state employees to have nonemergency medical surgeries overseas.” Concomitantly, companies in Florida, California and North Carolina have begun to specialize in selling medical insurance and services that rely on foreign hospitals.

Because of its economic advantages, the outsourcing of medical procedures has been widely touted as a panacea. However, outsourced medical procedures are outside the reach of many working class Americans, and these procedures have not been shown to lower the cost of healthcare in the U.S. These concerns, coupled with the lack of continuity of care after patients leave the foreign hospital, have raised concern among workers and patients’ advocates.

Additionally, while private, for-profit hospitals offer world-class, high-tech medical procedures to foreign patients and wealthy Indian nationals, most Indians are at the mercy of an under-funded and overstretched public health care system. Urban areas cannot keep up with the demand for treatment, and rural towns often have no medical facilities whatsoever. While foreign patients pay for their care at Indian hospitals, their fee only partially funds these private institutions. In the 1990’s the Indian government shifted from funding public health care institutions to supporting private health care facilities. Thus, foreign medical tourists may be reaping the benefits of Indian public funding that has been channeled to private medical institutions.

What should Amy do?

This case was based on and adapted from a case published by the Association of Practical and Professional Ethics for use in the national intercollegiate Ethics Bowl competition, and is being used with their permission.