The Making of Medical Subjects: Medical Tourism and Its Adherence to Neoliberal Ideologies

Abstract

Medical tourism is not a new phenomenon but in its current form, medical tourism or health travel is a practice that stems from the structures of the healthcare system. For citizens of countries with primarily private healthcare and citizens of countries with socialized healthcare the forces behind seeking international healthcare are economic (cheaper prices) and temporal (long queues), respectively. The foreign nation-state/patient relationship is an integral part in facilitating the medical tourist/hospital relationship and is also a way to discern discrepancies in welcomed versus unwelcomed visitors. On the one hand, medical tourists are welcomed visitors while other types of "tourists" are not. During my fieldwork as a volunteer at a private Costa Rican hospital, I was quickly made aware of the popular discourse that denigrated Nicaraguans entering Costa Rica while simultaneously catering to Euro-American tourists. This is a clear example of the discrepancy between neoliberal doctrine and neoliberal practices in that the free market promotes the transnational flow of capital while slowing or stopping altogether the flow of (certain) bodies. The United States and South Korea both issue special medical visas to medical tourists and these practices have thus far made international borders even more penetrable by the global elite and/or those with the capital to afford medical care in another country; thus graying the distinction between citizen and non-citizen. The means by which the medical tourism industry, from a marketing standpoint, attracts this global elite is through the accreditation process, which is the act of an accrediting body legitimizing a business, medical facility or school through an intense, expensive, and lengthy process. Within the medical tourism industry, hospitals located in developing nation-states are clamoring for accreditation from agencies based in the U.S. and Europe. Many in this industry believe that such accreditation will increase the number of foreign, primarily Western, patients. I argue that accreditation is a form of subjectification, because many international hospitals that cater to Western patients want to legitimize themselves through an American and/or European body even though their healthcare systems rank higher than the U.S. Accreditation makes international hospitals "qualified" to provide medical services in the eyes of Western medical tourists and the medical tourism industry as a whole, which underscores the quality and superiority of many healthcare systems in the developing world. The problems that I have undertaken is the discrepancy between neoliberalism and the flow of (certain) bodies and capital vis medical tourism and public policy as well as how accreditation is used as a form of surveillance, gaze, and subject making that renders hospitals nearly powerless to the standards set by accrediting bodies.