title: Understanding the impacts of medical tourism on health human resources in Barbados: a prospective, qualitative study of stakeholder perceptions.
abstract: BACKGROUND
  Medical tourism is a global health practice where patients travel internationally with the intention of receiving medical services. A range of low, middle, and high income countries are encouraging investment in the medical tourism sector, including countries in the Caribbean targeting patients in North America and Europe. While medical tourism has the potential to provide economic and employment opportunities in destination countries, there are concerns that it could encourage the movement of health workers from the public to private health sector.
  
  
  METHODS
  We present findings from 19 semi-structured interviews with stakeholders across the public health care, private health care, government, allied business, and civil society sectors. These interviews were conducted in-person in Barbados and via phone. The interview transcripts were coded and a thematic analysis developed.
  
  
  RESULTS
  Three themes were identified: 1) Stakeholder perceptions of the patterns and plans for health human resource usage by current and planned medical tourism facilities in Barbados. We found that while health human resource usage in the medical tourism sector has been limited, it is likely to grow in the future; 2) Anticipated positive impacts of medical tourism on health human resources and access to care in the public system. These benefits included improved quality control, training opportunities, and health worker retention; and 3) Anticipated negative impacts of medical tourism on health human resources and access to care in the public system. These impacts included longer wait times for care and a shift in planning priorities driven by the medical tourism sector.
  
  
  CONCLUSIONS
  Stakeholders interviewed who were connected to medical tourism expansion or the tourism sector took a generally positive view of the likely impacts of medical tourism on health human resources in Barbados. However, stakeholders associated with the public health system and health equity expressed concern that medical tourism may spread inequities in this country. The mechanisms by which observed negative health equity impacts in other countries will be avoided in Barbados are unclear. Continued study in Barbados and comparison with the regulatory frameworks in other countries is needed to help enhance positive and mitigate negative impacts of medical tourism on health human resources in Barbados. These findings will likely have import for other Caribbean nations investing in medical tourism and beyond.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada. jeremycsnyder@sfu.ca
authors.forename: Jeremy
authors.initials: J
authors.lastname: Snyder
authors.forename: Valorie A
authors.initials: VA
authors.lastname: Crooks
authors.forename: Leigh
authors.initials: L
authors.lastname: Turner
authors.forename: Rory
authors.initials: R
authors.lastname: Johnston
mesh_terms: D001460:Barbados; D003695:Delivery of Health Care; D006295:Health Resources / Q000592:standards*; D006801:Humans; D057193:Medical Tourism / Q000639:trends; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D000078329:Workforce