Chapter 3: The preconditions for trade
Medical travel evolves historically through a sequence of stages. The first stage is minority and privilege. It is Harley Street and the Marienbad spa. The second stage is moderate participation. It extends the option of dentistry, optometry, cosmetic surgery and major surgery to the nouveaux riches who float upward on the tide of economics. The third stage is democratic inclusion. Whether seen as a luxury or treated as a necessity, care abroad becomes available, affordable and accessible even to a mass market. Ordinary consumers need no longer be on the outside looking in. The modern era is the third stage. This chapter describes the preconditions for medical travel in an era that is both socially and geographically global. Section 3.1, ëProsperity and paymentí, says that rising incomes make possible more choices. Sections 3.2, ëPrivate insuranceí and 3.3, ëState insuranceí, argue that prepayment, itself made affordable by growth, is empowering ordinary people to demand better care. Section 3.4, ëThe ins and the outsí, assesses the patients who pay out-of-pocket and sometimes do not pay at all. Section 3.5, ëRegion and alliance: the European Unioní, explains the implications of multinational communities for cross-border health. Section 3.6, ëInstitutions and attitudesí, argues that the built infrastructure is essential for medical travel but so is an open mind that does not regard every foreigner as a problem to be solved.
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