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1
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The term 'global South' is meant to denote poorer nations. However, it is an imperfect heuristic device because there are considerable variations in development among those countries
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The term 'global South' is meant to denote poorer nations. However, it is an imperfect heuristic device because there are considerable variations in development among those countries
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2
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79952768103
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Different kinds of medical tourism procedures, such as reproductive, transplant and cosmetic, raise different ethical issues. As space constraints bar appropriate engagement with the moral questions that attend those forms of healthcare travel, this paper limits its focus to a form of medical tourism, specifically, non-cosmetic, non-reproductive, non-transplant, surgical medical tourism for procedures such as hip replacements
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Different kinds of medical tourism procedures, such as reproductive, transplant and cosmetic, raise different ethical issues. As space constraints bar appropriate engagement with the moral questions that attend those forms of healthcare travel, this paper limits its focus to a form of medical tourism, specifically, non-cosmetic, non-reproductive, non-transplant, surgical medical tourism for procedures such as hip replacements
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3
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34249671617
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It is not possible to determine the exact number of Americans traveling to India as medical tourists. Foreign patients prefer not to get a medical visa as it requires that they register within two weeks of their arrival with regional authorities (R. Chinai & R. Goswami. Medical Visas Mark Growth of Indian Medical Tourism. B World Health Organ 2007; 85). However, it will be argued that given the systemic problems with the US healthcare system and given that India is a prime medical tourism destination, the number of American patients seeking care there is likely to increase
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It is not possible to determine the exact number of Americans traveling to India as medical tourists. Foreign patients prefer not to get a medical visa as it requires that they register within two weeks of their arrival with regional authorities (R. Chinai & R. Goswami. Medical Visas Mark Growth of Indian Medical Tourism. B World Health Organ 2007; 85). However, it will be argued that given the systemic problems with the US healthcare system and given that India is a prime medical tourism destination, the number of American patients seeking care there is likely to increase2007
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Family Foundation. 2009. The Uninsured: A Primer. Melno Park, CA: Kaiser Family Foundation. Available at: [Accessed 25 Mar 2010]. While the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 is significant, it is not good enough. It not only leaves 23 million uninsured, it does not adequately control the rising cost of medical care or ensure good health insurance coverage for those who have or will have insurance (Physicians for a National Health Program. 2010. A False Promise of Reform. Available at: [Accessed 25 Mar
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Henry J. KaiserFamily Foundation. 2009. The Uninsured: A Primer. Melno Park, CA: Kaiser Family Foundation. Available at: [Accessed 25 Mar 2010]. While the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 is significant, it is not good enough. It not only leaves 23 million uninsured, it does not adequately control the rising cost of medical care or ensure good health insurance coverage for those who have or will have insurance (Physicians for a National Health Program. 2010. A False Promise of Reform. Available at: [Accessed 25 Mar2010
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They are covered under Medicare, which is a federally funded health insurance program
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They are covered under Medicare, which is a federally funded health insurance program
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7
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They have coverage through the federal and state funded Medicaid health insurance program
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They have coverage through the federal and state funded Medicaid health insurance program
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79952752600
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Understanding Health Policy: A Clinical Approach. New York, NY: Lange Medical Books/McGraw-Hill: 7
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T.S. Bodenheimer & K. Grumbach2005Understanding Health Policy: A Clinical Approach. New York, NY: Lange Medical Books/McGraw-Hill: 7
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Bodenheimer, T.S.1
Grumbach, K.2
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For instance, the annual cost of covering a family on an employment based plan in 2007 averaged US$12,000 (V. Fuhrmans. 2007. Health-Care Premiums Climbing Faster Than Inflation, Studies Say. Wall St J 12 September
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For instance, the annual cost of covering a family on an employment based plan in 2007 averaged US$12,000 (V. Fuhrmans. 2007. Health-Care Premiums Climbing Faster Than Inflation, Studies Say. Wall St J 12 September2007
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(2007)
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Last Chance Therapies
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Can a Just and Caring Society do Healthcare Rationing When Life Itself is at Stake? Yale J Health Policy Law Ethics
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L.M. FleckLast Chance TherapiesCan a Just and Caring Society do Healthcare Rationing When Life Itself is at Stake? Yale J Health Policy Law Ethics200222255-298
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Fleck, L.M.1
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The American Way of Politics at the Breaking Point. Boston, MA: Little, Brown
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H. Johnson & D. Broder1997The SystemThe American Way of Politics at the Breaking Point. Boston, MA: Little, Brown
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Johnson, H.1
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First World Health Care at Third World Prices': Globalization, Bioethics and Medical Tourism. Biosocieties
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L. TurnerFirst World Health Care at Third World Prices': Globalization, Bioethics and Medical Tourism. Biosocieties20072303-325
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Apollo Hospital Group (AHG). 25 Years Apollo Hospitals: Touching Lives: Chennai. Chennai: AHG. Available at: [Accessed 2 Mar
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Apollo Hospital Group (AHG). 25 Years Apollo Hospitals: Touching Lives: Chennai. Chennai: AHG. Available at: [Accessed 2 Mar2008
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[Unknown]. 2004. Medical tourism: Need surgery, will travel. CBC News Online. 18 June. Available at: [Accessed 20 Nov 2009]. Also, see J. Solomon. 2004. Traveling Cure: India's New Coup In Outsourcing: Inpatient Care - Facing Expense, Long Waits At Home, Westerners Fly In; A Hospital Empire Grows - Mr. Salo Has [Real Doubts]. Wall St J 26 April. Available at [Accessed 20 Nov
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[Unknown]. 2004. Medical tourism: Need surgery, will travel. CBC News Online. 18 June. Available at: [Accessed 20 Nov 2009]. Also, see J. Solomon. 2004. Traveling Cure: India's New Coup In Outsourcing: Inpatient Care - Facing Expense, Long Waits At Home, Westerners Fly In; A Hospital Empire Grows - Mr. Salo Has [Real Doubts]. Wall St J 26 April. Available at [Accessed 20 Nov2009
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Apollo Hospital Group (AHG). 25 Years Apollo Hospitals: Touching Lives: Medical Milestones. Chennai: AHG. Available at: [Accessed 2 Mar
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Apollo Hospital Group (AHG). 25 Years Apollo Hospitals: Touching Lives: Medical Milestones. Chennai: AHG. Available at: [Accessed 2 Mar2008
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Joint Commission International (JCI), op. cit. note 17
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20
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The category of underinsured includes persons whose health insurance coverage does not cover the entire cost of treatment for catastrophic illnesses. Persons whose health insurance does not cover treatment for certain conditions could also be classified as underinsured. Also, those with health insurance plans that have a high deductible or co-payment might resort to medical tourism because they might not be able to pay the deductible or co-payments that run into thousands of dollars. They might find traveling to poorer countries for medical care more feasible than seeking care in the US
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The category of underinsured includes persons whose health insurance coverage does not cover the entire cost of treatment for catastrophic illnesses. Persons whose health insurance does not cover treatment for certain conditions could also be classified as underinsured. Also, those with health insurance plans that have a high deductible or co-payment might resort to medical tourism because they might not be able to pay the deductible or co-payments that run into thousands of dollars. They might find traveling to poorer countries for medical care more feasible than seeking care in the US
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21
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Sending patients packing. USA Today 27 July. Available at [15 Mar
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J. Appleby & J. Schmit2006Sending patients packing. USA Today 27 July. Available at [15 Mar2010
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(2006)
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Appleby, J.1
Schmit, J.2
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22
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79952749605
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Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care. NY Times 11 October
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S. Rai2006Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care. NY Times 11 October
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(2006)
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Rai, S.1
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23
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79952771400
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Because of protest from the United Steelworkers Union, Blue Ridge Paper shelved its plan to offer its employees the option of getting expensive medical procedures in India (Ibid). However, given the rising cost of medical care in the US and the waning power of unions, labour organizations may not be able to stop businesses from 'urging' workers to get the treatment at a lower cost in the global South rather than within the US
-
Because of protest from the United Steelworkers Union, Blue Ridge Paper shelved its plan to offer its employees the option of getting expensive medical procedures in India (Ibid). However, given the rising cost of medical care in the US and the waning power of unions, labour organizations may not be able to stop businesses from 'urging' workers to get the treatment at a lower cost in the global South rather than within the US
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24
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Oxford Analytica. 2006. 'Medical Tourism' Industry Grows Rapidly. Forbes 25 October. Available at: [Accessed 15 March
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Oxford Analytica. 2006. 'Medical Tourism' Industry Grows Rapidly. Forbes 25 October. Available at: [Accessed 15 March2010
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Insurance for Overseas Surgery. Kiplinger.com September. Available at: [Accessed 19 Feb
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J. Anderson2007Insurance for Overseas Surgery. Kiplinger.com September. Available at: [Accessed 19 Feb2008
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West Virginia Legislature. 2006. H.B. 4359. Charleston, WV: West Virginia Legislature. Available at: [Accessed 2 Mar
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West Virginia Legislature. 2006. H.B. 4359. Charleston, WV: West Virginia Legislature. Available at: [Accessed 2 Mar2008
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West Virginia Legislature. 2006. H.B. 4711. Charleston, WV: West Virginia Legislature. Available at: [Accessed 2 Mar
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West Virginia Legislature. 2006. H.B. 4711. Charleston, WV: West Virginia Legislature. Available at: [Accessed 2 Mar2008
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United States Senate. 2006. The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?: Hearing before The Special Committee on Aging. 109th Congress, Second Session. Washington D.C., June 27, Serial No. 109-26. US Government Printing Office
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United States Senate. 2006. The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?: Hearing before The Special Committee on Aging. 109th Congress, Second Session. Washington D.C., June 27, Serial No. 109-26. US Government Printing Office2006
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79952747975
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Ibid; Anderson, op. cit., note 25; Appleby, op. cit., note 21; Oxford Analytica, op. cit., note 24; West Virginia Legislature op. cit., notes 27 & 29; US Senate, op. cit., note 30; U. Kher. 2006. Outsourcing your heart. Time 29 May; 22: 44-47; A. Milstein & M. Smith. America's New Refugees -Seeking Affordable Surgery Offshore. NEJM 2006; 19: 1637; A. Milstein & M. Smith.Will the surgical world become flat? Health Aff
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Ibid; Anderson, op. cit., note 25; Appleby, op. cit., note 21; Oxford Analytica, op. cit., note 24; West Virginia Legislature op. cit., notes 27 & 29; US Senate, op. cit., note 30; U. Kher. 2006. Outsourcing your heart. Time 29 May; 22: 44-47; A. Milstein & M. Smith. America's New Refugees -Seeking Affordable Surgery Offshore. NEJM 2006; 19: 1637; A. Milstein & M. Smith.Will the surgical world become flat? Health Aff200726137-141
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Medical Tourism in Developing Countries. New York, NY: Palgrave Macmillan
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M. Bookman & K. Bookma2007Medical Tourism in Developing Countries. New York, NY: Palgrave Macmillan176-177
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Bookman, M.1
Bookma, K.2
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31
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79952759616
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Ibid 177-185. Turner, in contrast to Bookman & Bookman (op. cit. note 32), believes that medical tourism is not likely to be beneficial for the poor of India and Thailand unless profits from it are used to provide and improve care for the local population (Turner op. cit. note 12
-
Ibid 177-185. Turner, in contrast to Bookman & Bookman (op. cit. note 32), believes that medical tourism is not likely to be beneficial for the poor of India and Thailand unless profits from it are used to provide and improve care for the local population (Turner op. cit. note 12320-321
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32
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79952760967
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Bookman & Bookman's image of poorer nations struggling to find a way out of poverty as fractious young children being taken on a long car trip by an adult (in this case, presumably, the global North) is paternalistic and obfuscates the reality of the past and current economic relationship between the global South and North
-
Bookman & Bookman's image of poorer nations struggling to find a way out of poverty as fractious young children being taken on a long car trip by an adult (in this case, presumably, the global North) is paternalistic and obfuscates the reality of the past and current economic relationship between the global South and North
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Bookman & Bookman, op. cit. note 32
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Bookman & Bookman, op. cit. note 32
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Globalization, Trade, and Health: Unpacking the Links and Defining Public Policy Options. In Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease: A Public Health Reader. R. Hofrichter, ed. San Francisco, CA: Jossey-Bass: 469-500: 472
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R. Labonte2003Globalization, Trade, and Health: Unpacking the Links and Defining Public Policy Options. In Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease: A Public Health Reader. R. Hofrichter, ed. San Francisco, CA: Jossey-Bass: 469-500: 472
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Living in a Global Economy. In Women's Lives: Multicultural Perspectives. G. Kirk & M. Okazawa-Rey, eds. Mountain View, CA: Mayfield: 182-192: 188. Also see Harvey (op. cit. note 37, pp. 92-93), J. Gershman, A. Irwin & A. Shakow (2003. Getting a Grip on the Global Economy: Health Outcomes and the Decoding of Development Discourse. In Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease: A Public Health Reader. R. Hofrichter, ed. San Francisco, CA: Jossey-Bass: 157-194: 168-170), and M. Weisbrot, D. Baker & D. Rosnick (2007. The Scorecard on Development: 25 Years of Diminished Progress. In Neoliberalism, Globalization and Inequalities: Consequences for Health and Quality of Life. V. Navarro, ed. Amityville, NY: Baywood Publishing
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G. Kirk & M. Okazawa-Rey1998Living in a Global Economy. In Women's Lives: Multicultural Perspectives. G. Kirk & M. Okazawa-Rey, eds. Mountain View, CA: Mayfield: 182-192: 188. Also see Harvey (op. cit. note 37, pp. 92-93), J. Gershman, A. Irwin & A. Shakow (2003. Getting a Grip on the Global Economy: Health Outcomes and the Decoding of Development Discourse. In Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease: A Public Health Reader. R. Hofrichter, ed. San Francisco, CA: Jossey-Bass: 157-194: 168-170), and M. Weisbrot, D. Baker & D. Rosnick (2007. The Scorecard on Development: 25 Years of Diminished Progress. In Neoliberalism, Globalization and Inequalities: Consequences for Health and Quality of Life. V. Navarro, ed. Amityville, NY: Baywood Publishing179-201
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In recent years, the World Bank and the International Monetary Fund (IMF) have made the claim that they are focused on poverty reduction, thus, they no longer use the term 'structural adjustment' to describe their programs. However, the change in terminology is not indicative of a deep ideological shift; the transnational financial institutions continue to require of poor debtor nations that they implement neoliberal reforms (T. Schrecker & R. Labonte. 2007. What's Politics Got to do With It? Health, the G8, and the Global Economy. In Globalization and Health. I. Kawachi & S. Wamala, eds. New York, NY: Oxford University Press:). Thus, this paper uses 'SAPs' to denote such policies and programs
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In recent years, the World Bank and the International Monetary Fund (IMF) have made the claim that they are focused on poverty reduction, thus, they no longer use the term 'structural adjustment' to describe their programs. However, the change in terminology is not indicative of a deep ideological shift; the transnational financial institutions continue to require of poor debtor nations that they implement neoliberal reforms (T. Schrecker & R. Labonte. 2007. What's Politics Got to do With It? Health, the G8, and the Global Economy. In Globalization and Health. I. Kawachi & S. Wamala, eds. New York, NY: Oxford University Press:). Thus, this paper uses 'SAPs' to denote such policies and programs284-310292
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IBRD offers financing at commercial rates primarily to middle-income nations
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IBRD offers financing at commercial rates primarily to middle-income nations
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IDA gives grants and below-market rate loans to nations which cannot afford commercial market loan rates
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IDA gives grants and below-market rate loans to nations which cannot afford commercial market loan rates
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Not all debtor nations adopted the SAPs. Cuba, for instance, resisted them
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Not all debtor nations adopted the SAPs. Cuba, for instance, resisted them
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A. Katz2007The Sachs Report: Investing in Health for Economic Development - or Increasing the Size of the Crumbs from the Rich Man's Table? In Neoliberalism, Globalization and Inequalities: Consequences for Health and Quality of Life. V. Navarro, ed. Amityville, NY: Baywood Publishing381-418
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Within the neoliberal paradigm, patients are conceptualized as consumers of healthcare good and services. This is in keeping with neoliberalism's tendency to construe virtually all relations, roles and interactions in market terms
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Within the neoliberal paradigm, patients are conceptualized as consumers of healthcare good and services. This is in keeping with neoliberalism's tendency to construe virtually all relations, roles and interactions in market terms
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Global Policy Networks: The Propagation of Health Care Financing Reform Since the 1980s. In Health Policy in a Globalising World. K. Lee, K. Buse & S. Fustukian, eds. New York, NY: Cambridge UP
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K. Lee & H. Goodman2003Global Policy Networks: The Propagation of Health Care Financing Reform Since the 1980s. In Health Policy in a Globalising World. K. Lee, K. Buse & S. Fustukian, eds. New York, NY: Cambridge UP97-119
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V. Navarro2007The World Health Situation. In Neoliberalism, Globalization and Inequalities: Consequences for Health and Quality of Life. V. Navarro, ed. Amityville, NY: Baywood Publishing203-212
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Bookman & Bookman, op. cit. note 32, p.128. However, citing the World Bank, Bookman et al. claim those problems are short term and they can be managed by policies aimed at realizing social goals. But that line of argument is not convincing because it does not take seriously the well-being of those compromised by such policies. It seems the following crucial ethical question is ignored by proponents of neoliberalism: Even if the poor and marginalized only suffer short-term hardships because of neoliberal reform of the healthcare sector, did they consent to enduring the harm or was that decision made on their behalf by others? The fact that the harm to the health and life prospects of the poor and marginalized may be irreversible is another issue that has been ignored by advocates of neoliberal reform
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Bookman & Bookman, op. cit. note 32, p.128. However, citing the World Bank, Bookman et al. claim those problems are short term and they can be managed by policies aimed at realizing social goals. But that line of argument is not convincing because it does not take seriously the well-being of those compromised by such policies. It seems the following crucial ethical question is ignored by proponents of neoliberalism: Even if the poor and marginalized only suffer short-term hardships because of neoliberal reform of the healthcare sector, did they consent to enduring the harm or was that decision made on their behalf by others? The fact that the harm to the health and life prospects of the poor and marginalized may be irreversible is another issue that has been ignored by advocates of neoliberal reform
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Rising Markets and Failing Health
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An Inquiry into Subaltern Health Care Consumption under Neoliberalism. Journal of Macromarketing
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J.D. Pedersen Explaining Economic Liberalization in India State and Society Perspectives200028 265-282
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The Political and Social Economy of Care
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United Nations Research Institute for Social Development
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R. Palriwala & N. Pillai2008The Political and Social Economy of CareIndia Research Report 1. GenevaUnited Nations Research Institute for Social Development
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Palriwala, R.1
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Lessons from Liberalisation in India. In Engendering International Health: The Challenge of Equity. G. Sen, A. George, & P. Ostlin, eds. Cambridge, MA: MIT Press
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Palriwala & Pillai, op. cit. note 70, section III
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67
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85127149089
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Sen et al., op. cit. note 71. Nair et al. have argued that the neoliberal ideology has reduced the issue of women's access to healthcare to availability of birth control, even though 'a large proportion of maternal and infant deaths in India, for instance, is attributable not to a lack of contraception, or even to little or no access to quality health care services, but to under-nutrition, anemia and communicable diseases stemming from a lack of food, poverty and inequity' (S. Nair, S. Sexton & P. Kirbat. 2006. A Decade after Cairo: Health in a free market economy. Indian J Gend Stud
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Sen et al., op. cit. note 71. Nair et al. have argued that the neoliberal ideology has reduced the issue of women's access to healthcare to availability of birth control, even though 'a large proportion of maternal and infant deaths in India, for instance, is attributable not to a lack of contraception, or even to little or no access to quality health care services, but to under-nutrition, anemia and communicable diseases stemming from a lack of food, poverty and inequity' (S. Nair, S. Sexton & P. Kirbat. 2006. A Decade after Cairo: Health in a free market economy. Indian J Gend Stud20063171-193
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68
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79952749642
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Sen et al. op. cit. note 71. Also see Varman & Vikas, op. cit. note 68.
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Sen et al. op. cit. note 71. Also see Varman & Vikas, op. cit. note 68.
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69
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79952752695
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Sen et al. op. cit., note 71, p. Also see Varman & Vikas, op. cit. note 68.
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Sen et al. op. cit., note 71, p. Also see Varman & Vikas, op. cit. note 68.297
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70
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79952772741
-
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Neoliberalism has two phases; roll-back neoliberalism and roll-out neoliberalism. During the former phase, neoliberalism calls for the elimination of Keynesian regulations and state actions (J. Peck & A. Tickell. 2002. Chapter 2: Neoliberalizing Space. In Spaces of Neoliberalism: Urban Restructuring in North America and Western Europe. N. Brenner & N. Theodore, eds. Malden, MA: Oxford's Blackwell Press:). In the roll-out phase, neoliberalism advocates government regulations and state intervention that serve its agenda of fostering free enterprise whilst cutting public programs and services. The Indian government's support for the private health sector falls under the latter category
-
Neoliberalism has two phases; roll-back neoliberalism and roll-out neoliberalism. During the former phase, neoliberalism calls for the elimination of Keynesian regulations and state actions (J. Peck & A. Tickell. 2002. Chapter 2: Neoliberalizing Space. In Spaces of Neoliberalism: Urban Restructuring in North America and Western Europe. N. Brenner & N. Theodore, eds. Malden, MA: Oxford's Blackwell Press:). In the roll-out phase, neoliberalism advocates government regulations and state intervention that serve its agenda of fostering free enterprise whilst cutting public programs and services. The Indian government's support for the private health sector falls under the latter category33-57
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71
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79952742180
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Sen et al. op. cit. note 71
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Sen et al. op. cit. note 71
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72
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79952741629
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Palriwala & Pillai, op. cit. note 70, section III
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Palriwala & Pillai, op. cit. note 70, section III
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73
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79952759247
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Varman & Vikas, op. cit., note 68
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Varman & Vikas, op. cit., note 68, pp. 165&167
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74
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79952765171
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Palriwala & Pillai, op. cit. note 70, section III
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Palriwala & Pillai, op. cit. note 70, section III
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75
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79952753243
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India Health Report. New York, NY: Oxford University Press
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R. Misra, R. Chatterjee & S. Rao2003India Health Report. New York, NY: Oxford University Press
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(2003)
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Misra, R.1
Chatterjee, R.2
Rao, S.3
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76
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79952770633
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Varman & Vikas, op. cit. note 68
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Varman & Vikas, op. cit. note 68165
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77
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79952760009
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Varman & Vikas, op. cit. note 68
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Varman & Vikas, op. cit. note 68168
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78
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79952746239
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The Indian government's support of the medical tourism industry falls under the category of roll-out neoliberalism
-
The Indian government's support of the medical tourism industry falls under the category of roll-out neoliberalism
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79
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79952741267
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Ministry of Health and Family Welfare. National Health Policy, 2002. New Delhi: Government of India. Available at: [Accessed 8 Nov
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Ministry of Health and Family Welfare. National Health Policy, 2002. New Delhi: Government of India. Available at: [Accessed 8 Nov2008
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80
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49849099804
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Medical tourism in India
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Indian J Med Ethics
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A.S. GuptaMedical tourism in IndiaWinners and LosersIndian J Med Ethics200814-5
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Winners and Losers
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Gupta, A.S.1
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81
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79952742565
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The Private Health Sector in India is Burgeoning, But at the Cost of Public Healthcare. Brit Med J
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A. Sengupta & S. NundyThe Private Health Sector in India is Burgeoning, But at the Cost of Public Healthcare. Brit Med J2005331
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, pp. 331
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Sengupta, A.1
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82
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Chinai & Goswami, op. cit. note 3
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Chinai & Goswami, op. cit. note 3
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83
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79952749604
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United Nation. United Nation's Human Development Report 2006: Beyond Scarcity: Power, poverty, and the Global Water Crisis. New York, NY: United Nations
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United Nation. United Nation's Human Development Report 2006: Beyond Scarcity: Power, poverty, and the Global Water Crisis. New York, NY: United Nations2006
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(2006)
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84
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79952752425
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In 2006, according to the World Bank, the US's GDP was US$13,164 billion, while India's GDP was US$912 billion (Data 360. [No Title]. San Francisco, CA: Data 360. Available at: [Accessed 6 Apr 2009]). In 2006, the US's population was 299 million, while that of India's was 1,122 million (Population Reference Bureau. 2006. World Population Data Sheet. Washington, DC: Population Reference Bureau. Available at: [Accessed 6 Apr 2009]). Thus, the per capita GDP for the US in 2006 was US$44,026 approximately while that of India was an estimated US$812
-
In 2006, according to the World Bank, the US's GDP was US$13,164 billion, while India's GDP was US$912 billion (Data 360. [No Title]. San Francisco, CA: Data 360. Available at: [Accessed 6 Apr 2009]). In 2006, the US's population was 299 million, while that of India's was 1,122 million (Population Reference Bureau. 2006. World Population Data Sheet. Washington, DC: Population Reference Bureau. Available at: [Accessed 6 Apr 2009]). Thus, the per capita GDP for the US in 2006 was US$44,026 approximately while that of India was an estimated US$812
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85
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79952746048
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Global Virtual University (GVU). India: Annual Population Growth Rate. Arendal, Norway: GVU. Available at: [Accessed 25 Mar
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Global Virtual University (GVU). India: Annual Population Growth Rate. Arendal, Norway: GVU. Available at: [Accessed 25 Mar2010
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86
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79952763862
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This figure is estimated using the 2000 population of India
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This figure is estimated using the 2000 population of India2000
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(2000)
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87
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79952757924
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United Nation, op. cit. note 92
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United Nation, op. cit. note 92
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88
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79952744952
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Chinai & Goswami, op. cit. note 3
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Chinai & Goswami, op. cit. note 3
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79952756417
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The Case of India. In International Trade in Health Services: A Development Perspective. Geneva: UNCTAD-WHO Joint Publication
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I. Gupta, B. Goldar & A. Mitra1998The Case of India. In International Trade in Health Services: A Development Perspective. Geneva: UNCTAD-WHO Joint Publication
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Goldar, B.2
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79952751661
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Chinai & Goswami, op. cit. note 3
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Chinai & Goswami, op. cit. note 3
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Responsibility and Global Justice
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A Social Connection Model. Soc Philos Policy
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I.M. YoungResponsibility and Global JusticeA Social Connection Model. Soc Philos Policy200623102-130
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(2006)
, vol.23
, pp. 102-130
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Young, I.M.1
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92
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79952750367
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Young, op. cit. note 104
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Young, op. cit. note 104119
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93
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79952744951
-
-
Given this paper's limited scope, it does not engage with the question of the compensation that the US citizenry and that of other nations dominant in the transnational financial institutions owe to those in India and other debtor nations of the global South harmed by SAPs
-
Given this paper's limited scope, it does not engage with the question of the compensation that the US citizenry and that of other nations dominant in the transnational financial institutions owe to those in India and other debtor nations of the global South harmed by SAPs
-
-
-
-
94
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79952760211
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-
While there is no necessary connection between SAPs and medical tourism, when the two phenomena co-exist as they do in India, the impact on availability of medical care for the poor and marginalized can be profound
-
While there is no necessary connection between SAPs and medical tourism, when the two phenomena co-exist as they do in India, the impact on availability of medical care for the poor and marginalized can be profound
-
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95
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22944454576
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Global Prescriptions
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Gendering Health and Human Rights. London, UK & New York, NY: Zed Books
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R.P. Petchesky2003Global PrescriptionsGendering Health and Human Rights. London, UK & New York, NY: Zed Books137
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(2003)
, pp. 137
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Petchesky, R.P.1
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96
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79952772539
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A Development Round of Trade Negotiations. Proceedings from the Annual Bank Conference on Development Economics 2004. Washington, DC: World Bank. Available at [Accessed 10 Sept
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J. Stiglitz & A. Charlton2004A Development Round of Trade Negotiations. Proceedings from the Annual Bank Conference on Development Economics 2004. Washington, DC: World Bank. Available at [Accessed 10 Sept2008
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(2004)
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Charlton, A.2
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97
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79952755870
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Note
-
A percentage of patients from the US who seek medical care in India are not American citizens. Usually, they are persons who are non-resident Indians (i.e., citizens of India working in the US on a work visa or Indian citizens who hold permanent resident status in the US). It is not known how many such persons seek medical care in India due to cost considerations. However, as non-resident Indians, they are charged the same fee by India's medical tourism facilities as foreigners (Chinai & Goswami, op. cit. note 3). Moreover, given that they are not US citizens and thus do not have the right to vote, they do not have political agency of the sort that American citizens possess and which they could use to bring about change in the US healthcare system. The denial of political agency to US permanent residents has profound implications for their well-being. For instance, the state of Massachusetts, facing budget cuts, decided that its commitment to provide universal healthcare coverage to all of its residents did not preclude denying coverage to some percentage of permanent residents (A. Goodnough. Massachusetts Adjusts a Cut, Providing Some Health Care for 30,000 Immigrants. NY Times. 30 July: A19). Presumably, the elected government officials who made the decision were aware that permanent residents are politically powerless.2009
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(2009)
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98
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79952762367
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Gupta op. cit. note 87
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Gupta op. cit. note 87
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99
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79952744201
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While the state of Kerala does a better job of meeting the healthcare needs of its residents, there are sub-groups whose medical needs remain unattended (see C. Thresia. Interplay of Gender Inequities, Poverty and Caste: Implications for Health of Women in the Cashew Industry of Kerala. Social Medicine
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While the state of Kerala does a better job of meeting the healthcare needs of its residents, there are sub-groups whose medical needs remain unattended (see C. Thresia. Interplay of Gender Inequities, Poverty and Caste: Implications for Health of Women in the Cashew Industry of Kerala. Social Medicine200728-18
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(2007)
, vol.2
, pp. 8-18
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100
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56749173514
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The migration of healthcare professionals from poorer to richer countries is a serious related ethical problem. However, it is not addressed at any length here because the focus of this paper is medical tourism. Readers interested in the issue will find useful articles by C.R. Hooper (Adding Insult to Injury: The Healthcare Brain Drain. J Med Ethics 2008; 34: 684-687), J. Snyder (Is Health Worker Migration a Case of Poaching? AJOB 9: 3-7), and J. Dwyer (What's Wrong with the Global Migration of Health Care Professionals? Hastings Cent Rep
-
The migration of healthcare professionals from poorer to richer countries is a serious related ethical problem. However, it is not addressed at any length here because the focus of this paper is medical tourism. Readers interested in the issue will find useful articles by C.R. Hooper (Adding Insult to Injury: The Healthcare Brain Drain. J Med Ethics 2008; 34: 684-687), J. Snyder (Is Health Worker Migration a Case of Poaching? AJOB 9: 3-7), and J. Dwyer (What's Wrong with the Global Migration of Health Care Professionals? Hastings Cent Rep20073736-43
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(2007)
, vol.37
, pp. 36-43
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101
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Bookman & Bookman, op. cit. note 32
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Bookman & Bookman, op. cit. note 32177-178
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102
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79952764228
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But then so would new or existing healthcare facilities that expanded their capacities to meet the currently unmet needs of the local indigent population
-
But then so would new or existing healthcare facilities that expanded their capacities to meet the currently unmet needs of the local indigent population
-
-
-
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103
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79952761869
-
-
It is presumably under the auspices of the World Trade Organization's General Agreement on Trade in Services that India has allowed foreign investments in hospitals (Adlung & Carzaniga, op. cit., note 54
-
It is presumably under the auspices of the World Trade Organization's General Agreement on Trade in Services that India has allowed foreign investments in hospitals (Adlung & Carzaniga, op. cit., note 54357
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104
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79952756986
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Gupta et al., op. cit. note 102
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Trade in Health Services. B World Health Organ
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Trade in Health Services. In World Health Organization Commission on Macroeconomics and Health, Working Group No. 4, Working Paper No. 5. Geneva: WHO: 45
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R. Chanda2001Trade in Health Services. In World Health Organization Commission on Macroeconomics and Health, Working Group No. 4, Working Paper No. 5. Geneva: WHO: 45
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(2001)
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Chanda, R.1
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107
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Three Billion New Capitalists, New York, NY: Basic Books
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C. Prestowitz2005Three Billion New Capitalists, New York, NY: Basic Books
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(2005)
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108
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79952755634
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The websites of the medical tourism facilities offer no such information
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The websites of the medical tourism facilities offer no such information
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109
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79952767923
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Apollo Hospital Group (AHG). [Untitled]. Chennai: AHG. Available at [Accessed 15 Mar
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Apollo Hospital Group (AHG). Touching lives in many ways. Chennai: AHG. Available at [Accessed 15 Mar
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Apollo Hospital Group (AHG). Touching lives in many ways. Chennai: AHG. Available at [Accessed 15 Mar2010
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111
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79952765539
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Society to Aid the Hearing Impaired (SAHI). Let All Hear: SAHI Campus in 2009. Available at [Accessed 15 Mar2010
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Cure Foundation (CF). Cure Foundation. Hyderabad: CF. Available at [Accessed 15
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Cure Foundation (CF). Cure Foundation. Hyderabad: CF. Available at [Accessed 152010
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