Gareth+-+Memo+-+23

Memo 23 – Hegemonic Backdrops:

In a broad sense, the topic of medical tourism is engulfed in traditional cultural hegemony including prevalent images of exotic subservient people of color, the othering of the local populace as in need of help by patient/tourists who are told their money not only helps them but the locals as well. The evocation and articulation of local populations as there to and desirous of providing comfort and service to visitors, and images of sexualized subservient females all perform traditional hegemonies of class, type, racial and sexual hierarchy. Promotion of global organization of power based on finance, and the conception of modernity as originating in the practices of the Western/First World, are omni-present in the promotion of the practice.

In order to narrow down I’m focusing on somewhat specific ideas. I’m choosing to frame hegemonies in terms of the statements of common sense that I have seen marked in statements around development of industry and practice. For clarity they take the form of a values statement in the affirmative, but in each case there would be an antithesis both of the central value and a counter-value that is hegemonic. The basic framing done is often in making the connection between the positive valuation statement and the object of its contrast presented in a formulary after the synthetic quotation.


 * “Outsourcing, off-shoring, increasing globalization and continuing formation of global markets is a natural and beneficial process.”
 * Globalization = Good; Overt Nationalism = Bad.


 * “Promotion of private healthcare market growth is the best way to increase access to medicine in the developing world. This market development discourages brain drain from, encourages investment within, and underscores the value of democracy in these countries.”
 * Healthcare Market = Good; Welfare/Entitlement distribution = Bad.


 * “Modern Dominant Western System of Biomedicine (defined through evidence based logics, standardized treatments, universal etiology, symptomatic treatment, advanced technological tools, and centralized on doctor-patient decision making) is the pinnacle of modernity, and is the best possible regime of medicine/healthcare.
 * Modern Medical System = Good ; Other Healing models = Bad.


 * “An appropriate mechanism for globalization and international governance is through the development of market forces, NGOs and the development of treaties and standards to make their work across nation-state borders easier.”
 * Governance through Market = Good; Direct Government Intervention = Bad.


 * “Though there are limitations to the American/Western healthcare industry, it is the home of Biomedicine, with immense ability to create knowledge, to improve standards of treatment, and constantly innovate. There is no ‘crisis’ but rather dissatisfaction among those who fail to understand the complexity, or respect the authority of doctors.”
 * American Healthcare structure/ Experts = good; Critics and Patients dissatisfaction/ Fear of “Crisis” = Bad


 * “Choice, especially as seen in consumer choice, is a vital form of freedom desired and appropriate for expansion.”
 * Choice = Good; Market Control = Bad


 * “Quality care can be understood through quantifiable measures of efficient cost-value appropriate, up-to-date, and consistent provision of the treatment sought by the customer/patient.”
 * Cost-Value service model of care = Good; Doctor centric


 * “The impression/experience of care for patients is part of the product, and is improved by travel to less-competitive better cost-value healthcare markets. The experience of care is provided through service, distinct from actual quality of care. Experience of medicine as separate product than the core-quality of medical care.” This one seems particularly important to me because it reinforces other hegemonies, including the definition of Care as specific treatments, the appropriatness of quantitative measure of care, and the dismissal of the patient experience as authoritative.
 * Medicine and Healthcare Service as separate product from Care = good; confounding service and Care = Bad.