ArticleBMJ global health2018
Achieving universal health coverage in small island states: could importing health services provide a solution?
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 24 citations in OpenAlex.
- Health financing and systems in African small and island states: Unique challenges and opportunities in achieving universal health coverage.SSM - health systems · 2025Article
- Health insurance coverage among men and women in six countries within the Southeast Asia Region (2015-2022): a multilevel analysis of DemographicThe Lancet regional health. Southeast Asia · 2025Article
- Mental health literacy of adolescents in Bermuda, according to age, gender and race.Health promotion international · 2024Article
- When one size does not fit all: aid and health system strengthening for Small Island Developing States.Health policy and planning · 2024Review
- Configurations associated with the efficiency of the ophthalmology departments in public hospitals of Central South China.PloS one · 2024Article
- Progress of island health in the Maldives.Public health challenges · 2023Article
- Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review.Archives of public health = Archives belges de sante publique · 2023Article
- Mental health systems in six Caribbean small island developing states: a comparative situational analysis.International journal of mental health systems · 2022Article
- Universality of universal health coverage: A scoping review.PloS one · 2022Article
- Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia.International journal of environmental research and public health · 2021Article
- Implementation Lessons from a Multifaceted National Newborn Program in Solomon Islands: A Mixed-Methods Study.The American journal of tropical medicine and hygiene · 2020Article
- Cancer control in small island nations: from local challenges to global action.The Lancet. Oncology · 2019Review
- The upside of trade in health services.BMJ (Clinical research ed.) · 2019Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUniversal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option.
methodsAnalysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003-2013, together with in-depth review of medical travel schemes for the two highest importing SIDS-the Maldives and Tuvalu.
findingsMedical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS.
interpretationOur findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.