[People in] developing countries don't have the resources nor the arrogance to self treat and self prescribe ... Knowing this, however, a traveler can get prescriptions refilled and monitoring tests done without the expense of a new doctor in every port.
The underdeveloped middle class in developing countries does not have disposable income to oversubscribe to medical services. Nor did Americans of my mother’s day. No slack exists between the suppliers of medical services and the people who need them. In the so-called developed countries a medical-government-legal-insurance complex has arisen to play in the slack that exists there. What an investor would call “playing in the arbitrage”. In rich countries, super developed middle classes provide good opportunity for human gain by institutional power seekers. And in the case of lawyers, of course, it becomes inhuman gain.
A poor country can’t find the slack in which to play such games. Just getting the medicines onto the shelves gives sufficient opportunity for profit. Bureaucratic barriers seldom get thrown between the purchaser and the medicine on the shelf, between the examiner and the examinee, between the testing labs and the testee.
What small middle class a developing country has may be close to revolution — government dare not dink with their antibiotics. Nor their beer nor rum nor tobacco, for that matter. Without slack in the system, insurance and malpractice lawyers don't even occur to anyone. But even in the DR an ominous growth in medical insurance has begun [which is raising prices — and next will come enforcement of prescriptions to force you into a quack's office].
From:
http://www.thornlesspath.com/healthcareexperiences.pdf