New article: Shifting subjects of healthcare: Placing ‘medical tourism’ in the context of Malaysian domestic healthcare reform

Ormond, M. (2011) "Shifting subjects of healthcare: Placing ‘medical tourism’ in the context of Malaysian domestic healthcare reform," Asia Pacific Viewpoint, 52(3), 247-259. Available HTTP: http://onlinelibrary.wiley.com/doi/10.1111/j.1467-
8373.2011.01457.x/abstract

Abstract: 
‘Medical tourism’ frequently has been held to unsettle naturalised relationships between the state and its citizenry. Yet, in casting ‘medical tourism’ as either an outside ‘innovation’ or ‘invasion’, scholars have too often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic healthcare systems of the ‘developing’ countries increasingly recognised as international medical travel destinations. While there is little doubt that ‘medical tourism’ impacts destinations’ healthcare systems, it remains essential to contextualise them.

This paper offers a reading of the emergence of ‘medical tourism’ from within the context of on-going healthcare privatisation reform in one of today’s most prominent destinations: Malaysia. It argues that ‘medical tourism’ to Malaysia has been mobilised politically both to advance domestic healthcare reform and to cast off the country’s ‘under-developed’ image not only among foreign patient-consumers but also among its very own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective healthcare consumers.

Media coverage:
Hanefeld, J. (2014) 'Medical tourism isn't all faulty PIP implants and NHS fraud', The Conversation, 30 July. Available HTTP: http://theconversation.com/medical-tourism-isnt-all-faulty-breast-implants-and-nhs-fraud-29806

Postgraduate Forum on Medical Tourism - York - Sept. 2011

A conference for PhD students working on issues linked to international medical travel/medical tourism was hosted by Dr Neil Lunt at York University (UK) in September 2011. Click here for more information: http://www.medicaltourismresearch.co.uk/index.php?q=node/20

Academic conferences dedicated to international medical travel

Academic conferences on international medical travel and 'medical tourism':

• Postgraduate Forum on Medical Tourism, York Management School, University of York, 8 Sept. 2011. Organised by Dr Neil Lunt.
  
• The Globalisation of Health Care: Legal and Ethical Challenges, Harvard Law School, 20-21 May 2011. Videos from panel discussions entitled 'Services legal in home and destination countries' and 'Services illegal or unavailable in home countries' are available on the conference website.
• 2011 Medical Tourism Research Conference, Washington, D.C., 23-25 Feb. 2011. Programme available on the conference website.
• Bodies Across Borders: The Global Circulation of Body Parts, Medical Tourists and Medical Professionals, Fondation Brocher, Geneva, 15-17 Dec. 2010. Programme available on the conference website.
  
• 2010 Medical Tourism Research Conference. Programme available on the conference website.
• Transnational Mobilities for Care: State, Market and Family Dynamics in Asia, National University of Singapore, 10-11 Sept. 2009. Click for programme and abstracts.
  

Planet Hospital's Diaspora project

It is unclear whether Planet Hospital's pilot project 'Diaspora' was fully launched in 2010. Only a few articles exist online that talk about it - and only in the future tense:

• 'US reforms may boost medical tourism', by Mohammed Cohen for Asia Times Online, 30 March 2010
• 'US medical outsourcing firm to tap Philippine market' by INQUIRER.net, 21 November 2007 - republished by National Competitiveness Council of the Philippines on 12 May 2010
• 'Medical tourism to get boost next year' by Philippine Star, 21 November 2007 - republished by National Competitiveness Council of the Philippines on 12 May 2010

The project appears to have first chosen to focus on Mexicans living in the US, though articles suggest that El Salvadoreans were initially meant to be the first test-subjects for this global accident insurance policy that covers emergency care in the US and non-emergency care back in migrants' countries of origin (it doesn't cover pre-existing conditions -- but it also won't deny coverage based on pre-existings). Filipinos living in the US also appear to have been on the list of prospective groups to cover in the future.

New conference: The Globalization of Health Care - HLS

The Globalization of Health Care:

Legal and Ethical Challenges

A Conference at Harvard Law School

May 20-21, 2011

For further information about this event: http://www.law.harvard.edu/programs/petrie-flom/events/globalization.html

Schedule Outline
Medical Tourism I: Services Legal in Home and Destination Countries

• Cross-Border Care in Post- Reform America
• Nathan Cortez
• Jurisdiction 101 for Medical Tourism Purchases Made in Europe
• Tom McLean
• Patients’ and Bioethicists’ Perceptions of the Ethics of Medical Tourism: Lessons from Canadian Medical Tourists
• Jeremy Snyder
• Bioethics, Transnational Medical Travel & the Global Health Services Marketplace
• Leigh Turner
• Current Legislation on Cross-Border Healthcare in the European Union
• Hilko J. Meyer

Medical Tourism II: Services Illegal or Unavailable in Home Country

• Medical Outlaws or Medical Refugees?: Medical Tourism and the Extraterritorial Application of Domestic Criminal Law
• I. Glenn Cohen
• Welcome to the Wild West: Protecting Access to U.S. Based Fertility Treatment for Reproductive Tourists
• Kimberly Mutcherson
• The Proportionality Problem in Cross-border Reproductive Care
• Richard Storrow
• The Roles and Responsibilities of Physicians in Patients' Decisions about Unproven Stem Cell Therapies
• Aaron Levine & Leslie Wolf
• Tourism: A matter of Life and Death in the UK
• Hazel Biggs & Caroline Jones

Research and Development/ Telemedicine

• Promoting Access to Clinical Trials Data and the Right to Health
• Trudo Lemmens
• Attributing Violations of the Prohibition on Nonconsensual Human Experimentation to the State: Questions from Abdullahi v. Pfizer
• Bethany Spielman
• The Global Politics of Influenza Vaccine Sharing
• Robert Gatter
• Globalization of Health Care in the Information Technology Era – Opportunities and Legal Challenges
• Gil Siegal
• Legal Barriers to Telemedicine in the United States: Their Constitutionality and the Role of Arbitration in the Context of Health Care Reform
• Amar Gupta & Deth Sao

Medical Worker Migration

• Ethical Challenges and Policy Options in the Recruitment of Internationally Trained Health Human Resources
• Vivien Runnels, Corinne Packer
• Permissible Ways of Managing the Labor Allocation of Medical Workers
• Lucas Stanczyk
• Conditioning Medical Scholarships on Long, Future Service: A Defense
• Nir Eyal &Till Bärnighausen
• WHO Global Code of Practice on the International Recruitment of Health Personnel
• Allyn Taylor

Health Care Globalization and Equity

• Global Health Justice
• Jennifer Prah-Ruger
• Global Health Care is Not Global Health: Populations, Inequities, and Law as a Social Determinant of Health
• Daniel Goldberg
• Intellectual Property Rights and Access to Medicine: The Special Case of Antibiotics In The Health Impact Fund
• Kevin Outterson
• Global Duties and the Sanctity of Life
• Pavlos Eleftheriadis
• Beyond Patents: The Impact of Patent-Related Rights on Global Access to Medicine
• Cynthia Ho

A Discussion on Organ Transplantation: Transplant Tourism is Different than Medical Tourism

• Alexander Capron
• Francis L. Delmonico
• Nancy Scheper-Hughes
• Daniel Wikler

'Superbug'

Recent information and work on the so-called 'superbug' -- the spread of which has been blamed on international medical travel from India to the UK:

• BBC article entitled "Europe 'losing' superbugs battle"
• Recent Lancet article (7 Apr 2011)
  
• C.M. Hall's new article on international medical travel and risks to biosecurity
  

EuroparlTV videos on EU patient mobility

New short videos available about cross-border patient mobility within the EU:

• Opening up healthcare - A new law on crossborder healthcare outlines who can seek treatment and who foots the bill. Date: 15/02/2011 Duration: 04:13 - http://europarltv.europa.eu/en/player.aspx?pid=704c2ff9-abdb-40f8-b338-9e8b00b74a4c
• Crossborder: Medical tourism - Who should pay if you want or need to go abroad for treatment? Will crossborder healthcare lead to a two-speed health system benefiting richer patients only? Date: 25/11/2010 Duration: 15:30 - http://europarltv.europa.eu/en/player.aspx?pid=d5e9f3ce-a2eb-4e27-a548-9e390094dd43
• If you need emergency treatment crossborder healthcare can work well, but routine care can leave patients with the double headache of red tape and high expenses. Date: 25/11/2010 Duration: 04:38 - http://europarltv.europa.eu/en/player.aspx?pid=6f447ca0-b95c-4113-91a2-9e390097b569
  
• Reporter: Crossborder healthcare - Dentists in Hungary are smiling: their affordable prices are attracting customers from all over the EU. Date: 25/11/2010 Duration: 02:57 - http://europarltv.europa.eu/en/player.aspx?pid=01b11a63-a5a7-4c8f-8394-9e390097a6b1
• Visit http://ec.europa.eu/health-eu/videos/index_en.htm for others

Current research projects on international medical travel

Here's a list of some of the large-scale projects currently underway that deal with international medical travel. If you are aware of others and would like to see information about them posted, please contact meghann.ormond (at) wur.nl with details.

• 'Inward and outward implications for the NHS of Medical Tourism' is a NIHR-funded 2010-2012 project that involves researchers from the University of York (Dr Neil Lunt), London School of Hygiene and Tropical Medicine (Prof Richard Smith), University of Birmingham (Prof Russell Mannion), Royal Holloway (Dr Mark Exworthy) and Sheffield Teaching Hospitals Foundation NHS Trust (Prof Steve Green). The proposal reads: 'Aside from anecdotal reports and media speculation relatively little is known about implications for the NHS of inward and outward out-of-pocket Medical Tourism. This is despite such flows having major implications for the NHS given around 50,000 UK residents travel overseas for treatment annually and there are overseas patients using the NHS and private facilities. The study provides insights for NHS policy-makers, regulators, providers, clinicians and consumer interests and will illuminate macro and local issues: costs, quality, administrative and legal dimensions, decision-making, and unintended consequences for the NHS'. See coverage of the project at http://www.imtj.com/news/?EntryId82=253846
  
• 'Evaluating Care Across Borders' (ECAB) is coordinated by Professor Mossialos (LSE Health) and runs from 2010-2012. It is the second largest research grant ever awarded to LSE by the Commission and the largest so far from the 7th Framework Programme. The aim of ECAB is to facilitate a process whereby Europe's citizens can make informed choices about whether to seek health care in another Member State, and if they so choose, to ensure that the administrative and clinical processes are straightforward and ensure continuity of care. It takes as its starting point the recent draft Directive on Patients' Rights, augmented by the existing body of research on cross-border care. It then focuses on those areas where the necessary information is incomplete and seeks to fill the gaps. It is equally important to state what it does not do. It does not seek to quantify the scale of movement, because our earlier research reveals this to be a dynamic area where data are often unavailable and rapidly become out of date.
• European Observatory on Health Systems and Policies' 2004-07 project 'Europe for Patients' (coordinated by Magdalene Rosenmöller, IESE Business School, Barcel). The project examines the legal frameworks at both national and European level, with a focus on recent European jurisprudence; systems for contracting for health services across borders; and systems for ensuring quality of care provided. Access one of its resulting publications: Patient Mobility in the European Union: Learning from Experience.
  

Medical tourism research centers

Here are some of the new academic research groups emerging:

• Simon Fraser University (Canada) - Medical Tourism Research Group: http://www.sfu.ca/medicaltourism/
• University of York (UK) - Medical Tourism Research: http://www.medicaltourismresearch.co.uk/
  
• The University of North Carolina at Pembroke (USA) - Medical Tourism Research Center: http://www.uncp.edu/mtrc/
• University of the Incarnate World (USA) - Center for Medical Tourism Research: http://www.uiw.edu/medicaltourism/index.htm

Special issue of the journal Signs dedicated to international medical travel

Signs, Vol. 36, No. 2, Winter 2011: Special issue based on the Comparative Perspectives Symposium: Gender and Medical Tourism

Edited by Andrew Mazzaschi and Emily Anne McDonald

Here's the TOC:

Mary Gilmartin; Allen White. 'Interrogating Medical Tourism: Ireland, Abortion, and Mobility Rights' (pp. 275-280). DOI: 10.1086/655907. Stable URL: http://www.jstor.org/stable/10.1086/655907

Sven Bergmann. 'Fertility Tourism: Circumventive Routes That Enable Access to Reproductive Technologies and Substances' (pp. 280-289). DOI: 10.1086/655978.
Stable URL: http://www.jstor.org/stable/10.1086/655978.

Annette B. Ramírez de Arellano. Medical Tourism in the Caribbean (pp. 289-297). DOI: 10.1086/655908. Stable URL: http://www.jstor.org/stable/10.1086/655908

Alexander Edmonds. “Almost Invisible Scars”: Medical Tourism to Brazil (pp. 297-302). DOI: 10.1086/655909.
Stable URL: http://www.jstor.org/stable/10.1086/655909

Andrew Mazzaschi. 'Surgeon and Safari: Producing Valuable Bodies in Johannesburg' (pp. 303-312). DOI: 10.1086/655941. Stable URL: http://www.jstor.org/stable/10.1086/655941

Amit Sengupta. Medical Tourism: Reverse Subsidy for the Elite (pp. 312-319). DOI: 10.1086/655910. Stable URL: http://www.jstor.org/stable/10.1086/655910

Justin M. Nolan; Mary Jo Schneider. Medical Tourism in the Backcountry: Alternative Health and Healing in the Arkansas Ozarks (pp. 319-326). DOI: 10.1086/655911. Stable URL: http://www.jstor.org/stable/10.1086/655911

Beth Kangas. Complicating Common Ideas about Medical Tourism: Gender, Class, and Globality in Yemenis’ International Medical Travel (pp. 327-332). DOI: 10.1086/655912. Stable URL: http://www.jstor.org/stable/10.1086/655912

CFP: Proposed special issue of Gender, Place and Culture

CFP: Proposed special issue of Gender, Place and Culture: Bodies Across Borders: The global circulation of body parts, medical tourists and medical professionals

Editors: Beth Greenhough, Tim Brown, Isabel Dyck and Bronwyn Parry

The fields of medicine and healthcare are being transformed by new communications and biomedical technologies, which have facilitated marked increases in the global circulation of body parts, patients and medical professionals across national borders. These movements often echo other movements of capital and resources, travelling from rural to urban areas, from poor to rich, and from the Global South to the Global North with implications for global health, access to medical professionals, healthcare services and body-parts, and for national and international monitoring and regulation. This special issue seeks to bring a feminist perspective to understanding the global circulation of body parts, medical tourists and medical professionals, highlighting how questions of gender and sexuality shape and are shaped by the movement of bodies across borders in pursuit of health, scientific knowledge and profit.

Possible topics for papers include:
- The role of female bodies as sources of bodily commodities
- The migration of female healthcare workers
- Medical tourism/reproductive tourism
- Women as subjects of clinical trials

They are looking for 5-6 papers to complete an invited proposal for a special issue.
Please send abstracts to Beth Greenhough (b.j.greenhough [at] qmul.ac.uk) by the 7th March 2011.

Global Social Policy

The Dec 2010 issue of the journal Global Social Policy is dedicated to international medical travel issues. Here's the TOC (http://gsp.sagepub.com/content/current):

Chee Heng Leng and Andrea Whittaker
Guest editors’ introduction to the special issue: Why is medical travel of concern to global social policy? Global Social Policy December 2010 10: 287-291, doi:10.1177/1468018110379627

Meri Koivusalo
Global Social Policy Forum: Introduction: Trade in health services and the commercialization of social and health policies Global Social Policy December 2010 10: 292-293, doi:10.1177/1468018110379689

Chantal Blouin
Trade in health services: Can it improve access to health care for poor people? Global Social Policy December 2010 10: 293-295, doi:10.1177/14680181100100030202

Alireza Bagheri
Global health regulations should distinguish between medical tourism and transplant tourism Global Social Policy December 2010 10: 295-297, doi:10.1177/14680181100100030203

David Hunter and Stuart Oultram
The ethical and policy implications of rogue medical tourism Global Social Policy December 2010 10: 297-299, doi:10.1177/14680181100100030204

GKD Crozier
Protecting cross-border providers of ova and surrogacy services? Global Social Policy December 2010 10: 299-303, doi:10.1177/14680181100100030205

Imrana Qadeer
Benefits and threats of international trade in health: A case of surrogacy in India Global Social Policy December 2010 10: 303-305, doi:10.1177/14680181100100030206

Beth Kangas
The burden of pursuing treatment abroad: Three stories of medical travelers from Yemen Global Social Policy December 2010 10: 306-314, doi:10.1177/1468018110379990

Mohd Jamal Alsharif, Ronald Labonté, and Zuxun Lu
Patients beyond borders: A study of medical tourists in four countries Global Social Policy December 2010 10: 315-335, doi:10.1177/1468018110380003

Chee Heng Leng
Medical tourism and the state in Malaysia and Singapore Global Social Policy December 2010 10: 336-357, doi:10.1177/1468018110379978

Sallie Yea
Trafficking in part(s): The commercial kidney market in a Manila slum, Philippines Global Social Policy December 2010 10: 358-376, doi:10.1177/1468018110379989

Dominique Martin
Medical travel and the sale of human biological materials: Suggestions for ethical policy development Global Social Policy December 2010 10: 377-395, doi:10.1177/1468018110379979

Andrea Whittaker
Challenges of medical travel to global regulation: A case study of reproductive travel in Asia Global Social Policy December 2010 10: 396-415, doi:10.1177/1468018110379981

IntHealthCert articles

News Articles

Volume 1 (2010-2011)

Inthealthcert International vol 1(1):Redefining Medical Tourism for Global Healthcare

Inthealthcert International vol 1(2): Global Healthcare and its Advantages

Inthealthcert International vol 1(3): Advances in Accreditation for Global Healthcare

Inthealthcert International vol 1(4): Patient Safety and Global Healthcare

Inthealthcert International vol 1(5): Legal issues in global health care

Inthealthcert International vol 1(6): Management and Patient safety for Global Healthcare

International medical travel and the politics of therapeutic place-making in Malaysia

I received the 2011 AAG Health and Medical Geography Specialty Group's Jacques May PhD Dissertation Award for my thesis (now available online):

Ormond, M. (2011) 'International medical travel and the politics of therapeutic place-making in Malaysia', PhD thesis, School of Geography and Geosciences, University of St Andrews, UK. Available from http://hdl.handle.net/10023/1681

Abstract:

This thesis examines the shifting relationship between the state and its subjects with regard to responsibility for and entitlement to care. Using Malaysia as a case study the research engages with international medical travel (IMT) as an outcome of the neoliberal retrenchment of the welfare state. I offer a critical reading of postcolonial development strategies that negotiate the benefits and challenges of extending care to non-national subjects. The research draws from relevant media, private-sector and governmental documents and 49 semi-structured, in-depth interviews with IMT proponents and critics representing federal, state and urban governmental authorities, professional associations, civil society, private medical facilities and medical travel agencies in Malaysia’s principal IMT regions (Klang Valley, Penang and Malacca). Across four empirical chapters, the thesis demonstrates how ‘Malaysia’ gets positioned as a destination within a range of imagined geographies of care through a strategic-relational logic of care and hospitality. I argue that this positioning places ‘Malaysian’ subjects and spaces into lucrative global networks in ways that underscore particular narratives of postcolonial hybridity that draw from Malaysia’s ‘developing country’, ‘progressive, moderate Islamic’ and ‘multiethnic’ credentials. In considering the political logics of care-giving, I explore how the extension of care can serve as a place-making technology to re-imagine the state as a provider and protector within a globalising marketplace in which care, increasingly commoditised, is tied to the production of new political, social, cultural and economic geographies.

A set of publications related to this work are available:

Ormond, M. (2013) Neoliberal Governance and International Medical Travel in Malaysia, London: Routledge. Available at: http://www.routledge.com/books/details/9780415502382/ 

Ormond, M. (2013) ‘Harnessing “diasporic” medical mobilities’, in F. Thomas and J. Gideon (eds) Migration, Health and Inequality, London: Zed Books, 150-162.

Ormond, M. (2012) ‘Claiming “cultural competence”: The promotion of multi-ethnic Malaysia as a medical tourism destination’, in C.M. Hall (ed.) Medical Tourism: The Ethics, Regulation, and Marketing of Health Mobility, London: Routledge, 187-200. Available at: http://www.routledge.com/books/details/9780415665759/

Ormond, M. (2011) ‘Medical tourism, medical exile: Responding to the cross-border pursuit of healthcare in Malaysia’, in C. Minca and T. Oakes (eds) Real Tourism: Practice, Care and Politics in Contemporary Travel, London: Routledge, 143-161. Available at: http://www.routledge.com/books/details/9780415582247/

Ormond, M. (2011) 'Shifting subjects of healthcare: Placing 'medical tourism' in the context of Malaysian healthcare reform', Asia Pacific Viewpoint, 52(3), 247-259.