Seminar: Transnational mobility and the Malaysian health system in transition
Date: Tuesday, 28 February 2012
Venue: Department of Social & Preventive Medicine Conference Room, Faculty of Medicine (Building J on the map), University of Malaya, Kuala Lumpur, Malaysia
Description
Across Southeast Asia, healthcare liberalisation is leading to profound social, economic and political changes. This is manifest in the shifting onus of care from the state to private individuals as well as the growing transnational flows of people, goods and services linked to health and care in the wake of trade agreements (e.g., AFTA and GATS) that treat health care as a commodity. In Malaysia, ‘healthcare travel’ has been seen as a driver for economic growth for over a decade. Significant investment is being made in the infrastructure and human capital necessary to promote the country as both a global and regional medical hub to foreign patients. At the same time, such investment raises concerns about the commodification of health care, the potential for increasing internal brain-drain and the risk that investment in private health care may detract from and potentially impoverish the public healthcare system.
This seminar was geared towards fostering dialogue on the economic, social, political and ethical complexities posed by transnational mobility on health systems within Southeast Asia more broadly and Malaysia in particular. Participants, hailing from the Netherlands, Japan, Indonesia, Burma, Singapore and Malaysia, included academicians, research students, representatives of civil society, medical travel entrepreneurs as well as the private-sector Pantai Hospital group and the government-sponsored Malaysia Healthcare Travel Council. Presentations included research findings from the field as well as agendas for further research in the context of regional integration of the private healthcare sector and incipient portability of healthcare benefits. This event was made possible thanks to financial and logistical support from the Cultural Geography Chair Group (Wageningen University) and Centre for Population Health (University of Malaya).
Programme
10:15-10:30 Tea
10:30-10:45
Welcome
10:45-12:00 Session 1 – Situating
Medical Tourism in Southeast Asia
·
Presenters
o
WONG Kee Mun
and Ghazali MUSA, University of Malaya (Malaysia) – ‘Medical Tourism in Thailand, Singapore,
Malaysia, and India’
o Ghazali MUSA, Darmesh R. DOSHI,
WONG Kee Mun and Thinaranjeney THIRUMOORTHY, University of Malaya (Malaysia) –
‘Travel
Motivation and Satisfaction of Health Tourists in Kuala Lumpur’
o
Mayumi ONO, Waseda University
(Japan) – ‘Making a Haven for Elderly Care:
Japanese Retirement Migration to Malaysia’
·
Chair
o
Meghann ORMOND, Wageningen University (The Netherlands)
12:30-13:30 Lunch
13:30-15:00 Session
2 – Health Care Commodification, Access, Entitlements
and Equity
·
Presenters
o David REISMAN, Nanyang Technical University
(Singapore) – ‘Medical Tourism: Southeast Asia Plans Ahead’
o PHUA Kai Lit, Monash
University (Malaysia) – ‘The Growth of
Cross-Border Medical Tourism: Investigating Possible Impacts on the Health Care
Systems of Host (Destination) Countries’
o Meghann ORMOND and Dian Sulianti, Wageningen University (The Netherlands) – ‘Respondingto the Cross-Border Pursuit of Health Care in East Malaysia’ (PDF)
·
Chair
o
CHAN Chee Khoon, University of Malaya (Malaysia)
15:00-15:15 Tea break
15:15-16:45 Session
3 – Panel Discussion: State, Capital
and Transnational Health Care
·
Panellists
o
Suresh PONNUDURAI, MalaysiaHealthcare.com (Malaysia)
o David QUEK Kwang Leng, Pantai Hospital Kuala Lumpur and Malaysian Medical Association (Malaysia)
o David QUEK Kwang Leng, Pantai Hospital Kuala Lumpur and Malaysian Medical Association (Malaysia)
·
Moderator
o David REISMAN, Nanyang Technical University
(Singapore)
16:45-17:00 Wrap-up
Event organisers / Contact persons
- Chan Chee Khoon (ckchan50 [at] yahoo.com), Head of Health Policy & Management Unit, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia
- Meghann Ormond (meghann.ormond [at] wur.nl), Assistant Professor, Cultural Geography Chair Group, Wageningen University, The Netherlands
This event has been made possible thanks to financial support from Wageningen University's Cultural Geography Chair Group and University of Malaya's Department of Social & Preventive Medicine.
Presentation abstracts
CHAN Chee Khoon, University of Malaya (Malaysia); Mary WONG Lai Lin,
Malaysia Healthcare Travel Council (Malaysia); Suresh PONNUDURAI,
MalaysiaHealthcare.com (Malaysia); David QUEK, Pantai Hospital Kuala Lumpur and Malaysian Medical Association (Malaysia)
Panel discussion: State, Capital and Transnational Health Care
In recent years,
Malaysia's sovereign wealth fund, Khazanah, has emerged as the controlling
shareholder of Southeast Asia's largest private healthcare conglomerate:
Parkway Pantai, anchored by its hospitals in Malaysia, Singapore and other
countries. The panel will explore how this might intersect with patterns of
cross-border medical travel, looking at mobility of patients and of investment
as well as the role of diasporic communities. Each panellist will take 10-15
minutes to make key points, as a prelude to interactive discussion.
Ghazali MUSA, Darmesh R. DOSHI, WONG Kee Mun and Thinaranjeney THIRUMOORTHY, University of Malaya (Malaysia)
Travel
Motivation and Satisfaction of Health Tourists in Kuala Lumpur
Despite
recording the highest growth among tourism sub-sectors, little is known empirically about travel
behaviour among inbound medical tourists in Malaysia. This study examines
demographic profile, travel motivation, travel satisfaction, healthcare
consumption and expenditure behaviour among them in Kuala Lumpur. The paper is
unique in providing empirical evidence of the city’s unique selling points
(pull factors) in attracting inbound medical tourists. The paper contributes to
knowledge on dimensions and items that are pertinent in measuring medical
tourists’ satisfaction. It also highlights the potential economic contribution
and some managerial implications in terms of marketing and product development.
Mayumi ONO, Waseda University (Japan)
Making a Haven for Elderly Care: Japanese Retirement
Migration to Malaysia
This paper
explores emerging transnational mobility among elderly Japanese seeking care and
the commoditization of care for guest consumer-patients in Malaysia. Elderly
care, as well as medical care, has been given ‘domestically’ within the
nation-state of modern societies. Care, however, has been in transition and has
become a transnational object of commoditization for the industry and the
target of consumption for individuals in the domain of global trade. Since the
late 1990s, Japanese international retirement migration to Southeast Asian
countries where retirement programs for foreign retirees are available, such as
in Malaysia, Thailand, Philippines, and Indonesia, has been increasing. The
government of Malaysia, the country which has been recognized as the most
desirable destination among the Japanese, has implemented tourism policies, the
“Malaysia My Second Home Programme” (MM2H) and others that focus on medical
tourism, to attract affluent foreign retirees in order to stimulate the
economy. Although Japanese international retirement migration is mostly
conducted by healthy retirees around sixty years of age, it consequently has
created a new stream of people leaving Japan to seek elderly care. This paper
argues that the flow of Japanese retirement migrants generates a transnational
mobility for care and therefore facilitates the Malaysian healthcare industry’s
catering for foreign retirees.
Meghann ORMOND, Wageningen University (The Netherlands)
Responding
to the Cross-Border Pursuit of Health Care in East Malaysia
There is a disjuncture between Malaysia’s growing desire for foreign patient-consumers
from high-income countries and the corresponding governmental and private
sector investments in spectacular medical tourism infrastructure, on the one
hand, and the foundational yet relatively invisible role that everyday
intra-regional medical travellers from nearby lower-income countries – who
comprise the bulk of medical travellers to Malaysia – actually play in
constituting and sustaining the country’s principal medical travel destinations,
on the other. Seeking to bring attention to the relevance and realities of
these more everyday medically-motivated mobilities, this paper draw on current fieldwork
exploring the pursuit of health care by Indonesian patient-consumers in
Kuching, capital of the East Malaysian state of Sarawak, where private
hospitals actively court and receive high numbers of Indonesians coming by land
and air from neighbouring Kalimantan districts. The paper argues for greater
consideration of the political, economic and social ties fostered by these everyday
medical mobilities and their potential for enhancing regional development.
PHUA Kai Lit, Monash University (Malaysia)
The Growth of Cross-Border Medical Tourism: Investigating
Possible Impacts on the Health Care Systems of Host (Destination) Countries
Cross-border
medical tourism (a variety of health tourism) is likely to have a major impact
on the health care systems of host or destination countries. In this
presentation, I argue that it needs to be studied from a system-wide
perspective. In other words, how would it impact on the following aspects of a
destination country's health system: human resources, facilities, health
information systems, technology, financing/economic aspects, and
governance/health policy?
David REISMAN, Nanyang Technical University (Singapore)
Medical Tourism:
Southeast Asia Plans Ahead
The old medical tourism was trips to the West. It was for the elite
only. The new medical tourism extends to the East and the South and includes
the rapidly expanding middle classes. The poor do not benefit directly,
although they may enjoy the spillovers from employment, growth and
cross-subsidisation. The paper explains why the trade exists and what the
social and economic implications are for both the importers and the exporters.
At each stage it assesses the ethical implications for class and commodification.
Globalisation cannot be reversed. The multinationals and the insurance
companies are a fact of life. What can be done is to adapt the inevitable to
the needs of consumer-patients who will want something more from medicine than
utility, profit and product image. The implication is that there must be a
managed market but on a world scale at a time when even State-run corporations
– and the National Health – are edging ever closer to what The Economist
calls ‘State capitalism’. The paper begins with the misleading name of tourism.
It then discusses the GATS four modes before proceeding to an assessment of why
patients travel for medical care. In doing this it also evaluates the
preconditions for care and the possibility that institutional changes will
reverse the flow. At the end it applies the results to Singapore.
WONG Kee Mun and Ghazali MUSA, University of
Malaya (Malaysia)
Medical Tourism in Thailand, Singapore, Malaysia, and India
This paper examines medical tourism in four countries
in Asia (Thailand, Singapore, Malaysia, and India) all of which are actively
developing and promoting medical tourism as a part of their economic
activities. It begins with the introductory concept and definition of medical
tourism and is followed by a discussion on travel motivations among medical
tourists who visit these countries. The detailed description of medical tourism
development in all four countries will be examined which includes hospitals,
medical tourism products, government support and promotions. Before making a
final conclusion, some issues and challenges in developing medical tourism in
the region has been discussed.
