Ormond, Meghann. (2013) Neoliberal Governance and International Medical Travel in Malaysia, Abingdon: Routledge.
This book’s examination of international medical travel (IMT) – where people cross national borders in the pursuit of healthcare – builds on an intersection of feminist and postcolonial scholarship that seeks to challenge embedded assumptions about the sources, directions and political value of care. In so doing, it contributes to contemporary social science debates on the role of mobility in questions of care, responsibility and interdependence. With many of the countries currently being promoted as IMT destinations holding ‘developing’ status, IMT poses a significant challenge to popular assumptions about who provides and receives care since it inverses and diversifies presumed directionalities of care. Taking as a point of departure the notion that the boundaries to the terrains and subjects engaged in the provision and receipt of care are constantly in flux, the book examines the discursive and material positioning of Malaysia as one of the world’s most prominent IMT destinations at a moment when the status of the nation-state is undergoing profound transformation. In light of rapidly growing academic interest in IMT, its focus on the political framings of transnational mobilities and claims to cultural competence will make a timely and important empirically-grounded theoretical contribution at a moment in which both critical theoretical engagement and in-depth empirical material are widely acknowledged to be sorely missing in literature on IMT.
The book aims to contribute to a growing body of work that pushes beyond the pronounced Ameri-centrism that currently dominates studies of IMT by decentring the focus from Western industry interests and medical travellers through acknowledging the significance and nuanced diversity of the majority of IMT flows and destinations which are, today, largely concentrated in the Asia-Pacific region. Reflecting important global shifts in healthcare provision and its regulation, the book frames Asian IMT destinations not as passive receptacles for Western ‘outsourced’ care interests but, rather, as active providers negotiating complex changes in health governance and the benefits and challenges of extending care beyond national borders. Across four empirical chapters, it demonstrates how ‘Malaysia’ gets positioned as a hospitable destination within a range of imagined geographies of care. The extension of care – through the harnessing of IMT – 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. This signals a fundamental reterritorialisation of care aligned with the pursuit of greater ‘global’ economic, political, social and cultural integration and legitimacy that reconfigures the relevance of the nation-state.
Neoliberal rationalities of governance have manifested themselves in the retreat of the welfare state along with projects of economic liberalisation that have profoundly affected the pursuit and provision of healthcare in recent decades. With healthcare increasingly framed as a tradable commodity via international trade agreements and the involvement of transnational agencies and companies, states are reimagining healthcare less as a public good and more as an industry. Reflecting this shifting conceptualisation are increasingly hybrid, transnationalised spatialisations of healthcare. With the movement of people, goods and services rapidly redrawing the geographical boundaries to healthcare, IMT represents a significant shift from what were previously imagined as nationally-bound, locally-based care settings to what are now commonly held to be ‘chaotic global networks, controlled by large mega healthcare corporations, consumer demand, employers, governmental offices of economic development and increasingly insurers… in an era of ever deteriorating national, technological, mental and physical boundaries in the delivery of healthcare services’. Given healthcare’s significant role in defining both the legitimacy of the modern nation-state and the value of its citizenry, much of the disquiet surrounding IMT derives from profound uncertainties regarding the future of care – both responsibility for it and entitlement to it – in light of this shifting relationship between the state and its subjects.
While much scholarly work has attended to the configuration of places of health and healing at the micro-scale, little has explicitly conceptualised them at the national level. This book ventures to do just that by deconstructing claims, made by a broad range of social actors keen to turn Malaysia into an international hub of medical excellence, about the country’s credentials for providing care to specific markets of foreign patient-consumers through the provision of a unique ‘package’ of regulation, human resources, political and economic stability and cultural expertise and the (post)colonial, development and ethnic/religious discourses through which they are imagined and performed. As hopes for economic growth and development shift focus from manufacturing to the knowledge and service-based economy, a new form of national development project gets conjured through the extension of care to non-citizen subjects. Specific forms and practices of ‘Malaysian-ness’ deemed expedient to engaging in lucrative globalising care networks are emphasised and nurtured, underscoring particular narratives of postcolonial hybridity that draw from its ‘developing country’, ‘progressive, moderate Islamic’ and ‘multi-ethnic’ credentials. The realisation of development through the medium of the nation-state, via the nationalisation and protection of resources and services that fostered and privileged home-grown industry with an ethic of self-sufficiency, has given way to one increasingly articulated through explicit interdependency.