Thursday, 28 February 2013

New book: Neoliberal Governance and International Medical Travel in Malaysia

Ormond, Meghann. (2013) Neoliberal Governance and International Medical Travel in Malaysia, Abingdon: Routledge. 

Hardback £80 (ISBN: 978-0415502382); paperback for £28 (early 2015, ISBN: 978-1138910560) Available at:

"What this insightful, challenging and beautifully written book demonstrates, then, is that the destinations, routes and points of departure of MT [medical tourism] are formed by specific geographies, historical relationships and power struggles […] This book is not only about Malaysia. In many ways it provides a model for analysing and evaluating MT in any destination. It makes a significant contribution to debates on MT and will no doubt prove its influence as this important field develops." – Ruth Holliday, University of Leeds, UK, in Australian Geographer, 45(1), 2014, pp. 93-94.

"Meghann Ormond [...] explores the shifting post-developmental relationships between states, their subjects and their scopes of intervention through the prism of health care. The author perfectly illustrates how the promotion of a country as an IMT [international medical travel] destination has become part of a broader development strategy, widely differing from a previously inward-looking ‘developmental’ focus on containment and national self-sufficiency. [...] Each chapter presents a well-articulated argument substantiated by multi-layered case studies, making the book an up-to-date and perfect contribution to the definition of IMT. In conclusion, the book's meticulous research and robust conceptual framework, along with its discussion on methodology, make it a useful guide on how issues in IMT need to be further analysed and tackled at various geographical levels, i.e. from regional to global." - Audrey Bochaton, University of Paris Ouest Nanterre la Défense, France, in Singapore Journal of Tropical Geography, 36(1), 2015, pp. 134-136.

"This book provides great detail on the actors and activities involved in the industry, along with discussion of the impacts of neoliberal strategies on public health and the ongoing policy considerations created by this industry. [...] Her book provides great insight into the difficulties facing  health care systems that are increasingly reliant on other nations, philanthropic organizations, and corporations to provide appropriate health care. [...] Ormond’s book provides an excellent description of neoliberal practices and the impacts of international travel for health care on public health." - Krystyna Adams, Simon Fraser University, Canada, in The Canadian Geographer, 2015, DOI:10.1111/cag.12144 

International medical travel (IMT), people crossing national borders in the pursuit of healthcare, has become a growing phenomenon. With many of the countries currently being promoted as IMT destinations located in the ‘developing’ world, IMT poses a significant challenge to popular assumptions about who provides and receives care since it inverses and diversifies presumed directionalities of care. 

This book -- the first monograph on medical tourism and travel to present original qualitative data -- analyses the development of international medical travel in Malaysia, by looking at the benefits and challenges of providing health care to non-Malaysians. It challenges embedded assumptions about the sources, directions and political value of care. The author situates the Malaysian case study material at the fruitful cross-section of a range of literatures on transnational mobility, hospitality, therapeutic landscapes and medical diplomacy to examine their roles in the construction of national identity. The book thus contributes to wider debates that have emerged around the changing character of global health governance, and is of use to students and scholars of Southeast Asian Studies as well as Politics and Health and Social Care.

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.

Tuesday, 26 February 2013

New article from Time magazine: "Why Medical Bills Are Killing Us"

A February 2013 piece from Time magazine that all of us interested in comparing healthcare systems and studying international medical travel should read: