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.

Reports on medical travel

A range of international consultancies and research centres have recently published reports on medical travel. Here are a few:

• United National Economic Commission for Latin America and the Caribbean (ECLAC) (2010). 'Medical tourism: A survey', Washington, D.C., March. (PDF)
  
• Deloitte (2008) 'Medical tourism. Consumers in search of value'. (PDF)
• Deloitte (2008) 'Medical tourism. The Asian chapter'. (PDF)
• Grail Research (2009) 'The rise of medical tourism'. (PDF)
  
• Herrick, Devon M. (2007) 'Medical tourism: Global competition in health care', National Center for Policy Analysis, Policy report 304, November.
  
• McKinsey & Co. (2008) 'Mapping the market for medical travel'. (PDF)
• UNESCAP (2007) 'Patients without borders: An overview of the medical travel industry in Asia, its challenges and opportunities', United Nations Economic and Social Commission for Asia and the Pacific Conference, Bangkok, 9-11 October.
  

New volume of Medical Anthropology dedicated to IMT

Here's the TOC of the December 2010 issue(http://www.informaworld.com/smpp/title~db=all~content=g929643788):

Carolyn Smith-Morris; Lenore Manderson, Editorial: The Baggage of Health Travelers

Andrea Whittaker; Lenore Manderson; Elizabeth Cartwright, Introduction: Patients without Borders: Understanding Medical Travel

Beth Kangas, Traveling for Medical Care in a Global World

Andrea Whittaker; Amy Speier, “Cycling Overseas”: Care, Commodification, and Stratification in Cross-Border Reproductive Travel

Priscilla Song, Biotech Pilgrims and the Transnational Quest for Stem Cell Cures

Sara L. Ackerman, Plastic Paradise: Transforming Bodies and Selves in Costa Rica's Cosmetic Surgery Tourism Industry

Aren Z. Aizura, Feminine Transformations: Gender Reassignment Surgical Tourism in Thailand

Books on international medical travel

• C. Michael Hall (ed.) (2012, forthcoming) Medical Tourism: The Ethics, Regulation, and Marketing of Health Mobility (Routledge).
• Todd, M.K. (2011) Handbook of Medical Tourism Development (Routledge – Productivity Press)
• Todd, M.K. (2011) Medical Tourism Facilitator’s Handbook (Routledge – Productivity Press)
• John Connell (2011) Medical Tourism (CABI) - Abstract: 'Tourism has long been associated with improved health, resulting in a boom of spas, yoga and rejuvenation treatments. Medical tourism itself is a more recent example of niche tourism, with increasing numbers of people travelling abroad in search of cosmetic enhancement and solutions to various serious medical conditions often by surgery. Medical Tourism looks at the background and rise of health tourism, new emerging facets of the sector, and examines how medical tourism benefits local health care providers, economies and the tourism industry as a whole. It offers a unique overview of an emerging component of the tourist industry and a distinct and controversial element of health provision'.
• Minca, C. and Oakes, T. (eds.) (2011) Real Tourism: Representation, Practice and the Material in Contemporary Travel (Routledge) - This edited collection will include a chapter by Meghann Ormond entitled, 'Medical tourists, medical refugees: Responding to the pursuit of cross-border healthcare in Malaysia'.
• Connell, J. (ed.) (2010) Migration and the Globalisation of Health Care (Edward Elgar) - Abstract: 'The international migration of health workers has been described by Nelson Mandela as the ‘poaching’ of desperately needed skills from under-privileged regions. This book examines the controversial recent history of skilled migration, and explores the economic and cultural rationale behind this rise of a complex global market in qualified migrants and its multifaceted outcomes'.
• Reisman, D.A. (2010) Health Tourism: Social Welfare Through International Trade (Edward Elgar)
• Smith, M. and Puczko, L. (2009) Health and Wellness Tourism (Butterworth Heinemann) - This book lays out the history and definitions relative to this broadly defined field as well as its management and marketing peculiarities. It also includes a range of case studies contributed by several authors. It is, however, mostly geared towards wellness (e.g. spa, alternative therapies, etc) tourism. There is one medical tourism study, by B. George, looking at Apollo Hospitals in India.
• Chee H.L. and Barraclough, S. (eds.) (2009) Health Care in Malaysia: The Dynamics of Provision, Financing and Access (Routledge – Malaysian Studies Series) - This book contains information about medical tourism to Malaysia and its broader relationship to the national health system.
• Bookman, M. and Bookman, K. (2007) Medical Tourism in Developing Countries (Palgrave MacMillan) - This is the first academic book published on medical travel. It takes a political economy perspective on the real and potential advantages and disadvantages for developing countries engaged in promoting medical tourism. Abstract: 'Western patients are increasingly travelling to developing countries for health care and developing countries are increasingly offering their skills and facilities to paying foreign customers. The potential and implications of this international trade in medical services is explored in this book through analysis of the market'.

Personal narratives

• Maggi Ann Grace (2007) State of the Heart - This personal narrative tells of the medical travel experience of Grace's partner, Howard Stabb, who made headlines in the US when he went to India for heart surgery. He later testified at the US Senate Special Committee on Aging Hearings on 27 June 2006 on the benefits of medical travel for uninsured Americans. (See the webcast)

Fiction

• Robin Cook (2008) Foreign Body - This is a novel about a young Hispanic American doctor whose grandmother, unable to pay for a necessary operation in the US, goes to an Indian hospital and dies under mysterious conditions. There were concerns among industry stakeholders that the novel would have negative effects on the burgeoning industry. Interestingly enough, Cook joined up with Michael Eisner to adapt Foreign Body to WebTV, and 50 2-minute episodes are now available online. (See the episodes for free on iTunes)