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CrossBorder Medical Tourism: A Typology and Implications for the Public and Private Medical Care Sec


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Title: CrossBorder Medical Tourism: A Typology and Implications for the Public and Private Medical Care Sec

Cross-Border Medical Tourism A Typology and
Implications for the Public and Private Medical
Care Sectors in the South-East Asian Region
  • Kai-Lit Phua, PhD FLMI
  • Associate Professor
  • School of Med and Health Sciences
  • Monash University (Sunway Campus)

Biographical details
  • Kai-Lit Phua received his BA (cum laude) in
    Public Health Population Studies from the
    University of Rochester and his PhD in Sociology
    (medical sociology) from Johns Hopkins
    University. He also holds professional
    qualifications from the insurance industry.
  • Prior to joining academia, he worked as a
    research statistician for the Maryland Department
    of Health and Mental Hygiene and as an Assistant
    Manager for the Managed Care Department of a
    leading insurance company in Singapore.
  • He was awarded an Asian Public Intellectual
    Senior Fellowship by the Nippon Foundation in

Lecture Objectives
  • Definition of Cross-Border Medical Tourism
  • GATS and trade in medical services
  • Typology of medical tourism
  • Hypotheses for further research
  • Possible impact on the home country
  • Possible impact on the host country

What is Cross-Border Medical Tourism?
  • Medical care of short term foreign visitors whose
    primary purpose for the visit is to seek medical
  • In other words, the seeking of medical care in
    foreign countries

WTOs General Agreement on Trade in Services
  • WTOs four modes of trade in services
  • (i) Consumption abroad
  • e.g. cross-border medical tourism
  • (ii) Commercial presence
  • e.g. foreign investment in medical care
  • (iii) Presence of natural persons
  • e.g. foreign doctor who arrives to treat
  • patients on a voluntary or paid basis
  • (iv) Cross-border supply
  • e.g. cross-border telemedicine
  • (teleconsultation, remote surgery etc)

A Typology of Cross-Border Medical Tourism
(Consumption Abroad)
  • Price-sensitive medical tourism
  • Quality-sensitive medical tourism
  • Note that medical tourism is not a new
    phenomenon e.g. Third World elites have sought
    medical care in Australia, Britain, France, USA
    etc (quality-sensitive medical tourism resulting
    in higher cost overseas treatment)
  • Whats new is ordinary people from more
    developed countries seeking care in less
    developed countries because of large price
    differentials e.g. American seeking medical care
    in Thailand (price-sensitive medical tourism
    resulting in lower cost overseas treatment)

A Comparison of Price-Sensitive
Quality-Sensitive Medical Tourism
Medical Tourism in SEAsia and in South Asia
  • Main destinations are Thailand, India Singapore
  • Lesser destinations are Malaysia and the
  • In 2006 (full citations are listed in my paper),
  • Thailand 1,200,000 medical tourists
  • (One hospital in Bangkok treats 400,000
  • medical tourists per year)
  • India 600,000 (Indian embassies give out M
  • valid for 1 year)
  • Singapore 374,000
  • (Medical tourists and other foreigners
    make up 60 of
  • the patients of one major private sector
  • corporation in Singapore)
  • Malaysia 292,000
  • (Earnings in 2006 RM 204 million.
    Expected earnings
  • in 2010 US1 billion or RM 380 million)

What Can Account for the Growth in Medical
  • Malaysian health policy expert Dr Chee Heng Leng
  • (Asia Research Institute, NUS) argues that
  • This is a side effect of the commodification of
    medical care
  • Commodification
  • Product standardization
  • Market expansion
  • Active marketing of medical care to consumers

Characteristics of Medical Tourists
  • Quality-sensitive medical tourists
  • Affluent people e.g. wealthy citizens
  • Ruling elites e.g. Myanmar army Generals
    seeking medical care in more developed SEAsian
  • Price-sensitive medical tourists
  • Middle class people who are reasonably
    well-informed about foreign countries and which
    foreign medical centers to go to

Kinds of Medical Treatment Likely to be Sought
  • 1. Quality-sensitive medical tourism
  • sophisticated services e.g. open heart
  • 2. Price-sensitive medical tourism
  • Non-urgent medical procedures such as hip
    replacement or knee replacement surgery, cosmetic
    surgery, dental surgery, gender reassignment
  • Other possibilities organ transplants
    (transplant tourism)
  • Medical procedures that do not require
  • an extensive period of treatment or extensive
  • followup

Favored Destinations and Treatment Sites
  • Destination Countries with these
  • characteristics
  • Ranked high in terms of perceived
  • medical care quality
  • Major languages such as English,
  • Spanish, French etc are widely spoken
  • Foreign visitors feel welcome and safe
  • Politically stable with a relatively high
  • standard of living
  • Easy to fly to

Favored Destinations and Treatment Sites
  • Treatment sites (hospitals or medical
  • centers) that are
  • Accredited by the accreditation agency of
  • the medical tourists own home country
    Owned by the medical tourists own home
  • country health care corporations
  • World-renowned e.g. Mayo Clinic in
  • Rochester, Minnesota, USA
  • Staffed by doctors with credentials from
  • the medical tourists own country

Motivations (besides perceived higher quality
or lower cost)
Motivation of Less Costly Care
  • For many medical tourists, ........ the
    real attraction is price. The cost of surgery in
    India, Thailand or South Africa can be one-tenth
    of what it is in the United States or Western
    Europe, and sometimes even less. A heart-valve
    replacement that would cost 200,000 or more in
    the U.S., for example, goes for 10,000 in
    India--and that includes round-trip airfare and a
    brief vacation package. Similarly, a metal-free
    dental bridge worth 5,500 in the U.S. costs 500
    in India, a knee replacement in Thailand with six
    days of physical therapy costs about one-fifth of
    what it would in the States, and Lasik eye
    surgery worth 3,700 in the U.S. is available in
    many other countries for only 730. Cosmetic
    surgery savings are even greater A full facelift
    that would cost 20,000 in the U.S. runs about
    1,250 in South Africa.
  • B. Hutchinson Medical Tourism Growing
  • http//

Organisation and Financing of Trips Overseas
  • By individual patients and their families using
    personal savings/borrowed money
  • By self-insured employers eager to reduce the
    cost of health care generated by their employees
  • By insurance companies or administrators of
    national health care systems who realise that
    costs can be reduced by having enrollees treated
  • By cultural brokers such as tour operators,
    agents and others who work with overseas
    hospitals and foreign health care providers
  • By public agencies set up by governments to
    promote medical tourism e.g. Singapore Medicine
    and National Committee for the Promotion of
    Health Tourism in Malaysia

Possible Impact on the Health Care Industry in
the Home Country
  • In high cost countries like the USA, there may be
    a significant reduction in demand for particular
    medical procedures
  • If so, health care providers such as hospitals
    and specialists will be forced to react e.g.
    health care corporations may open up branches
    overseas specialists may go overseas to seek
    patients to treat

Possible Impact on the Health Care Industry in
the Host Country
  • 1. An influx of medical tourists into a host
    country is equivalent to an increase in the
    demand for higher end medical services. This
    implies higher prices for local people (in the
    short run).
  • 2. May accelerate movements of health personnel
    e.g. from poorer countries to more developed
    countries in SE Asia from the public sector to
    the private sector from less lucrative medical
    specialties to more lucrative specialties (e.g.
    general surgery to plastic surgery)
  • 3. May further distort the allocation of health
    care resources (more devoted to tertiary care)

Possible Impact on the Health Care Industry in
the Host Country
  • . initial observations suggest that medical
    tourism dampens external migration but worsens
    internal migration it does not augur well for
    the health care of patients who depend largely on
    the public sector for their services as the end
    result does not contribute to the retention of
    well-qualified professionals in the public sector
  • Dr. Manuel Dayrit, World Health

  • American Cancer Society. Questionable cancer
    practices in Tijuana and other Mexican border
    clinics. 2006. http//
  • Barraclough S, Phua KL. Health imperatives in
    foreign policy the case of Malaysia. Bull of
    World Hlth Org 2007 85(3)225-229.
  • BBC News. Doctors concern at overseas care plan.
    2002. http//
  • Bishop RA, Litch JA. Medical tourism can do harm.
    BMJ 2000 3201017.
  • CBC News Online. Medical tourism need surgery,
    will travel. 2004 June 18. http//
  • Chee HL. Medical tourism in Malaysia
    international movement of healthcare consumers
    and the commodification of healthcare. Working
    Paper Series No. 83. Singapore Asia Research
    Institute, 2007.

  • Chinnai R, Goswami R. Medical visas mark growth
    of Indian medical tourism. Bull of World Hlth Org
    2007 85(3)164-165.
  • Connell J. Medical tourism sea, sun, sand and
  • Tourism Mgmt 2006 27(6)1093-1100.
  • De Arellano R. 2007. Patients without borders
    the emergence of medical tourism. Int J of Hlth
    Serv 2007 37(1)193-198.
  • Fawthrop T. Cuba sells its medical expertise.
    2003 21 November. http//
  • Ghods AJ, Nasrollahzadeh D. Transplant tourism
    and the Iranian model of renal transplantation
    program ethical considerations. Exp Clin
    Transplant 2005 3(2)351 4.
  • Gupta P. Medical tourism in Asia. Asharq Alawsat
    2007 May 16.
  • http//
  • Hutchinson B. Medical tourism growing worldwide
    2005 July 25. http//
  • Moore JD Jr. Medical Mecca. Foreign patients
    flock to Miami seeking care and service. Mod
    Healthc. 1997 27(22)30 7.
  • Olarte AM. And now, hospitals as tourist spots.
    2006. http//

  • Online NewsHour. Traveling for treatment. 2005
    Feb 21. http//
  • Phua KL. World Trade Organization (WTO)
    negotiations possible effects on health and
    health services in Malaysia. Jurnal Kesihatan
    Masyarakat 2004 107 13.
  • Runckel CJ. Where to go for medical tourism?
    2007. http//
  • Scheper-Hughes N. The global traffic in human
    organs. Current Anthro 2000 41(2)191 224.
  • Schweimler D. Cubas medical success story. 2001
    September 10. http//
  • Straits Times. Medical attraction. 2007 March
  • Walker T. Consumers go abroad in pursuit of
    cost-effective healthcare. Managed Healthcare
    Executive 2006. http//www.managedhealthcareexecut
  • World Trade Organization and World Health
    Organization. WTO agreements and public health.
    Geneva WTO and WHO, 2002.

The End
  • Thank you