International trade in health services Yodi Mahendradhata
International trades in services Cross-border trade Consumption abroad Commercial presence Natural presence
International trades in services Cross-border trade Consumption abroad Commercial presence Natural presence
Consumption abroad (Medical Tourism)
Indonesia is the biggest outbound global medical Number of Indonesian patients seeking treatment overseas tourism country source Annual spending on overseas medical treatment (in thousand dollar) 700,000 16000 600,000 14000 500,000 12000 400,000 300,000 10000 8000 6000 200,000 4000 100,000 2000 0 2006 2012 0 2006 2012
Overview of the development of Malaysia Healthcare towards Medical Tourism, Dr Mary Wong Lai Lin, CEO of Malaysia Healthcare Tourism Council, 2012
Indonesia is a source of patients for its next-door neighbours Singapore Indonesian market accounted for 56 per cent of total medical tourism revenues in 2013 Revenue from Indonesian medical tourists in 2013 was S$463 million (US$347.35 million), down 38 per cent from 2012 Malaysia 2011 data: >330,000 Indonesians sought treatment in Malaysia spending over $150 million in direct medical costs. 2013 data: > 400,000 Indonesians sought treatment in Malaysia -> may be worth close to $1 billion in 2013 for Malaysia and this figure is growing around 30% a year Source: http://www.edelman.id/medical-tourism-in-southeast-asia-indonesias-opportunity-cost/; http://www.asianewsnet.net/singapore-losing-medical-tourists-to-neighbours-74854.html
Why do patients go abroad?
Many people suggested that we come to Kuching because they said that the medical treatment here was good. The guy over there had the experience of falling ill and being cured here. We weren t sure about coming to Kuching, but after we heard about it through word-of-mouth, we decided to come. (Wife of an Indonesian medical traveller in Malaysia, a civil servant in his 50s)* *Source: Ormond (2014)
I think that 90 percent of patients here come from Indonesia especially from Pontianak. We understand why. Doctors here are more open, honest, and explain to us whether illnesses can be cured or not. They will keep us informed giving us the percentage of likelihood for a cure, giving us all the information we need. They are clearer and more open friendlier, more familiar. (Indonesian medical traveller in Malaysia, a small business owner in her 40s)* *Source: Ormond (2014)
People are forced to come here [to Malaysia]. It s about our lives. We already spent money on local health treatment [in Indonesia] without being cured. The situation makes it difficult for Indonesia to develop its health services.. (Indonesian medical traveller in Malaysia, a small business owner in his 60s)* *Source: Ormond (2014)
Familiarity Affordability Perceived quality Availability Drivers for foreign medical care (Glinos et al 2006)
International patients visits* 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 Thailand Singapore Malaysia 400,000 200,000 0 2001 2002 2003 2004 2005 2006 2007 2008 *Kanchanachitra et al 2012
Million USD Annual Medical Tourism Revenue 2006-2008* 1600 1400 1200 1000 800 600 400 200 0 Malaysia Philippines Singapore Thailand *Kanchanachitra et al 2012
Million USD Revenue per international patient* 2500 2000 1500 1000 500 0 Malaysia Thailand Singapore *Kanchanachitra et al 2012
Popular Medical Tourism Services* Services Malaysia Philippines Singapore Thailand Cosmetic surgery Health screening Orthopedics Cardiology Coronary artery bypass Neurosurgery Oncology Hip replacement Stem cell Internal Medicine Endocrinology Health rejuvenation *Kanchanachitra et al 2012
Areas of origin of the medical tourists attending five hospitals, Thailand, 2010* Origins Number of med tourist (%) Eastern Mediterranean 40,554 (38.7) Southeast Asia 14,730 (14.1) Europe 14,004 (13.4) South Asia 12,703 (12.1) North America 9,481 (9.0) East Asia 4,166 (4.0) Africa 3,957 (3.8) Australasia 3,949 (3.8) Unknown 1,252 (1.2) Other area 34 (0.0) TOTAL 104,830 (100.0) *Ref: Noree et al (2016)
Medical Travel costs from major US cities (US$) Chicago Los Angeles Miami Bogota, Colombia 316 590 299 San Jose, Costa Rica 423 559 333 New Delhi, India 1264 1390 1313 Amman, Jordan 1307 4503 1626 Seoul, Korea 1170 1301 1758 Monterrey, Mexico 737 642 521 Tel Aviv, Israel 1602 4229 5481 Bangkok, Thailand 3617 1369 3509 Kuala Lumpur, Malaysia 2603 1279 3804 Managua, Nicaragua 376 578 346
Average cost of medical procedures (US$)* Procedure US UK Malaysia Singapore Thai Heart-by-pass graft surgery 113,000 13,921 9,000 20,000 13,000 Heart valve replacement 150,000-9,000 13,000 11,000 Hip replacement 47,000 12,000 10,000 11,000 12,000 Knee replacement 48,000 10,162 8,000 13,000 10,000 *Kanchanachitra et al 2012
USD Single private hospital room per night 1400 1200 1000 800 600 400 200 0 Malaysia Thailand Singapore US
Touristic healthcare services in demand Lifestyle Invasive Diagnostic Life enhancing Dental work General check up Stress reducing Plastic surgery Bone density testing Skin improving Eye surgery Heart stress test Sleep psychology Physical therapy Holistic healing Cancer treatment Lipid analysis Joint replacements
Average cost of braces in the US (2012) US$ 5,200
Dental tourism... Favored destinations Procedures in demand Implants Hungary Mexico Poland Thailand Turkey Spain Others Veneers Crowns Teeth whitening Bridges Braces Others
Innovative medical tourism Toothache tourism Pregnancy tourism Fasting tourism Detox tourism Dialysis at sea Women on wave/sperm ship Health research Suicide tourism
Medical tourism by patient profile Rich patients Poor patients From developed countries From developing countries Elective invasive, Diagnostic, Lifestyle Elective invasive, Diagnostic Lifestyle Low-tech invasive, Diagnostic, Border medical care Border medical care
Incidental medical tourists? 8% of traveler to developing country requires medical care (e.g. diarrhea, Short term stayers Ordinary tourists Business traveler Long term stayers Foreign students Foreign workers Retirees malaria)
Strategies and comparative advantages: Thailand National strategy as Asian Regional Med Hub, e.g. Center for trans-sexual surgery Large number of JCI accredited hospitals Highly skilled med professionals Strong private participation Competitive costs
Strategies and comparative advantages: Singapore Well-established medical tourism destination High technology equipment Highly skilled med professionals Large number of JCI accredited hospitals Strong goverment support
Strategies and comparative advantages: Malaysia Strong goverment support Competitive costs Strategic alliances with foreign partners Easy entry for foreign patients Destination for Muslim Patients
Targets in medical tourism Country Target Singapore One million patients by 2012 S$ 3 billion revenue (0.95% of its GDP) S$ 400 million from related industries 13,000 new jobs Thailand US$ 3,2 billion for 2014
Malaysia s Economic Transformation Program (ETP) Earmarked health care as one of the country s 12 National Key Economic Areas (NKEAs) deemed to have the potential to spur growth Medical tourism is intended to generate MYR 9.6 billion in revenue and MYR 4.3 billion in gross national income and to require 5,300 more medical professionals by 2020 For-profit hospitals are expected to invest MYR 335 million in hospital infrastructure in order to be prepared for 1.9 million foreign patients annually by 2020.
Common policies and strategies (Johnston et al 2015) Creation of visas specifically for medical tourists Reduction or elimination of taxation on imported medical equipment and supplies Incentives and/or requirements for international hospital Accreditation International marketing efforts that advertise the high quality of medical care available
8 success factors for medical tourism Competitive price Human capital Local R &D Developed physical infrastructure Developed political and legal institutions Market economics Confluence of western and traditional medicine Tourist appeal
Barriers to medical tourism Standards. Accreditation and credentialing Insurance Legal recourse and protection of patients Entry requirements and transportation International regulation
International trades in services Cross-border trade Consumption abroad Commercial presence Natural presence
Yodi_mahendradhata@yahoo.co.uk