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The Star January 13th 2003
Aiming for foreigners
EDITED BY LOH FOON FONG
Health tourism is big business these days, and the Government's
efforts to give this sector a boost is understandable, given
its huge economic potential. While the Health Ministry, Culture,
Arts and Tourism Ministry, state governments and private hospitals
have been busy pushing their case for health tourism, consumers
and doctors have voiced their concerns.
Currently, different concepts are being explored.
Beautiful Holidays, a division of Medi Travels Sdn Bhd, offers
a cosmetic surgery-cum-holiday package. Besides enjoying the
sun, sea and beaches of Penang, tourists can even go home
with a new look.
And then there’s Country Heights Medical Tourism Sdn
Bhd which offers comprehensive health screening in a five-star
hotel to Mines health club members. They are treated to water-taxi
joy rides at the Mines Resort lakes in Selangor, a rejuvenating
spa experience, golfing and other activities.
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Corina
van Leeuwen (left) recently received a breast
enhancement job in Penang. The medical fraternity
here however, should be ready for litigation
when facing more demanding foreign patients.
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In Malacca, plans
are under way for Upeh Island to be converted into a holistic
healing centre.
Meanwhile, big private hospitals are linking up with the
Malaysian External Trade Development Corporation (Matrade)
and tour agencies to promote their facilities to tourists.
What is health tourism?
The Health Ministry defines health tourism as a combination
of activities relating to healthcare and tourism that
generate wealth for the local economy. It can be wellness
or curative healthcare programmes aimed at foreign nationals
who are visiting or working in Malaysia, says Datuk Dr
Abdul Gani Mohammed Din, director of medical development,
Health Ministry.
Dr Abdul Gani says health tourism, which was introduced
in 1997, includes sun and fun activities that enhance
health such as trekking, golfing and cycling; services
such as medical treatment, health screening and massages;
and facilities such as health resorts and spas.
The medical treatment offered by private hospitals are
usually elective procedures such as dialysis, coronary
artery bypass grafting, lithotripsy (a technology which
uses shockwaves to break up stones inside the body), bone
marrow transplant and liver transplant. |
The enthusiastic promotions among various groups is only to
be expected, considering that Malaysia earned RM26.5mil from
foreign tourists seeking outpatient medical treatment in 2001
alone. The number of foreign patients is increasing every year.
In 2000, there were 78,316 foreign patients; in 2001, there
were 91,865 and up till August 2002, there were 73,588 patients.
Monthly, there are 5,743 patients and most of them are from
Indonesia, Brunei and the Middle East, says Datuk Dr K. Kulaveerasingam,
a board member of the Association of Private Hospitals Practitioners
in charge of health tourism.
Hospitals in Malacca and Penang benefit the most because of
the states’ proximity to Indonesia.
“Indonesians living nearer to the Peninsula find it is
further and more expensive for them to travel to Jakarta than
to Malacca,” says Dr Kulaveerasingam. It is not surprising
that Malacca alone sees 2,000 foreign patients a month.
The benefits of health tourism are manifold: it expands the
cake of the private sector, handles overcapacity within the
country, makes Malaysia a centre for health excellence, helps
raise standards and increases competition.
In view of the vast potential for growth, the Government set
up the National Committee for the promotion of Health Tourism
in 1998. The committee is headed by the director-general of
the Culture, Arts and Tourism Ministry.
Promotions
Much has been done to boost health tourism in the country. The
Health Ministry, Matrade and Tourism Malaysia organise trade
and promotion missions abroad. A network of Tourism Malaysia
offices and Malaysian embassies or consulates worldwide also
provides information, distributing brochures with the names
and contact numbers of hospitals.
Matrade held exhibitions in Asean countries in 2000, the Middle
East in 2001, and in Jakarta and Surabaya last year to match-make
deals between hospitals and tour agents. Other countries that
the Government is trying to woo are Britain, Japan, Taiwan and
China.
“We are targeting markets where a particular service is
not available or is too expensive, where there is a long waiting
list or where patients feel more comfortable and safer for religious
or cultural reasons,” says Dr Abdul Gani.
Since foreign patients may not want to go to a less developed
country for medical treatment, Dr Abdul Gani says their trust
can be gained if hospitals participate in accreditation programmes
by the Malaysian Society for Quality in Healthcare or the internationally
recognised ISO certification. These hospitals are also encouraged
to form alliances and affiliations with foreign centres of medical
excellence. Currently, 34 hospitals have government approval
to participate in health tourism, but only half of those meet
the ISO 9002 standard.
“Although some hospitals are not accredited, they can
still attract patients from overseas if they offer a certain
expertise,” says Dr Abdul Gani.
Escalating costs
Health tourism can have mixed implications for the country’s
healthcare system. While there are economic gains and technological
advances, excessive focus on this sector may give rise to escalating
costs, warns Consumers International Asia Pacific.
Healthcare tourism has the effect of raising healthcare costs
not only in the tourist sector but also for the whole population.
There is concern that the inflation rate in healthcare costs
may rise substantially higher than the general inflation rate.
Consumers International also warns that health tourism may move
resources away from primary healthcare to high-end curative
services, adding that it is critical that these risks be considered
and appropriate counter measures adopted.
Tham Kam Choy, director of Clinical Services at the Sunway Medical
Centre in Selangor, points out that people from more developed
countries where the standard of care is very high would demand
a similar standard if they seek treatment in Malaysia.
As such, Malaysia needs highly-trained surgeons, specialists,
nurses and technicians as well as high quality pre-operative
tests and post-operative follow-ups for hospitals to be accredited.
“It is costly to maintain high standards and it also puts
a strain on manpower and technology,” says Tham.
Lack of expertise
There is concern that the healthcare resources in this country
are insufficient to cater to foreigners, particularly in the
area of oncology, cardiology, neurology and other highly specialised
fields.
Currently there are 1,570 specialists registered with the Health
Ministry.
“The average length of hospital stay is generally shorter
now due to better technology, better drugs, less invasive methods
of treatment and better post-surgical care,” says Kalamhamidi
Abu Bakar, CEO of Pantai Medical Centre in Kuala Lumpur.
“There is an excess of beds that can be offered to foreigners.
We don’t need to incur further capital commitment or additional
expenditure.” However, he admits that there are insufficient
oncologists in the Pantai hospitals though they have more than
enough cardiac expertise.
“The bulk of regular demand comes from the locals, so
people do not have to fear any neglect over local health needs.
Foreign tourists are just the icing on the cake,” says
Dr Kulaveerasingam of the Association of Private Hospitals Practitioners.
“Since the Sept 11 tragedy, more people are coming to
this region and many choose Malaysia because it is affordable
and we have many highly-trained specialists.”
The government of Brunei foots the medical bills for its patients seeking
treatment in Malaysia.
“In specialities where we are lacking, such as neurological
services, we could try to attract world-renowned specialists
if we want to capture the more advanced market,” says
Dr Kulaveerasingam.
Medico-legal and ethical issues
Going into the health tourism business requires the medical
fraternity to be ready for litigations when faced with more
demanding foreign patients.
In the event of a legal suit, would a Malaysian doctor’s
services be examined against a higher standard of care such
as may be available in the patient’s country of origin?
And if a patient should win a medical negligence suit, would
the damages awarded reflect the expectations and living standards
of the country of origin of the plaintiff?
These are some of the issues which need to be examined in
determining whether the demand for health tourism would raise
the cost of medical defence for local doctors and hospitals.
Meanwhile, a senior doctor in a private practice in Penang
says people who seek cosmetic surgery are not patients in
the true sense of the word for they do not have a real medical
illness, unless complications occur.
He also points out that the medical ethical code states that
a doctor should not associate with non-medical persons or
bodies to “tout for business.”
“This is the part that really sullies the medical profession
and brings it into disrepute. When we do this, we are no longer
doctors; we have become businessmen. We doctors lose our right
to the respect and courtesy that society accords us.”
Two-tier system
Health tourism enhances the dual market structure –
a two-tier healthcare delivery system. The higher quality,
expensive segment caters to wealthy tourists and the lower
end to the general public.
“The facilities earmarked for health tourism will definitely
not address broader social needs. Those who can pay more are
served better,” says a spokesman from Consumers International.
The two-tier system will also aggravate brain drain when
healthcare providers from the public sector move to the more
profitable private sector. Thailand, which leads health tourism
in the region together with Singapore, has seen an increased
outflow of service providers from the public to the private
sector, aggravating the already uneven distribution of human
resources in the country.
Datuk Dr M. Jegathesan, former deputy director-general at
the Health Ministry, says the overall concern about health
tourism must be viewed in the context of a national health
system. “If there is a national health insurance scheme,
the extras can compete in the market,” he says.
The National Health Financing Authority will determine the
healthcare packages, and the market players will have to accept
a reasonable payment of fees.
“Never can health tourism compare with the size of
the local market. The foreign market is just a niche market
and the Government is encouraging the private sector to move
in the way that Singapore is doing with its hospitals,”
says Dr Jegathesan.
However, Consumers International says safety net measures
such as having a policy and control over pricing, and the
direction and role of the private sector, should be stipulated
before health tourism is implemented. “Laws are needed
to protect local needs,” says a spokesman.
It is ironic that while the Health Ministry aims to remove
the two-tier system through the National Health Financing
Authority, its promotion of health tourism may just lay the
groundwork for such a system to be entrenched in our midst.
Now more than ever, we need to push for a national health policy
and the restructuring of the public healthcare system to provide
better access and protection for the general public before we
continue wooing more foreign tourists to our hospitals.
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