2017 GH Sesi 4 YM World Trade vs World Health
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
tourism country source
Number of Indonesian patients seeking
treatment overseas
Annual spending on overseas medical
treatment (in thousand dollar)
700,000
16000
600,000
14000
12000
500,000
10000
400,000
8000
300,000
6000
200,000
4000
100,000
2000
0
0
2006
2012
2006
2012
O er ie of the de elop e t of Malaysia
Health are to ards Medi al Touris , 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?
Ma y 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 ere t sure a out
coming to Kuching, but after we heard about it
through word-of-mouth, we decided to o e.
(Wife of an Indonesian medical traveller in Malaysia,
a civil servant in his 50s)*
*Source: Ormond (2014)
I thi k that 9 per e t of patie ts 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 for ed to o e 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
de elop its health ser i es..
(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
Thailand
800,000
Singapore
600,000
Malaysia
400,000
200,000
0
2001 2002 2003 2004 2005 2006 2007 2008
*Kanchanachitra et al 2012
Annual Medical Tourism Revenue 2006-2008*
1600
1400
Million USD
1200
1000
800
600
400
200
0
Malaysia
*Kanchanachitra et al 2012
Philippines
Singapore
Thailand
Revenue per international patient*
2500
Million USD
2000
1500
1000
500
0
Malaysia
*Kanchanachitra et al 2012
Thailand
Singapore
Popular Medical Tourism Services*
Services
Cosmetic surgery
Health screening
Orthopedics
Cardiology
Coronary artery bypass
Neurosurgery
Oncology
Hip replacement
Stem cell
Internal Medicine
Endocrinology
Health rejuvenation
*Kanchanachitra et al 2012
Malaysia
Philippines
Singapore
Thailand
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
TOTAL
*Ref: Noree et al (2016)
34 (0.0)
104,830 (100.0)
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
737
642
521
Tel Aviv, Israel
1602
4229
5481
Bangkok, Thailand
3617
1369
3509
Kuala Lumpur, Malaysia
2603
1279
3804
376
578
346
Monterrey, Mexico
Managua, Nicaragua
Average cost of medical procedures (US$)*
Procedure
US
UK
Malaysia
Singapore
Thai
Heart-by-pass graft
surgery
113,000
13,921
9,000
20,000
13,000
Heart valve replacement
150,000
-
9,000
13,000
11,000
Hip replacement
47,000
12,000
10,000
11,000
12,000
Knee replacement
48,000
10,162
8,000
13,000
10,000
*Kanchanachitra et al 2012
Single private hospital room per night
1400
1200
USD
1000
800
600
400
200
0
Malaysia
Thailand
Singapore
US
Touristic healthcare services in demand
Lifestyle
Life enhancing
Stress reducing
Invasive
Dental work
Plastic surgery
Diagnostic
General check up
Bone density
testing
Skin improving
Eye surgery
Heart stress test
Sleep psychology Cancer treatment Lipid analysis
Physical therapy Joint
replacements
Holistic healing
Average cost of braces in the US (2012)
US$ 5,200
Dental tourism...
Favored destinations
Procedures in demand
Implants
Hungary
Veneers
Mexico
Crowns
Poland
Thailand
Teeth
whitening
Turkey
Bridges
Spain
Others
Braces
Others
I
o ati e
Toothache
tourism
edi al touris
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
From developed
countries
Poor patients
Elective invasive,
Low-tech invasive,
Diagnostic, Lifestyle Diagnostic, Border
medical care
From developing Elective invasive,
Diagnostic Lifestyle
countries
Border medical care
Incidental medical tourists?
8% of traveler
to developing
country
requires
medical care
(e.g. diarrhea,
malaria)
• Short term stayers
– Ordinary tourists
– Business traveler
• Long term stayers
– Foreign students
– Foreign workers
– Retirees
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
Singapore
Thailand
Target
• One million patients by 2012
• S$ 3 billion revenue (0.95% of its
GDP)
• S$ 400 million from related industries
• 13,000 new jobs
• US$ 3,2 billion for 2014
Malaysia s E o o i Tra sfor atio Progra
ETP
• Ear arked health are as o e of the ou try s Natio al 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
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
tourism country source
Number of Indonesian patients seeking
treatment overseas
Annual spending on overseas medical
treatment (in thousand dollar)
700,000
16000
600,000
14000
12000
500,000
10000
400,000
8000
300,000
6000
200,000
4000
100,000
2000
0
0
2006
2012
2006
2012
O er ie of the de elop e t of Malaysia
Health are to ards Medi al Touris , 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?
Ma y 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 ere t sure a out
coming to Kuching, but after we heard about it
through word-of-mouth, we decided to o e.
(Wife of an Indonesian medical traveller in Malaysia,
a civil servant in his 50s)*
*Source: Ormond (2014)
I thi k that 9 per e t of patie ts 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 for ed to o e 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
de elop its health ser i es..
(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
Thailand
800,000
Singapore
600,000
Malaysia
400,000
200,000
0
2001 2002 2003 2004 2005 2006 2007 2008
*Kanchanachitra et al 2012
Annual Medical Tourism Revenue 2006-2008*
1600
1400
Million USD
1200
1000
800
600
400
200
0
Malaysia
*Kanchanachitra et al 2012
Philippines
Singapore
Thailand
Revenue per international patient*
2500
Million USD
2000
1500
1000
500
0
Malaysia
*Kanchanachitra et al 2012
Thailand
Singapore
Popular Medical Tourism Services*
Services
Cosmetic surgery
Health screening
Orthopedics
Cardiology
Coronary artery bypass
Neurosurgery
Oncology
Hip replacement
Stem cell
Internal Medicine
Endocrinology
Health rejuvenation
*Kanchanachitra et al 2012
Malaysia
Philippines
Singapore
Thailand
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
TOTAL
*Ref: Noree et al (2016)
34 (0.0)
104,830 (100.0)
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
737
642
521
Tel Aviv, Israel
1602
4229
5481
Bangkok, Thailand
3617
1369
3509
Kuala Lumpur, Malaysia
2603
1279
3804
376
578
346
Monterrey, Mexico
Managua, Nicaragua
Average cost of medical procedures (US$)*
Procedure
US
UK
Malaysia
Singapore
Thai
Heart-by-pass graft
surgery
113,000
13,921
9,000
20,000
13,000
Heart valve replacement
150,000
-
9,000
13,000
11,000
Hip replacement
47,000
12,000
10,000
11,000
12,000
Knee replacement
48,000
10,162
8,000
13,000
10,000
*Kanchanachitra et al 2012
Single private hospital room per night
1400
1200
USD
1000
800
600
400
200
0
Malaysia
Thailand
Singapore
US
Touristic healthcare services in demand
Lifestyle
Life enhancing
Stress reducing
Invasive
Dental work
Plastic surgery
Diagnostic
General check up
Bone density
testing
Skin improving
Eye surgery
Heart stress test
Sleep psychology Cancer treatment Lipid analysis
Physical therapy Joint
replacements
Holistic healing
Average cost of braces in the US (2012)
US$ 5,200
Dental tourism...
Favored destinations
Procedures in demand
Implants
Hungary
Veneers
Mexico
Crowns
Poland
Thailand
Teeth
whitening
Turkey
Bridges
Spain
Others
Braces
Others
I
o ati e
Toothache
tourism
edi al touris
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
From developed
countries
Poor patients
Elective invasive,
Low-tech invasive,
Diagnostic, Lifestyle Diagnostic, Border
medical care
From developing Elective invasive,
Diagnostic Lifestyle
countries
Border medical care
Incidental medical tourists?
8% of traveler
to developing
country
requires
medical care
(e.g. diarrhea,
malaria)
• Short term stayers
– Ordinary tourists
– Business traveler
• Long term stayers
– Foreign students
– Foreign workers
– Retirees
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
Singapore
Thailand
Target
• One million patients by 2012
• S$ 3 billion revenue (0.95% of its
GDP)
• S$ 400 million from related industries
• 13,000 new jobs
• US$ 3,2 billion for 2014
Malaysia s E o o i Tra sfor atio Progra
ETP
• Ear arked health are as o e of the ou try s Natio al 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