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News Article

Medical tourism: not just about price

Research examines motivations of Indonesians going to Malaysia for treatment

The general perception of medical tourism among many people in Western countries is either that of people from the West travelling to countries in the global South to take advantage of cheaper treatment prices, or of overseas visitors 'abusing' free health care provided by systems such as the UK's National Health Service. But it is increasingly recognized that the largest sector of international medical travel is in South-South flows. A paper by Meghann Ormond and Dian Sulianto, submitted to Current Issues in Tourism and available online on, looks at medical travel flows between Indonesia and Malaysia and suggests that the perception that Indonesians go to Malaysia just for the cheapest price deal is too simplistic.

The study 'More than medical tourism; lessons from Indonesia and Malaysia on South to South intra-regional travel' concentrates on motivations, preparation and practices. Using 35 detailed interviews of Indonesians going to Malaysia for healthcare, it fleshes out how things work beyond the basics. The authors asked about treatment, accommodation and transport, as well as length of stay.

One key point it highlights is that the idea of medical tourists traveling across the world for the cheapest care is out of date as most medical travel is regional, often between easy to reach nearby countries. The ease of travel determines where in the country medical tourists go, as does how comfortable they are with the final destination.

The report also highlights that people from Laos go to Thailand mainly because it is a short trip across the border and they go there even for basic healthcare, as the Laos system is very poor. Rather than being welcomed, this cross-border trade is causing problems for some hospitals as many Laotians do not have the means to pay and hospitals are being over-burdened. In South Africa and India, whereas the countries are marketed heavily to customers in Europe and North America, foreigners coming for treatment are much more likely to come from within their regions. In South Africa there is high demand and large informal flow of patients from neighbouring countries, but source countries struggle to reimburse South Africa for treating their citizens.

Regional medical travellers vary in terms of socio-economic group, medical condition, ability to travel, distance travelled, destination, length of stay, number of people with them and type of hospital they go to. Many patients travel with family and friends for support, and they may also depend on family and friends for free accommodation. A high proportion of medical travellers pay in cash, and to minimise costs, most travellers opt for land transport (cross-border economy coach services, shared vans and taxis).

While cost of treatment is a factor for some, other important drivers are availability of healthcare, quality of equipment and doctors, and recommendations.

With a dearth of quality healthcare in Indonesia, the growth of a prosperous middle-class, increased affordable cross-border transport and ease of border crossing- an increasing number of Indonesians (maybe as many as a million) go to Thailand every year for healthcare, but they tend to stay for a shorter time and spend less than other nationalities, partly as much of this is outpatient care.

Two out of three travel to the state of Penang, a quarter to Melaka and the rest to Sarawak.

Diagnostic, treatment and medication costs were widely regarded by medical travellers as similar across Indonesia and Malaysia. Care in Kuching entails the additional burden of transport and accommodation costs as well as sometimes temporarily closing their businesses or taking leave from work or care responsibilities to go abroad. Yet all travellers found the additional financial burden to be worth it: as it was better healthcare than they get at home.

Proximity also enables a different type of health care than is possible for long-haul North-South medical tourists. Intra-regional medical travel becomes a feasible way to manage chronic health needs, with people commuting on a routine basis for treatments, check-ups and refills.

The study concludes that by focusing marketing efforts on further away patients, the development of promotional campaigns, travel infrastructure and attractions that interest and engage higher-spending medical tourists are all ignoring the lower spending but far more numerous nearby medical tourists that are the basic customer base of most hospitals. Campaigns focusing on low cost may miss the point that it costs many of these people more to get treatment in Malaysia than it would in Indonesia, so price is not the main driver. More important are proximity, cross-border support networks, and confidence in the quality of diagnoses, treatment and medication.

In a previous study of medical tourism in Malaysia, Yeoh et al. (2013) reported that the majority of the tourists were repeat tourists from Indonesia and most of these outpatient patients spend about seven days in Malaysia with at least one companion. The results also revealed that most of the tourists were influenced by friends, family, relatives and doctor's referral. Musa et al. (2012), discussing inbound medical tourists in Kuala Lumpur, found that most respondents were female, middle aged, travelling with two others and Indonesians. Their main travel motivation factors were 'value for money', 'excellent medical services', 'supporting services', 'cultural similarity', and 'religious factor' in descending order of importance. Medical treatment, cosmetic procedure, surgical procedure, and medical check-ups were important healthcare services sought by the respondents.

Whittaker (2008) discusses medical tourism in Thailand, India, Malaysia and Singapore. Ormond (2011) discusses the emergence of medical tourism in the context of reform of domestic health care in Malaysia. Sarwar (2013) discuss prospects and challenges of medical tourism in Malaysia, while Krishnan and Chelliah (2013) examine factors contributing to medical tourism growth in Malaysia by studying the medical tourists' satisfaction from the aspects of medical cost, quality healthcare services, specialist medical services, government regulations and contribution of medical tourism agents.

The Site Search "medical tourism" OR "medical tourists" OR "medical travel" currently finds nearly 250 database records, and nearly 40 previous news articles.

Article details

  • Author(s)
  • David Simpson
  • Date
  • 30 June 2014
  • Subject(s)
  • Tourism