CHAPTER 2

LITERATURE REVIEW

2.1 World Trade Organization (WTO) and World Tourism Organization (UNWTO)
on Medical Tourism
It was not until 1973 that medical tourism was first categorized as a commercial
activity by the International Union of Travel Officials. As a form of international trade in
services, it can be classified according to the categorization of trade in services of the
World Trade Organization (WTO). The World Tourism Organization (UNWTO) defines
tourists as people who "travel to and stay in places outside their usual environment for
not more than one consecutive year for leisure, business and other purposes not related to
the exercise of an activity remunerated from within the place visited". A country that
offers medical tourism services to foreign patients, the destination country is, therefore,
the exporter while the patients home country becomes the importer of the service.
2.2 Medical Tourism
Over the years the need for better healthcare has grown significantly in recent
years, which resulted in an increasing number of countries started promoting medical
tourism (Bookman and Bookman, 2007). Demographic change especially in the increase
of ageing population promotes the requirement for more medical services with this
population. The rise of chronic diseases also fuels the demand for more and better health
services. Factors such as waiting time, cost of medical treatment and unavailability of
organ donor in developed countries, has lead new healthcare consumers, or medical
tourists, to seek treatment overseas (Sarwar,2012). This activity eventually coins the term

medical tourism. Medical tourism is a new branch of the tourism industry that
encompasses both the healthcare and tourism components. Tourism is defined as
traveling for predominantly recreational or leisure purposes or the provision of services to
support this leisure travel. Globally, tourism has become a popular global leisure activity.
In 2012, there were over 81.035 billion international tourist arrivals according to United
Nations World Tourism Organization (UNTWO, 2013). The primary goal of international
patients or medical tourist engaging in medical tourism is to have access to the highest
quality of health care from internationally accredited hospitals around the world at a more
affordable medical treatment cost.
Medical costs are very high in developed countries such as in United
States and United Kingdom which eventually promotes more and more people to travel
abroad in search of less expensive medical treatment. Factors such as state-of-the-art
hospital facilities, excellent health care services, certified professional physicians and
reasonably priced medical procedures are some of the key drivers for medical tourism
(Churnrurtai et al., 2009). It furthers encourages medical tourist to opt for treatment
aboard rather than in their home countries. Certain medical tourists will deliberately
choose medical tourism is an option to perform certain surgeries as it provides anonymity
since it is been carried out miles away from their home country (Bhavin, 2008).
Medical tourism is being actively promoted in developing Asian countries,
Middle East and South American countries which targets mainly patients from developed
countries (Bookman and Bookman, 2007). The scope of medical treatment in medical
tourism is broad and it involves the trade of service in particularly the health sector in the
form of surgery for example and the tourism sector in terms of accommodation. Types of

10

treatment include wellness, cosmetic surgery and also dental surgery. Countries such as
Jordan, Singapore, Israel, and India have adopted medical tourism as the main thrust
behind national economic development (Medical Tourism Magazine, 2010).
According to Mattoo and Rathindran (2006), for a surgery to be easily traded, it
not only has to constitute treatment for a non-acute condition and the patient has to be
able to travel without major pain or inconvenience, but the surgery also has to be fairly
simple and commonly performed with minimal rates of post-operative complications. Not
all healthcare procedures can always be traded across borders. For instance, an acute
condition or a surgery that requires intensive follow-up treatment on-site are some of the
factors that inhibit consumption health care abroad. Even though the tradability of health
care does not apply to all treatments, the authors still suggested that a sufficiently large
range of treatments can be obtained through medical tourism. Various academic
literatures have stated different medical tourism terms in their context. Even the term
medical tourism and health tourism is reported to have different functions. According to
Lee et al. (2007), medical and health tourism can be distinguished into separate
categories. The first is the serious medical tourism that consists of treatments of illness,
cosmetic surgeries, dental tourism and reproduction (fertility). The health tourism is
considered to be less medical and more focused on wellness tourism which includes spa,
alternative therapies and fitness tourism.

Figure 2.1: Components of Medical Tourism (Source: Lee et al., 2007)

11

Another term that is suggested by Carrrera (2007) is that medical tourism may be
defined as the deliberate attempt on the part of a tourist facility example hotels or
destination to attract tourists by promoting healthcare services and facilities in addition to
regular tourist amenities. Authors such as Connell (2006) define medical tourism as a
new form of niche tourism where people travel often long distances overseas to obtain
medical, dental and surgical care while simultaneously being holidaymakers. Bookman
and Bookman (2007) identify three forms of medical tourism which are invasive,
diagnostic and lifestyle. Invasive treatments involve high-tech procedures performed by a
specialist; diagnostic procedures encompass several types of tests such as blood
screenings and electrocardiograms; and lifestyle includes wellness or recuperation
treatments. Gonzales, Brenzel and Sancho (2001) for instance, define medical tourists as
people traveling to another country specifically to consume health care services, without
even making reference to touristic activities. Another study elucidated medical tourism
as the combination of products and services intended to encourage patients in preserving
and maintaining their health through a mixture of vacationing and other form of
recreational activities in a different location other than their home. Medical tourism may
be defined as the provision of cost effective medical care with due consideration to
quality in collaboration with tourism industry for foreign patients who need specialized
treatment and surgery.

12

Figure 2.2: Concept of healthcare tourism (Source: Caballero Danell & Mugomba, 2006)

World Tourism Organization (WTO) defines medical tourism as the tourism

services based on healthcare and nursing, sickness and health, and recovery and
rehabilitation, where medical tourism contains Health Tourism and Medical Tourism. The
former aims at tourism but is assisted with healthcare, while the latter focuses on
healthcare but includes travel. Early medical tourism, based on health tourism, promoted
tourism for health but however, modern people pursue health abroad because of the
progress of medical technology. While it is clear that medical tourism is an economic
activity that involves trade in services from two distinct sectors, health care and tourism,
it is not necessarily clear which kinds of treatments are encompassed in health care.
Engaging in one or more of the above-mentioned forms of medical or wellness treatments
should be the primary reason for traveling. Touristic activities, although possible, are not
necessarily required. Although medical tourism agents promote the tourism feature as
an essential part of the healthcare package, the recreational value of travel is less
important for patients with complex medical problems (Horowitz, Rosensweig and Jones,
2007). Further, the term medical tourism is preferred in this survey over health tourism

13

because the former is perceived to better describe the fact that it can involve highly
specialized and complex treatments. Besides, the phrase is increasingly being used by the
general public and the media (Horowitz, Rosensweig and Jones, 2007).

Figure 2.3: Concept of health tourism (Source: Jabbari, 2007)

The term medical tourism in relatively new but the practice of travelling for
treatment has existed years back. In the early times people have been travelling around
the world to seek treatment. According to Ross (2001) the earliest form of health tourism
is said to date back to the Neolithic and Bronze ages and in Europe when people traveled
to visit mineral and hot springs. Medical tourism can also be traced back to the ancient
Greeks and Egyptians who went to hot springs and baths to improve their health. As early
as 4000 BC, the Sumerians constructed the earliest known health complexes that were

14

built around hot springs. These healthcare facilities included majestic elevated temples
with flowing pools. Greek pilgrims traveled from the Mediterranean to Epidauria, a small
territory in the Saronic Gulf. It was said that this small territory was the sanctuary of
Asklepios, known as the healing God. Thus, it was recorded in medical tourism history
that Epidauria is the original destination for medical tourism (understandingmedicaltourism, 2013). During the 16th century, the rich and the elite of Europe
rediscovered Roman baths and flocked to tourist towns with spas like St. Mortiz, Ville
d'Eaux, Baden Baden, Aachen and Bath in England. Bath or Aquae Sulis enjoyed royal
patronage and was famous throughout the known world. It became the center of
fashionable wellness and became a playground for the rich and famous (medvarsity.com,
2013). By the 18th and 19th centuries, spa towns, especially in the south of France,
became popular destinations for people living in the north of Europe searching for sun
and an escape from the cold weather at home (Cook, 2008). In the late 19th century
patients from less developed countries would travel to medical centers in Europe and the
United States for diagnostics and treatment procedures not available in their own
countries (Horowitz, Rosensweig and Jones 2007).
Asia also has a history of medical tourism. India and Japan are two Asian
examples. Yoga and Ayurvedic medicine became popular in India as early as 5000 years
ago, wherein constant streams of medical travelers and spiritual students flocked to India
to seek the benefits of these alternative-healing methods (medvarsity.com, 2013). Japans
affluence of mineral springs known as on sen have also been favorite health retreats for
therapeutic properties for centuries. These springs are known for healing wounds. The
modern concept of medical tourism has only emerged in the past 10 to 15 years (Yanos,

15

2008). According to Bookman and Bookman (2007), what is different in the twenty-first
century is that tourists are traveling farther away, to poorer countries and for medical care
that is invasive and high tech.

2.3 Medical Tourism Market

The wide expansion of the global market allows some international organizations
to be established in order to prevent malpractice and raise awareness of best business
practices that sustain incentive growth and respond directly to future demands. For
example, the General Agreement on Trade in Services (GATS) was established in 1995
by the World Trade Organization and the Council for Trade in Services. The aim of this
agreement is to create policies, standards, and regulations that encourage the
development of international trade in services between countries. These foundations
create a safe environment for global trade in services, allowing developing countries to
benefit from their developed counterparts through the exchange of information, ideas and
technology. Therefore, some developing countries such as Jordan, Singapore, and India
have recruited skilled physicians who have obtained their degrees in the western world
and returned to their home countries to practice their profession (Lambier, 2009). This is
a general trend in healthcare and medical education by which developing countries
provide physicians and developed countries provide consultations and education in best
medical practices. Thus, international patients seeking to travel to developing countries
for medical services could be viewed as people seeking adequate medical procedures
(Zahra, 2008). Medical tourism cannot enter the global market, and services cannot be
traded safely, unless there is a global market environment that allows trust to be

16

established between developing and developed countries (Bookman & Bookman, 2007).
Cateora and Graham (2005) have constructed a framework that demonstrates the
environment of the global market. The framework contains three overlapping circles. The
inner circle represents the controllable elements that impact a service provider decision
(e.g., price, product, promotion, research, and channel of distribution). The second circle
represents the internal local environment that has a direct impact on the foreign
operations decisions. These local environmental elements include the competitive
structures of the local market, political and legal forces, and/or economic climates. The
third circle represents the uncontrollable elements, namely, cultural forces that influence
the life style of the local population, geography and infrastructure, structure of
distribution, level of technology, competitive forces, and economic forces. These
elements cannot be controlled by a service provider because they represent the external
market in different countries where foreigners do not have the authority to change their
policies, standards, or regulations. To overcome these uncontrollable elements, service
providers must work with the requisitions and standards of the external market. Horowitz
and Rosensweig (2007) argue that certain countries, namely those which put
confidentiality and privacy as a first priority for patients seeking sex changes, plastic
surgery, or drug rehabilitation, offer attractive medical destinations for American patients
who are looking for privacy somewhere outside their home country.
In the case of medical tourism, the international market often leads patients to
travel abroad to a medical destination in order to receive a medical service for a lower
price. Facilitators who work to promote a medical facility at a particular destination
should understand the internal medical policies and standards, the international medical

17

policies and standards, and the market policy and standards (Bravin, 2008). In this
market, foreign tourism operators and facilitators looking to attract for example American
patients should have an in-depth knowledge of up-to-date medical regulations in order to
target the United States market. The global medical tourism market (GMT) is a
confluence of such factors as medical and healthcare development, information
technology and local law, economics and politics. These factors can be considered as
barriers for many medical destinations to reaching an external market such as the US,
unless these medical destinations modify their medical regulations, standards, and polices
to match those regulations existing in the US market. To this end, Jagyasi (2009) suggests
that the international community should agree on an organization that is able to develop
rigorous international policies and standards to motivate medical facilities around the
world to become part of the global medical tourism market. To adapt and better reflect
large, global trends, the development of the medical tourism sector on a greater scale by
medical and tourism stakeholders could incorporate more factors that play a primary role
in enhancing the medical tourism market at a particular location for promoting extensive
medical services (Garcia-Altes, 2005). Some of these factors include lifestyle changes.
For example, the rapid growth of the population is prompting the creation of new models
of medical facilities and procedures including retirement communities, fitness centers and
cosmetic surgeries. These new models of medical and healthcare facilities are being
established by local or international investors according to the market demands. Also,
what could further motivate patients to travel abroad is to experiment with new tourism
models.

18

Figure 2.4: Medical tourism countries (Source: Medical Tourism: Consumers in Search
of Value, Deloitte, 2008)

Medical tourism offers incentive opportunities such as interacting with local culture,
visiting historical sites, and visiting relatives and friends. These opportunities could be
attractive for foreign patients that are interested to receive adequate medical treatments
and visit some tourism attractions. The limitations of domestic medical services, the lack
of medical insurance, the length of local waiting lists, and the high costs at home have
forced patients to travel abroad in search of adequate medical treatments that offer a high
quality of medical service at low costs.
Malaysia has focused on developing the quality of its healthcare, realizing
that to enter the global market requires fulfilling certain requirements (Chee, 2007). The
19

government has initiated a collaboration strategy to promote the medical tourism sector in
Malaysia as one piece (Garcia-Altes, 2005). Local health private providers and
government agencies cooperate together in order to provide excellent healthcare services
for foreign patients. On the other hand, hotels have integrated with hospitals and medical
facilities to provide incentive healthcare packages at attractive costs, which will play a
crucial role in the marketing campaign that will reach new markets in North America and
Eastern Europe.

2.4 Medical Tourism Factors

The rising healthcare cost in the United States and in many European countries
has left little choice for patients. This has forced the patients to seek treatment in other
countries (Bookman and Bookman, 2007). The choice of country that a medical tourist
will seek for treatment depends on various factors and not solely on cost. According to a
study by Palvia (2007) on the perceptions of the American medical tourist, there two
types of factors that will influence the choice of medical tourism destination, which are
internal factors and external factors. The external factors consist of

economic conditions
political climate
social behavior
regulatory standard

In terms of political culture, most patients are only attracted to regions where safety is a
high priority in the host country, and where the political system is protected from
corruption and violence (Smith & Forgione, 2007). In terms of social behavior, the local
residents perceptions about tourism in general and medical tourism in specific play a
primary role for attracting foreign patients. According to Smith and Forgione (2007),
20

foreign patients like to travel to destinations where they can feel welcomed by the local
community and travel around the countries without limitations. In terms of regulatory
standards, American patients often care about the regulations and laws of the host
country.

Figure 2.5: External factors (Source: Smith and Forgione, 2007)

The internal factors consist of:

costs,
accreditation
quality of care
physician training

The first factor is cost. According to Sarwar, et al (2012) cost is the most important factor
for medical tourist when planning for medical tourism. Cost is likely to be mostly and
importantly

considered. For

the

patients,

the

cost is the only

factor

for

preferring

medical tourism

and the current

healthcare cost

back in their

home. As the

American

21

cost of healthcare in the United States is excessively soaring, many employers together
with the insurance companies prefer medical tourism as an option in lowering healthcare
costs. The most important thing countries that are involved in medical tourism is that,
they offer premium medical services at significantly lower prices, which have become the
major motivation for the patients in traveling abroad for the intention of treatment.
Studies have found that the cost of surgery is 30% to 70% lower in the countries those are
promoting medical tourism than in the United States (Caballero et al., 2007).

Figure 2.6: Internal factors (Source: Smith and Forgione, 2007)

According to statistics the number of uninsured Americans in healthcare exceeded

46 million in 2005, which means that Americans who are not covered by a health
insurance plan will pay a significant amount of money to be medically treated, while
insured Americans have access to medical facilities with low fees (Insurance Information
Institute, 2007). However, despite this rapid growth in uninsured American patients, the

22

World Bank has outlined that the medical industry in the United States is excessively
expensive and higher than in any other country in the world. In Smith and Forgiones
(2007) study, the lower costs to medical services in developing countries are cited in as
due to lower labor costs, lower pharmaceutical costs and no malpractice insurance costs.
Other factors related to Palvias work (2007) are based on hospital accreditation
and quality of care. In this rapidly growing consumer oriented health industry, quality has
become the integral part. Without providing quality services, no business can survive.
People from rich countries are traveling to less developed countries because of less
expensive but high quality medical care (Sarwar, 2012). In the healthcare industry,
technical equipment and other related medical diagnoses systems is a core for patients
checkup for their treatment and functional quality is measured by the service offer by the
healthcare centers such as services of staffs, nurses, administrations and most importantly
the doctors towards the patient and their assistants. It has been found from different
healthcare researches that, patients mostly give priority to the functional quality rather
than the technical quality though the technical quality may not be satisfactory. However
according to Sarwar (2012) for the medical patients, the technical quality should be a
prime object because the proper treatment of patients largely depends upon the proper
diagnoses of the diseases. Service quality works as a bridge, which links within customer
and organization, thus shows the valuable exchange among them.
Likely the first thing that comes to any medical tourist mind is the qualifications
or reputation of the hospital to be having the treatment. Most American patients are more
attracted to hospitals that work with similar standards in the quality of care to the ones in
the United States. In many cases, hospitals in developing countries are equipped with

23

advanced technology and trained practitioners that exceed western standards and
expectations (Nicola PS & Hong PK, 2011). The World Bank has conducted a study that
clearly shows that healthcare quality in developing countries is above the minimum
acceptable standards in industrial countries (Matto & Rathindran, 2005). Accreditation is
crucial as it strengthens confidence in the quality of healthcare. This confidence increases
if accreditation is accompanied by an affiliation with prestigious hospitals or health care
systems in industrial countries. The intending medical tourist should check whether or not
a hospital is wholly accredited by an international accreditation group or at least with
local government system. Once healthcare providers are accredited and part of
international referral networks, they can be properly rated for risks and consequently,
helps in building confidence among the potential medical tourists (Sarwar, 2012).
Another factor and the last factor studied by Palvia (2007) is physician training. A
hospital without properly trained practitioners will not be as attractive as a medical
facility with skilled physicians for the American patients. Consequently, developing
countries provide incentive work opportunities within the medical industry given that
they attract international doctors, some of whom are trained in western hospitals. Now,
international medical facilities offer complex surgeries that compete with other facilities
in terms of costs and quality (Marlow & Sullivan, 2007). Despite this, however, hospitals
around the globe are attempting to enhance the communication technologies between
medical facilities in order to connect all trained physicians within one network. This plan
will help patients in their selection of whom they deem to be the most appropriate
physician to preside over their surgery (Smith & Forgione, 2007).

24

Other factors that can also contribute to the medical tourism are treatment types
and the availability of the treatment. According to Sarwar (2012), types and availability
of various types of treatments are also an important factor in selection on medical
tourism. Medical tourism is procedures that are routinely covered by health care benefits
knee replacement surgery and elective cosmetic surgery, cosmetic dentistry and
reproductive (in vitro fertilization). However, medical tourism is not limited to few
specific treatments as a wide range of treatments can be obtained through medical
tourism. Medical tourism involves a wide range of therapeutic treatments ranging from
various essential treatments to different sorts of traditional and alternative treatments.
Citizens of England and other European countries are traveling both within the European
Union and to Asia for various medical and surgical procedures, which are not available in
their home country. Certain types of surgery such as gender change or sex change is not
common in every country. Although United States and United Kingdom are developed
countries but it does not ensure that the type of treatment in their country is available or it
might be ethical wrong back in their country. Thus the factor of unavailability of a
particular treatment is also drives the medical tourism industry.

2.5Medical Tourism Stakeholders

Medical tourism stakeholders can be identified as serving multi-purposes such as
the promotion of medical services through the use of tourism facilities. By combining the
medical and tourism sectors and highlighting the area of overlap between the two sectors,
a clearer image of the medical tourism sector will be recognized, making it easier for

25

stakeholders to identify a medical tourism network for improving the medical tourism
sector. The definition of medical tourism network may vary from one country to another.
Therefore, having a single definition of network is becoming trickier (Lambier, 2009). In
2009, a meeting was organized by the Medical Tourism Association (MTA) to discuss the
development of medical tourism in developing countries such as Jordan, Turkey, Mexico
and Costa Rica. They all agree that the development of a medical and healthcare tourism
network (MHC) is vital for increasing the growth of medical tourism in the most efficient
way (Lambier, 2009). The medical tourism network contains four stages of evolution:
pre-network stage, the start-up stage, expansion stage and mature stage. The pre-network
stage represents all stakeholders such as hospitals, hotels, and facilitators, but no
collaborative efforts have taken place at this stage. The start-up stage represents
cooperative efforts among medical and tourism stakeholders for the purpose of achieving
mutual benefits. The expansion stage represents insurance companies, medical tourism
operators, educational institutions, and government bodies which participated in the
overall medical tourism network and which can be called a medical tourism network
(Lambier, 2009). Finally, in the mature stage, medical tourism stakeholders collaborate
among each other on a regular basis. For instance, Thailand has identified its medical
tourism stakeholders by developing a medical tourism network that is based on four
elements: suppliers, core activities, service providers and support players. The network
among medical tourism stakeholders has been expanded to include the support players
like the Medical Research Affiliations and Certification, which help private hospitals
obtain accreditation by international organizations such as the Joint Commission
International (JCI). Industry Professional Accreditation Groups can help local doctors

26

meet the minimum American and British standards and gain the relative accreditation.
Educational Institutions are considered important players when it comes to providing the
medical and tourism industry with a capable labor force. Ultimately, the last group of
players within this network is that of the government agencies, which includes the
ministries of tourism and health. Some researchers, however, realize that the network
among medical tourism stakeholders faces some challenges (Harryono, Huang,
Miyazawa, & Sethaput, 2006). First of all, having insurance companies play a part within
the medical tourism network will increase the cost of medical services for patients,
because private hospitals will be obligated to buy insurance to cover potential malpractice
issues. Second, in the network there is no a specific organization that directs medical
facilities for improving their medical services in order to target medical tourism market.
Therefore, private medical facilities have their own market campaign for promoting their
medical services without putting into the consideration how they are going to handle the
operation of medical tourism businesses. Therefore, private medical facilities should have
direct participations with the medical tourism network for collaborating with other
stakeholders such as medical institutions, tourism agencies, facilitators to conduct
medical

tourism

services

more

professionally. Also,

including

environmental

organizations within the medical tourism network (MTN) is crucial for private hospitals
to

convert

from

being

profit-focused

organizations

to

sustainability-focused

organizations. Hart and Milstein (2003) have proposed a framework for achieving a
sustainable value, meaning a value that provides environmental, social, and economic
outcomes.

27

2.6 Medical tourism in Malaysia

In the year 1997 the Asian financial crisis, most of the industries in Malaysia were
badly hit. Even the private health sector was not spared during this time. Many of the
businesses affected by the crisis either closed, downsized, or cut back on the range of
benefits for employees, resulting in healthcare benefits being reduced or removed.
Companies also cut benefits, or placed restrictions on healthcare spending per person and
choice of providers (Chee, 2009). This not only affected purchasing power for healthcare
and employer health benefits, but also caused utilization rates in private hospitals to drop,
plus the prices of imported pharmaceuticals, medical supplies, and medical equipment to
soar. Many of the patients had to opt for treatments from the public sector due to the
situation at that time. In the prevailing economic climate then, private hospitals could not
increase prices, and therefore, their operating margins and profits were badly affected. It
was downturn in private healthcare sector in Maldrdgraysia as many were struggling to
cope with the losses (Chee, 2009).
The 1997 Asian financial crisis was a turning point in Malaysia, where it signaled
the start of the medical tourism industry. The devaluation of ringgit Malaysia caused the
private hospitals to lose out in their revenue but in turn it was the best way to promote to
international market with respect with the treatment cost. The private hospitals started to
turn to international patients in order to compensate the excess capacity left during the
crisis. The private hospitals were equipped with the best technology and also with
expertise to make it attractive for international market for health tourist. Learning from
this cue, the government in January 1998 decided to start up the National Committee for
the Promotion of Medical and Health Tourism. This committee was placed under the

28

Ministry of Health (MOH) and was given three important functions which are to
formulate a strategic plan, to promote a strategic partnership between the government and
the stakeholders of the industry namely from the private sectors (healthcare facilities,
travel organizations, insurance agencies and to forge also partnerships with centers of
excellences in other countries such as the Mayo Clinic, John Hopkins University Medical
Center and Great Ormond Street Children Hospital (MOH,2010). The committee also
formed subcommittees whereby their task was to find and identify suitable target
countries for patients, develop tax incentives for the stakeholders, to come up with a fees
structure to make it more competitive with other countries, accreditation of the healthcare
service providers and promotion guidelines.
There are many factors which influence medical tourism. Among them are
modern medical facilities, quality internationally recognized professional, short waiting
time, political stability, low medical cost, infrastructural and lodging facilities and so on.
Two important factors make Malaysia a desirable choice for medical tourism: competitive
medical cost and modern sophisticated infrastructural facilities (Nicola and Hong, 2011).
For example, heart surgery in Malaysia costs within the range of RM 18,000 to RM
21,000 compared to the same in United States which costs about RM 60,000. Cost of
treatment in Western countries is usually high. This causes many of their citizens to seek
treatment in medical tourism destinations which offer a lower cost. Malaysia offers a
lower and competitive cost compared to United States and European countries as well as
other countries in the Asian region. The Asian countries which become competitors in
various low cost health services are Thailand and India. For example, Thailand offers
various health services, such as heart surgery to organ transplant, at a far lower cost than

29

in Western countries, whereby a patient who undergoes coronary artery bypass surgery in
Bangkok Hospital pays a total cost of about USD 12,000 (RM 37,908) compared to 10
times more or about USD 100,000 (RM 315,947) in his own country (Herrick, 2007).
Furthermore, overseas treatment also cuts down long waiting time for surgery due to the
system or procedure in their respective countries. Thus, they are inclined to choose
overseas treatment. The United Kingdom government is also beginning to encourage its
citizens to seek overseas medical treatment to avoid the long queue and for the lower cost
(Bookman and Bookman, 2007).
According to the industrial firm, Frost & Sullivan in International Medical Travel
Journal (2010), a medical tourist pays attention to three important matters when choosing
the destination for treatment: accredited doctor and nurse, easy access to hospital and
accommodation facilities. Malaysia has the advantages of all three factors. The study by
them shows that Malaysia has the added advantage of political stability. Furthermore, the
economic crisis has caused medical cost in Western countries to go up and many choose
treatment in Asian countries which can offer treatment and sophisticated infrastructure. In
some countries, the patient faces difficulty having to wait a long time for treatment with
limited choices thus leading them to choose treatment in Malaysia. Penang Island is the
main center for this sector, followed by Langkawi Island.

30

Figure 2.7: The Cost of Medical Procedures in Selected Countries (in US dollars)
Source: (Herrick, 2007)

Private hospitals have not generally been seen as ideal investment because it has
often taken up to 10 years before companies have seen any profits. However, with the
advent of medical tourism, the situation has now changed and hospitals are looking
forward to lure foreigners coming to Malaysia for medical care. Majority of private
hospital facilities are in urban areas and, unlike many of the public hospitals, are
equipped with the latest diagnostic, imaging facilities and western trained doctors are
generally to be attached with the hospitals (Quek, 2009). The number of private hospitals
is increasing yearly and providing more specialist treatment not to just cater the health
tourist but also the general public. There are currently more than 210 private hospitals
providing more than 10,000 beds (AHPM, 2012). The figures have increased
tremendously compared to only 50 private hospitals with 2,000 beds in 1980 (Cruez,
2008). The potential medical tourists are targeted from countries with inadequate medical
facilities within the South East Asia countries such as Indonesia, Myanmar, Vietnam and
Laos. Medical tourism in Malaysia is also targets medical tourist from Singapore, Japan
and Taiwan due to high cost of treatments or surgery procedure in their country. It offers
an alternative to the medical tourist in sense of cost and quality. Other factors that might

31

attract medical tourist to Malaysia are also with long waiting list for in their public
healthcare system and the expensive private healthcare system in their country such as
United Kingdom. Malaysia image as a Muslim country provides an advantage also in
promoting medical tourism among Muslim countries such from the Middle East
countries, Brunei and Bangladesh (Mujani et al., 2012).
Malaysia has gained reputation as one of the preferred locations for medical
tourism by virtue of its highly efficient medical staff and modern healthcare facilities.
The top medical tourism destinations are Malacca and Penang state. Both states garner
more than 70% of the medical tourism revenue for Malaysia followed by the Klang
Valley (23%) and Johor (3%) (Lek, 2004). Penang has the highest number of hospital
attracting medical tourists from Indonesia due its location nearer to the west coast of
Indonesia and traveling there is faster and cheaper than to travel to Jakarta.
Approximately 70% of the patients are from Indonesia and Singapore. The rest belong to
Australia, Bangladesh, China, New Zealand and Saudi Arabia. The European market is
attracted to Malaysia from wellness tourism perspective (Chee, 2007). A survey
conducted by APHM shows that in 2005, 232,161 foreign patients were treated in
Malaysian private hospitals, generating over RM 150.9 million in revenue. The year 2006
has attracted over 295,000 medical tourists to Malaysia. This figure has risen to 341,288
in 2007(Cruez, 2008). Number of medical tourist was 583, 000 in 2011 and 670,000 in
2012 respectively. This is a positive development in the medical tourism industry,
whereby it is said to have successfully generated financial returns of RM203.66 million
up to the year 2006. From 2001 to 2008, the number of outpatients increased threefold
while generating income of about RM 180 million in 2006. The medical tourism industry

32

was expected to generate as much as RM 540 million for the country in the year 2010
compared to RM 300 million in the year 2009. There is growing demand in healthcare
tourism in this region due to its value-for-money, high quality care and competitive
pricing (Chee, 2007)

2.7 Public Private Partnership (PPP) in Medical Tourism

In a general term, a partnership is an agreement between two or more parties.
However, most partnerships are more formal than merely a handshake or verbal
agreement, and require a written agreement that specifies the reciprocal rights and
obligations of each party, the objectives of the partnership, and how the partnership will
be managed or governed. Put simply, a partnership is a relationship based upon
agreements, reflecting mutual responsibilities in furtherance of shared interests. Two
elements of this definition are critical: one is the specification of the shared interests or
objectives of the partnership. Partnerships only work when both parties benefit from the
relationship and the expected benefits are made clear in advance. A second key element is
the mutual responsibilities. Partners must understand that they will share both the risks
and the benefits of any joint venture, and how this sharing will occur must also be
specified in advance.
Public Private Partnership (PPP) is a strategic partnership alliance between the
government and also the private sector to carry out or joint together to execute projects
deemed useful for the public and also for the private sector (Marc Mithcell, 2007).
According to Johannes Jtting (1999) the increasing interest in the potentials of a publicprivate-partnership (PPP) in developed as well as in developing countries can be mainly

33

explained by three factors. First, due to fiscal pressures governments have to reallocate
resources with the utmost effectiveness. Important projects or services to the country at
times are impossible to be implemented by the government of the day for the benefits of
the people of the country during economic turmoil. Financial situations at time of a
country will not permit the government to carry put the necessary projects. Lacking of
financial inputs or the risk to be taken might be catastrophic in long run if a project turns
out to be a failure. Secondly, private providers both non-profit or for profit oriented play
an important role in social service provision a role which has been largely neglected by
governments. Third, given the intrinsic different strengths and public infrastructure and
services both play a huge part in any modern society. PPP is a globally accepted public
sector procurement mechanism whereby the government engages commitment from
private sector and transfers a certain level of responsibilities to the private sector in
providing public facilities or services. The fundamental justifications for adopting PPP
are claimed to be that PPP would significantly reduce upfront costs of for the government
in providing and maintaining public facilities and it allows improvement in the public
facilities and services as PPP encourages innovation by the private sector (Suhaiza Ismail,
2013).

The

Public Private Partnerships (PPP) is formally defined in the Ninth Malaysia Plan report
(2006) as: the transfer to the private sector the responsibility to finance and manage a
package of capital investment and services including the construction, management,
maintenance, refurbishment and replacement of the public sector assets which creates a
standalone business. The private sector will create the asset and deliver a service to the
public sector client. In return, the private sector will receive payment commensurate with

34

the levels, quality and timeliness of the service provision throughout the concession
period. During the past private and public sector were completely independent, but today
that world does not exist. According to Marc Mitchell, (2009), there is probably no
country in which the private sector is not deeply affected by government regulations and
laws, by policies on practice and pharmaceuticals, and increasingly by government
funding of private services. Similarly, almost all governments today rely on the private
sector for pharmaceuticals and equipment, and increasingly contract with private (often
not-for-profit) organizations for training, IEC development, and often for direct service
delivery in areas where the government does not provide services. The author also
stressed that as the government programs move toward social insurance programs and
contracting mechanisms as ways to expand coverage, the interdependence of the public
and private sectors has deepened. The interdependence has also made each sector
understand how cooperation and partnership might be mutually beneficial despite the
effort that is required to maintain the relationship. Although many governments and
private organizations find the need for trust and transparency difficult, they also
recognize that their interdependence must lead to an environment of mutual cooperation.
Medical Tourism is an inevitable emerging industry and it is the fastest growing
healthcare service industry worldwide (Carrerra, 2007). According to Medhekar (2011)
the growth of the medical tourism phenomenon is based on two factors which is the
number of foreign medical tourist travelling and the amount of revenue they generate in
terms of foreign exchange. Medical tourism can play an important role in improving a
countrys balance of payment position and foreign exchange reserve position. The growth
of medical tourism can also be seen as an opportunity for regional innovation,

35

regeneration rejuvenation for economic development and growth in developing countries.

Using medical tourism as an export led growth strategy, many socio-economic challenges
and problems faced by developing countries can be resolved.
Public Private Partnership (PPP) provides a mechanism that it ensures that
sustainability in the medical tourism industry is able to be achieved in the long run. It
provides the platform for a strategic partnership between the government and the private
sector to work together in medical tourism industry. The medical tourism involves more
of the private sector not only in terms of healthcare services but also the tourism sector in
terms of accommodation (hotel). The role of government is largely on the regulations
side for example in providing a medical visa for the health tourist. Sustainable PPP in
medical tourism involves the sharing of responsibilities, planning, accreditation of
medical facilities and qualifications, service quality, product innovation, promotion,
packaging, trade expos and marketing, undertaking financial risks, insurance
accountability and implementing various health and medical packages (Medhekar 2011).
In Malaysia the context of PPP is more prevalent in the infrastructure or the
service industry in terms of construction, procurement activities or privatizing the service
sector. Malaysia healthcare system is a two tier system whereby the medical tourism is
more on the private and not related the public healthcare system. It is solely under the
private healthcare in terms of providing service. Nevertheless realizing the importance of
medical tourism, the government is working closely with the private sector to implement
strategic plans for the sustainability of the medical tourism industry. It is impossible
without the cooperation of the private sector in the medical tourism industry is able to
move forward. The government has outlined certain incentives for the betterment of the

36

industry such as providing tax relief and also setting up an agency under Ministry of
Health to monitor and collaborate with the stakeholders of the medical tourism industry.
PPP will enhance the competitive advantage of the medical tourism industry. It
will provide viable and alternative efficient and effective delivery of healthcare and
medical tourism infrastructure facilities and value for money medical treatment to not
only the foreign patients, but also to the local community, through collaborations and
partnership between the various stake key stakeholders from medical tourist and the
service providers (private and government sector) (Medhekar, 2011).

2.8 Healthcare System in Malaysia

Malaysia healthcare spans from the British colonization time where the first
hospital was built in Taiping in 1880s. The demographic of building the hospitals were
then more concentrated on areas focused on tin mining industry (MOH, 2010). This was
the first introduction of western based healthcare system and the essence of it is still
being practice especially in commonwealth countries. Before independence the practice
pre-colonial medical care was confined to traditional remedies current among local
populations of Malays, Chinese and other ethnic groups. This practice is still continued
until today and even offered at the some hospitals in Malaysia. Over the years the
healthcare system in Malaysia has evolved in accordance with time and also the needs of
the people in general. The current Malaysia healthcare system is operated based on a twotier health care system consisting of both government healthcare system and also the coexisting private healthcare system (David Kl Quek, 2009). The public healthcare system
is fully funded by the government where the allocation of the budget is being done every

37

year. The public healthcare system encompasses from the infrastructure such as the
general hospitals in major cities, district hospitals and also rural clinics. Some of these
facilities predate back before independence and the cost of managing of this hospitals are
fully taken by the government. The ministry responsible of healthcare is the ministry of
health and its under the prerogative of the minister of health. The workforces of the
public health system are employed under the government such as the doctors, nurses and
allied health personnel.
In Malaysia the fresh graduate doctors are required to serve the government for at
least 3 years during their houseman ship. This is to ensure the doctors are fully trained
and aware of the Malaysian healthcare system. However, Malaysian medical officers and
specialists above the age of 45 and working abroad have been exempted from this rule as
an incentive to attract more them to return back and serve the country. Foreign doctors
are encouraged to apply for employment in Malaysia, especially if they are qualified to a
higher level. The need of the medical staff is based on the location and also size of the
population based on the districts and also states. (David Kl Quek, 2009). Patients are only
needed to pay a nominal sum for their outpatient treatment or hospitalization. Every state
in the country will have its own hospitals. There is still, however, a significant shortage in
the medical workforce, especially of highly trained specialists. Thus certain medical care
and treatment are available only in large cities. Recent efforts to bring many facilities to
other towns have been hampered by lack of expertise to run the available equipment. As a
result certain medical care and treatment is available only in large cities.
Various health related training colleges are established by the government to
provide sufficient allied staff to the respective hospitals. For example the first nursing

38

training college was Penang Nursing College, established back in 1947. Today the private
college offers also the same courses that were used to be only available in government
related health colleges. The number of private universities in Malaysia offering medical
and dentistry programs have increased in the early 2000. At the moment it is estimated
there are 10 private university offering medical programs. The Malaysian government has
allocated RM 10,276 million for health services according to the Ninth Malaysia Plan
report (9MP), a 7% increase over the previous plan. It has plans to improve the condition
of its existing hospitals in order to cope up with the rising and aging population. Over the
last couple of years they have increased their efforts to overhaul the systems and attract
more foreign investment. Various departments are based under the health ministry in
terms of public health management, disease control and also research centers. The
established research centers such as Institute for Medical Research (IMR) in Kuala
Lumpur was also a part of the government needs in to have a proper healthcare facility
that accommodate all the basic needs of the people in the country.

39

Figure 2.8: Outline of the two tier healthcare system in Malaysia

(Source: Rozita, MOH, 2011)

The private sector of healthcare is more concentrated in providing specialist

treatment compared to outpatient treatment. Nevertheless the existence of clinics to
provide is still there since from the older days. Malaysia private hospitals are focused on
providing specialist care and most of specialists are largely based in private specialist
centre. The majorities of private hospitals are in the urban areas and unlike many of the
public hospitals are equipped with the latest diagnostic and imaging facilities. Private
hospitals have not generally been seen as an ideal investment as it has often taken up to
ten years before companies have seen any profits. However, the situation has now
changed and companies are now exploring this area again, corresponding with the
increased number of foreigners entering Malaysia for medical care and the recent
government focus on developing the health tourism industry (Chee, 2007).
The Government has also been trying to promote Malaysia as a health care
destination, regionally and internationally. Healthcare industry players such as the stateowned KPJ group (Johor State Development Board), Parkway Holdings (Singaporebased, American-invested), and latterly Khazanah National Berhad (a Ministry of Finance
Malaysian GLC) have greatly influenced the direction and expansion of these private
services, while at the same time inflating the cost of private health care services by
offering more sophisticated amenities and newer technology driven expert care (Nambiar,
2009).

40

One of the major issues related with healthcare for any developed country or
developing country is the escalating cost per year that has to be absorbed by the
government or from the society. The needs for a better facility plus manpower whether
from the public or private sector are the issues that need to be attained. The concept of
public private partnership in healthcare system is an ideal way of going forward for the
benefit of both parties namely the government and also the private sector. The
participation of private sector in healthcare dates back in 20 years time. According to Dr.
David KL Quek the past president of Malaysia Medical Association (MMA), there have
been efforts of privatizing and the successful attempts of various components of the
public health sector. One of the examples is Pharamaniaga. It is responsible for the
government drug procurement and distribution to all the government based hospitals and
clinics. Apart from that the support service which is the cleaning, waste management and
equipment maintenance has also been contracted out to private companies such Medivest
and Faber Medicare.
In the economic transformation program ETP outlined by the government, it is
stated that the healthcare industry is capable to generate a RM35.3 billion incremental
gross national income from the sector between 2010 and 2020 (ETP Annual Report,
2011). The government is set to change the healthcare sector from a social service and to
a private driven section driven for economic growth. One of the subsector which has been
identified as a key driver of this growth is the medical tourism industry (Chee, 2009).

2.9 Public Private Partnership in Malaysia

41

Public Private Partnership (PPP) in Malaysia starts years back with the important
component of the Malaysian Incorporated concept, a development approach introduced in
1981 (Nambiar,2009). Through this policy both parties depend on each other; where the
private sector upholds the commercial and economic activities, while the public sector
draws up major policies, identify the direction and provides the specialized supporting
services which are conducive to the success of businesses (ERIA Report, 2009). In 1983
the Privatization Policy was launched to support the Malaysia Incorporated Policy
towards increasing the private sector's role in the country's economic development. The
main objective of this policy is to lessen the financial and administrative burden of the
Government, improve skills and production, accelerate economic growth, reduce the size
and involvement of the public sector in the economy, and to assist in reaching the
country's economic policy's goal. This policy was subsequently replaced by the
Privatization Masterplan in 1991. The Masterplan contains an overall policy framework
for privatization which outlines its objectives, models, guidelines on asset and equity
valuation, staffing and ownership structure as well as changes to relevant laws and
regulations (ERIA Report, 2009).

Figure 2.9: Timeline of PPP in Malaysia (Source from PricewaterCoopers, 2007)

In March 2006 the Private Finance Initiatives (PFI) programme was announced in
the Ninth Malaysia Plan, aimed at facilitating greater participation of the private sector to
improve the delivery of infrastructure facilities and public service (PPP Guideline Book,
42

2009). It sets out many of the key principles on how some of the public sector
infrastructure projects will be procured and implemented. PFI will be undertaken as part
of the new modes of procurement under the Public Private Partnerships (PPP) to further
enhance private sector participation in economic development (Ninth Malaysia Plan,
2006). In the light of further refinement to the partnership concept, the Government has
introduced a new guideline in 2009 entitled PPP Guideline. This Guideline complements
the Privatization Masterplan, particularly for projects where a Government entity is the
paying party. Under the Ninth Malaysia plan, the government officially announced the
implementation of public projects using the Public Private Partnership (PPP) or Private
Finance Initiative (PFI) scheme. In the Tenth Malaysia Plan, the persistent continuous
effort of the Malaysian government in promoting private sector involvement was revealed
with the announcement of more development projects to be implemented using the PPP
scheme (Tenth Malaysia Plan, 2010). Malaysia adopts a centralized approach in the
implementation of the PPP program, whereby 3P Unit (3PU) or Unit Kerjasama Awam
Swasta (UKAS) a dedicated unit under the Prime Ministers Department, is entrusted
with the responsibility of spearheading the development and execution of PPP projects.

43

Figure 2.10: Typical PPP structure (Source: Public Private Partnership Guideline, 2009)

2.10 Role & Models of Public Private Partnership (PPP)

The role of Public Private Partnership (PPP) in developing countries such as
Malaysia is currently being used in sectors such healthcare, infrastructure and also
education. PPP have become an accepted norm in delivering public infrastructure or
services in Malaysia since the Privatization Plan back in 1980s (Suhaiza, 2007). PPP is
not new approach being practiced in Malaysia. Countries such Hong Kong, United
Kingdom, Singapore and Australia are among the countries that are have been successful
in implementing PPP in various industries in their country. The concept of PPP existed
way back in 1983 when Tun Dr. Mahathir then the prime minster of Malaysia started to
privatize some of the government agencies and also the healthcare industry. The
privatization of the medical procurement division and also the National Heart Centre
(IJN) pave the way in late 1980s for the involvement of private industry in the
government day to day activities (Ismail and Rashid, 2007).
The main objective of PPP in Malaysia is to revise and improve the
implementation process of the existing privatization policy (Ninth Malaysia Plan, 2006
and Tenth Malaysia plan, 2010). PPP will be employed for infrastructure and service
development projects that meet two conditions. First, the implementation of PPP must be

44

able to make government projects more efficient where the risks and rewards are
optimally shared between the two parties. Second, PPP is to be used where government
support enhances the viability of the private sector projects in strategic or promoted
areas .The five year development plan, with a total expected investment of RM230 billion
aims to increase private sector participation in the Malaysian economy through a variety
of means including public-private partnerships (Ninth Malaysia Plan, 2006). This proves
that Malaysia government emphasis PPP for economy development and sustainability.
Hence the effective risk allocation strategies and framework of PPP projects should be
established and developed to achieve a more efficient process of contract negotiation.
PPP in Malaysia is defined broadly as an arrangement where the private sector
provides services and invests in infrastructure assets which would traditionally have been
undertaken by the Government. At the core of this arrangement there is an optimal risk
sharing among the parties involved, mutually pre agreed performance parameters that
govern the conduct of the business and a definite duration for the service concession.
Another important characteristic is the continuing interest of the Government, directly in
the form of an equity holding or indirectly in the form of operational oversight in the
projects. These features differentiate PPP projects from the privatization model, whereby
Government no longer has control or interest in the entity. Since the introduction of the
PPP approach in 1983, more than 500 projects have been implemented using PPP /
Privatization approach. These projects cut across a variety of sectors, such as transport,
highways, communication, health, energy and utilities, education and training and general
administration. Given the differences in output specifications, risk appetite, payment

45

structure and a host of other factors, four distinct PPP models have been adopted (ERIA
Report, 2009). These are:
a. Concession Model: This model is used for highways/ bridges and it is normally
structured on the BOT (Build Operate, Transfer) concept.
b. Accommodation Model: This is used for administrative complexes, teaching hospitals
and university branch campus projects. The model is typically structured on the BLMT
approach. Recently, Government has introduced the BLMOT (Build, Lease, Operate,
Maintain and Transfer) approach for this model too.
c. Process Plant Model: This particular model is being used for power generating
projects. It is structured with two forms of payment, a fixed capacity payment and a
utilization payment.
d. Usage Model: This model is suitable for projects with high risk of technology
obsolescence where Government is not planning to take ownership of the underlying
asset upon the expiry of the contract, such as for services in sophisticated medical
facilities. Investment is recouped from charges imposed on the utilization of the facilities
by the ultimate users, i.e. user charges. By using PPP model it enables governments to
utilize alternative private sector sources of finance while simultaneously gaining the
benefits that the private sector can bring in terms of skills and resources. The type of
partnership is useful for counties that are already stretched for resources during uncertain
economic climate. The speed, efficient and cost effective delivery of proposed project or
service industry is made better. To date the PPP model has been applied in a wide range
of public projects, such as development of administrative complexes, university
campuses (including student residential buildings), hospitals, highways and bridges,

46

integrated transport terminals, port facilities, medical equipment and supplies, solid-waste
treatment and public cleansing, power generation, and a guest worker monitoring
system.

Figure 2.11: Models of PPP (Source: ERIA report, 2009)

2.11 Public Private Partnership (PPP) in Malaysia Healthcare System

According to Blanken and Dewulf(2009),

governments

are

increasingly looking for ways to cope simultaneously with both booming health
care

costs

and

decreasing

governmental budgets and publicprivate

partnership

arrangements have emerged as one mechanism to manage this set of problems. The
discussion of a new public management also had an impact on health policy debates in

47

developed as well as in developing countries. The specific term used here is contracting
out meaning the outsourcing of activities former done by the public sector to the private
sector. The private sector is not under the direct control of the government and it can
function according to a different set of objectives and norms. Private providers can
choose which services to provide, determine their own levels of quality, mix of inputs and
costs (Berman, 1997). Two lines of argumentation why contracting out improves health
care systems are used (WHO 1998):

Economic: the replacement of direct, hierarchical management structure by

contractual relationships between purchasers and providers will increase
transparency of prices, quantity and quality as well as competition which will lead
to a gain in efficiency.

Political: In the context of welfare systems reform worldwide, decentralization of

services from the national to the local level is frequently suggested in conjunction
with an improved participation of the population in determining and
implementing the services. The PPP application in healthcare sector is gaining
importance in recent years. Over the years the cost of healthcare is rising and
governments of developed and developing countries are faced with at times fiscal
constraints that force them to reduce expenditure. Other factors such as the
increase in ageing population and outbreak of certain diseases will further put the
strain on the expenditure. In the past, the private and public sectors in health
operated more or less independently in most countries. The theory was that the
private sector provided services mostly to the wealthy in any country, while the
government served the poor who were unable to pay for services.

48

Figure
2.12:

Conceptual Framework of PPP in healthcare sector

49

(Source: Johannes Jtting, 1999)

The role of private health sector in Malaysia is something that is not new.
Malaysia has always had private healthcare during colonial times prior to independence.
The private healthcare can be considered as the engine of growth and in future greater
integration and synergism is expected between government and the private health care
sector. Its undeniable that the government healthcare delivery system has been stronger
than private healthcare sector.
The idea of public private partnership in healthcare in Malaysia existed back in
1960s and 1970s. Traditional Birth Attendants (TBA) were preferred during that time by
the public and in order them to recognize the public preferences at that time, government
decided to carry out certain steps to ensure that maternal and child safety at the time of
delivery (Rozita, 2007). Among the step taken is by registration of TBAs and providing
proper training to the TBAs. The TBAs are required to attend monthly meetings with
public sectors. The TBAs are also provided with sterile midwifery kits and medicines
which can be obtained at the health centers for free. At present there a lot steps are taken
by the government and also the private in order to provide the public sector the best
healthcare services. One of the fields that the government is focusing is the medical
tourism industry. The medical tourism industry enables the health sector service to be
exported to the tourist that comes over to Malaysia.
The government has long been the provider for health services in Malaysia. In the
pre-privatization era, the government engaged itself in the entire of healthcare, from
public health to preventive medicines and including curative and rehabilitative care. The
first part of privatization occurred in the early 1990s, when the government decided to

50

privatize non-medical services only, excluding core medical functions and services. In
1994, the Ministry of Health (MOH) divested its pharmaceutical store and services,
which was followed by the outsourcing of hospital support services in 1996 and the
privatization of health examination of foreign workers in 1997. The privatization of the
health support services in Malaysia was part of the larger attempt to launch privatization
in the health sector and to liberalize the sector. The objective, ostensibly, was to improve
economic efficiency in the health sector. These developments also coincided with the
Ministry of Health's plan to privatize clinical waste management services since public
hospitals did not appear to have adequate facilities. Two factors were for the attention of
the government: the increasing costs of providing medical care, and the burden of
providing a wide range of services for the public in connection with administrative,
support, medical and preventive services. The government's responses to these problems
were twofold. First, it decided to concentrate on its core health services and privatize
other activities within the health sector. Second, the government was convinced that it
would continue maintaining its commitment to civil servants and the deprived. In
consonance with these views, the government chose to privatize non-core activities and
to liberalize the health sector. The latter implied that the private sector was encouraged to
provide health care (which would lead to the opening of private hospitals) to cater to
those who could afford more expensive health care and medical treatment.
The following are some of the key areas that were privatized by the Ministry of Health
(MOH):
i. Supply of pharmaceutical services;
ii. Supply of hospital support services;

51

iii. Monitoring and consultancy services; and

iv. Monitoring and supervision of foreign workers health certification.
The supply of pharmaceutical services was contracted to Pharmaniaga Logistics, a
private limited company. Pharmaniaga received a concession period of 15 years, and it
was agreed that the government would make purchases from Pharmaniaga at an agreed
price that would be re-negotiated every two years. The supply of hospital support services
was contracted to two private limited companies, Pantai Medivest and Faber Mediserve.
The concession period for these companies was 15 years with the government purchasing
the supply of hospital support services at an agreed price. The supply of monitoring and
consultancy services was contracted out to SIHAT for a concession period of 5 years. The
monitoring and supervision of the health certification of foreign workers was privatized
to FOMEMA and regulated by the Disease Control Division and the Ministry of Health.
Financing in this case was borne entirely by foreign workers.

2.12 The Public Private Partnership (PPP) roles in medical tourism

The government of Malaysia realized the huge potential of medical tourism
industry. The medical tourism is mainly under the private healthcare providers. Therefore
steps were taken to ensure the participation of the government and the private sector was
fruitful. The medical tourism industry requires synergistic action from both parties and a
public private partnership (PPP) entity was important in due course. Although the
government and the private sector have contributed together in healthcare and tourism
industry in the past but the complexity of the medical tourism requires a more strategic
planning. The initial work of setting up medical tourism started back in the year 1998

52

with formation of National Committee for the Promotion of Medical and Health Tourism
(Mujani et al., 2012). This small unit then was expanded in the year 2009 where the
government started the Malaysian Healthcare Travel Council MHTC, a government
agency under Ministry of Health (MOH) to overlook the medical tourism with
involvement of private sector.

2.12.1 Malaysian Healthcare Travel Council (MHTC)

In the year 2005, the government under ministry of health started a small unit
known as to promote medical tourism after the recommendations done by the National
Committee for the Promotion of Medical and Health Tourism. This small unit later
became an agency that will be responsible to promote medical tourism effectively
between the government and stakeholders. The government acknowledged the need to
have a proper functional unit coordinate the activities related to medical tourism (MHTC,
2012). On the 3rd of July in 2009 with the approval of the Malaysian Cabinet, the
government decided to form Malaysian Healthcare Travel Council (MHTC) directly
under MOH. MHTC was established to serve as link and also streamline travel service
providers and industry players in both private and government sectors so as to drive the
industry to greater heights. The MHTC reports to an Advisory Committee chaired by the
Minister of Health and co-chaired by the Minister in the Prime Minister's Department
heading the Economic Planning Unit (EPU). Members of the Committee are appointed
from representatives of the government and the private sector involved in healthcare and
the tourism industry. The committee is responsible for advising on policy issues and
setting directions for the healthcare travel industry.

53

Figure 2.13: Malaysian Healthcare Travel Council Logo (Source: MHTC, 2013)
The core of MHTC was to establish to link and facilitate the public private
partnership in medical tourism in issues affecting the industry as whole. With this council
it is able to streamline both parties and actively plan and promote the medical tourism
industry globally. The strategies undertaken by MHTC are making development of
strategic planning and programs with the stakeholders of the industry. Among the
stakeholders who contribute to actively to the council are The Association of Private
Hospitals of Malaysia (APHM), Malaysia External Trade Development Corporation
(MATRADE), Malaysian Investment Development Authority (MIDA), Tourism Malaysia
and Malaysian Dental Association (MDA). The mentioned bodies will work together with
agency to create strategic plans and also execute them in making the industry more viable
player in the internationally market. Promotion is one of the core effective in marketing
the medical tourism of Malaysia to the international world and with this MHTC also
coordinates the promotional activities in Malaysia and globally. Realizing the medical
tourism is more private driven MHTC acts also as the nodal point on the developing the
policies and also program with involvement of the government agencies. Realizing that
the medical tourism is still a new industry, MHTC also organizes training programs and
workshops. This workshop brings experts from the industry for that prospective

54

companies or individuals whether local or foreign learn more about the prospects of
medical tourism in Malaysia. With the number of private hospitals are on the rise, MHTC
also makes ensures only certain hospitals which have the necessary credentials and
expertise are considered for the medical tourism package. This is to ensure the industry
is not affected by negative perceptions.
In a nutshell the government of Malaysia realized the huge potential of the
medical tourism market and the establishment of MHTC was one of the core incentives in
helping to ensure the private public partnership in making the industry successful in
Malaysia.

2.12.2 malaysiahealthcare.com
One of the most powerful marketing strategies in medical tourism is the usage of
internet. Increased access to information via the internet and international media has
nourished a global mindset and this eventually created awareness in the medical tourism
(Sarwar et al., 2012). In the past people tend to settle for the nearest clinic or hospitals
when it is required in their own country. The patient mobility was between states within
the country to the maximum and only the well to do can afford to gain treatment in other
countries. Today there are more people who are willing to seek treatment beyond their
countries (Bookman and Bookman, 2007). With the usage of internet the necessary
information pertaining as the health matters and prices of the treatment can be compared.
It provides a platform for the patients to access information regardless in which part of
the world they are. Realizing this is one of the core promotion strategies the government
of Malaysia created a website known as www.malaysiahealthcare.com. This website

55

serves as focal point which serves information on health tourism destination centre for all
medical needs and tourism. It brings the entire service provider on this platform and
channels the information to facilitate all aspects of medical tourism linking prospective
tourist with all related agencies in Malaysia. Information such as hospitals, health service
providers, insurance agents, flight information, hotels and so on can be obtained in the
website. It provides and enables the health tourist to plan, arrange and manage matters
related to complete treatment and vacation package in Malaysia from their own home.
Apart from making a selection on the hospital in Malaysia, a potential medical tourist can
also inquire the respective doctors or specialist via online for the required treatment
regarding procedure and advice on the available treatment. This will indirectly help to
foster a better perception on the quality of healthcare and at the same time obtain a
comprehensive package to medical tourist from healing to recreation process. The
website was launched in the year 2007 by the Tourism ministry in line with the visit
Malaysia year 2007. Until now the website still functions as the information channel to
health tourist planning to come to Malaysia. The website shows another incentive taken
by the government in pursuing it aim to succeed in medical tourism industry with the
help of the private sectors.

2.12.3 Tax incentives

The government of Malaysia is committed to promote Malaysia as a medical
healthcare tourism destination and aims to attract more than 1.9 million health tourists to
Malaysia by 2020 (MHTC,2011). The government also realizes this figures can only be
achieved by the active participation of the private sectors that are keen in medical tourism

56

industry. Medical tourism business means a huge initial investment, especially in

facilities and equipment. State-of-art technology, visually appealing exteriors and
interiors, add-on facilities such as restaurants, prayer rooms, kids playing area and so on,
have become a norm to attract medical tourists. User-friendly software to present a
globally accepted output format of electronic medical records adds up to the sunk costs
(Chee, 2010). To attract the potential and existing stakeholders in the healthcare industry
the government had announced tax incentives in the form tax relief. It encourages new
players to come into the industry. Private hospitals that are interested to open their doors
to medical tourism business are encouraged to apply to the tax incentives offered by the
government. However these hospitals must be registered with MOH and also the AHPM.
In the budget 2012 tabled by the Prime Minister, Dato Seri Najib Tun
Razak announced several tax incentives to healthcare service providers. The tax
incentives are income tax exemption of 50% on the value of increased exports will be
increased to 100% (10th Malaysian Plan, 2011). This step will encourage the healthcare
service providers to offer high quality services and attract more health tourists. In the year
2011 the health minister then Dato Seri Liow Tiong Lai had announced that tax
exemptions also will be granted to private hospitals that have received accreditation from
the Joint Commission International (JCI), the Malaysian Society for Quality of Health
(MSQH) and ISO (New Straits Times, 2011). Any healthcare service providers wishing to
build new hospitals, refurbishing and modernizing or expand their current facilities in
order to promote medical tourism will also be given tax reliefs as announced in the
budget. International unit patients in these hospitals also qualify for this tax incentive.
The tax incentive is up until December 31st 2014. This move was important to promote

57

the increase of the number of beds and facilities to achieve the target of nearly 2 million
health tourist to Malaysia by the year 2020. This also will make Malaysia to have a
competitive advantage to other competitors such Singapore and Thailand in terms of
facilities and number of service provider. This is because the cost can be lowered down
further as tax incentives will provide a relief in their income.

2.12.4 International Accreditation

In this rapidly growing medical tourism industry, quality has become an integral
part. Without providing quality services no business can survive. In medical tourism
industry, people from rich countries travel to less developed countries because of less
expensive but high quality medical care. Quality in the healthcare sector focuses on the
technical and serviceable or functional quality. In the healthcare industry, technical
equipments and other related medical diagnoses systems is core for patients checkup for
their treatment and functional quality measured by the service offer by the healthcare
centers such as services of staffs, nurses, administrations and most importantly the
doctors towards the patient and their assistants (Nicola et al., 2011). It has been found
from different healthcare researches that, patients mostly give priority to the functional
quality rather than the technical quality though the technical quality may not be
satisfactory. However, for the medical patient, the technical quality should be a prime
object because the proper treatment of patients largely depends upon the proper diagnoses
of the diseases. Service quality works as a bridge, which hangs within customer, and
organization, thus, shows the valuable exchange among them (Sarwar et. al, 2013).
Understanding of the customers requirements has become necessity as this helps the

58

practitioners in developing new approaches to provide improved service quality. The

service quality in healthcare industry is a vital part for attracting customer as in the
medical tourism and also the healthcare generally. Patient perceptions are measured
through the quality of services provided by a healthcare centre. Delivering quality
services to the customers is necessary in order to meet customers perception.
Many countries such as Singapore and Thailand promote medical tourism by
promoting their standard or accreditation obtained by the healthcare providers as a tool
for marketing. The government of Malaysia strongly encourages the private healthcare
sectors to obtain domestic or international recognition in providing their service. The
quality of the healthcare service is common question especially in the private sector and
also for potential health tourist travelling thousands of miles to come for treatments or
surgery procedure.
In Malaysia there nearly 220 private hospitals and they are required to be
registered with The Association of Private Hospitals of Malaysia (APHM). This is an
association representing private hospitals and medical centers in Malaysia and has been
in existence since 1972. APHM member hospitals are key partners with the public sector
healthcare providers in bringing comprehensive medical care to all Malaysians through
its member hospitals. In Malaysia, all private medical centers are approved and licensed
by the Ministry of Health (MOH). APHM plays the link between the private hospitals and
the MOH.
Many of the private medical centers have achieved certification for internationally
recognized quality standards. The types of accreditation are awarded by Joint
Commission International (JCI), the Malaysian Society for Quality of Health (MSQH)

59

and International Society for Quality in Healthcare (ISQua). The JCI is an international
body that is well known all over the world and the follow an international standard to
ensure patient safety and quality of care. JCI is accredited by the International Society for
Quality in Health Care (ISQua). Accreditation by ISQua provides assurance that the
standards, training and processes used by JCI to survey the performance of health care
organizations meet the highest international benchmarks for accreditation entities. JCI
accreditations are well-known globally and being accredited by this association is a
positive sign to attract foreign tourists especially from Europe and America (AHPM,
2012). As of middle of year 2012, there eight hospitals in Malaysia with JCI accreditation
namely Gleneagles Hospital (Penang), National Heart Institut (IJN), Adventist Hospital
(Penang) and Sime Darby Medical Centre (Selangor) (MHTC, 2013). 85 private hospitals
and facilities have also obtained accreditations from MSQH as the same time.
The government is striving hard to encourage more private healthcare providers to
go for accreditations and also have given tax relief for eligible healthcare providers
whom have spent money to obtain the accreditations. Affiliation with world renowned
healthcare centers such as the MAYO Clinics, Johns Hopkins University Medical Centre,
and Great Ormond Street Childrens Hospital is also considered a quality assurance step.
Bringing in foreign patients was even used, or at least expressed, as the reason for
efforts to benchmark the corporatized teaching hospital, University Malaya Medical
Centre, to medical institutions in Australia, New Zealand, and the United States (The
Star, 2004).

2.12.5 Promotions

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According to Sarwar (2013) in his study stated that low cost compiled with other
factors such as technological capability, governments inventiveness and promotional
campaigns in developing healthcare facilities and qualified workforce coupled with the
natural resources like beaches, greens have built the confidence of many from the
developed countries to visit foreign locations for medical procedures. In another study on
marketing in health tourism by Yang (2013) purposed that marketing of medical tourism
should be in line with the promotion of national brand image internationally, in addition
to the cooperation of medical institutes and travel agencies. Tourism industry is
considered as the major dimension to reflect the national brand, as the product
characteristics and positive image in tourism industry would result in considerable
benefits. What attracts medical tourist to Malaysia is how the rest and healing time can be
spent there. The medical tourist or the patient with their guest shave the opportunity to
sightseeing and enjoy tourist activities during the healing period.
The Malaysia government has appointed MHTC to coordinate its promotions
locally and overseas with the help of other government agencies such as the MATRADE.
MHTC is tasked with the responsibility to formulate strategic plans for promotion of
healthcare travel services such as to brand Malaysia brand in medical tourism
internationally. Every year since the establishment of MHTC, an expo titled Malaysia
Travel Expo is held annually to promote medical tourism (MHTC, 2012). To further
promote Malaysia medical tourism offering abroad MHTC opened new offices in Dhaka,
Bangladesh and Jakarta, Indonesia in the year 2012 (The Edge, 2013). MHTC also plans
to open another branch in Hong Kong to increase the marketing activities.

61

Apart from that MHTC also have their own call center known as MHTC Care line
which is dedicated to answer questions all over the world. The call centre is based in
Kuala Lumpur. MHTC also are in the pipeline to establish a Medical gallery and Medical
Concierge in Kuala Lumpur International Airport (KLIA). The main purpose is to
disseminate and facilitate healthcare services information as well as questions pertaining
to transportation, accommodation and travel within Malaysia. A team of dedicated
medical personnel will assist and facilitate all medical travel inquiries from providing
information pertaining to treatment centers to certified doctors, treatment available and
even up to assisting with the appointment requests with participating hospitals. It gives
much assurance to the medical tourist and providing easy access to all their medical
tourism enquiries for a comfortable and fruitful stay in Malaysia. Currently the MHTC
promotions have been fully funded by the government. The method of promotion is by
attending international exhibitions in various countries and also by using the internet.
Among the potential markets that have been identified by MHTC are the Muslim
countries. A strong element in the Malaysian strategy is to capitalize on its image as a
Muslim country, with easily available halal food and conveniences for practicing
Muslims. The Muslim countries targeted include Middle East countries, Brunei, and
Bangladesh. Gleneagles Intan Medical Centre, for example, formed a partnership with a
Bangladeshi company whereby patients will meet up with appointed medical
representatives in Bangladesh who will assess the type of treatment needed and give an
estimate of costs before travelling to Malaysia. (The Business Times, 10 March 2004).
One recently established company is aggressively employing both strategies of targeting
Muslim countries as well as tying up with agents in these countries. Medical Service

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Coordination International, officially launched on 30 December 2003, and led by

executive chairman Datuk Syed Hussein Al Habshee, former Malaysian ambassador to
the United Arab Emirates, aims to act as a one-stop medical tourism agency among
various parties locally and abroad. In Malaysia, it collaborates with a panel of hospitals,
the government-owned National Heart Institute, as well as Sunway Medical Centre,
Gleneagles Intan Medical Centre, six hospitals in the Pantai group, and six hospitals in
the Kumpulan Perubatan Johor (KPJ) while in Indonesia, it has teamed up with 20 travel
agents. (The Sun Weekend, 2004). Together with the Association of Private Hospitals
Malaysia (APHM), the MOH, the Ministry of Culture, Arts and Tourism, and the
Ministry of International Trade and Industry (MITI), it created a commercial on medical
tourism for airing on satellite television stations beamed to West Asia, one of its targeted
Muslim markets (The New Straits Times, 2004). Other countries that are being explored
by the MHTC are Cambodia and Myanmar.
In another move, the conventionally stringent prohibitions on medical advertising
have been gradually relaxed (The Star, 2002). The Medicine Advertising Board
reevaluated the guidelines so as to provide more flexibility in the content of
advertisements, and also agreed to accord special attention in expediting the applications
for publications of advertisements from the APHM. In June 2005, it was announced that
medical practitioners and institutions were allowed to advertise their services with
immediate effect, and allowed to publish their names, disciplines, places of practice,
credentials and photos, in newspapers, websites and telephone directories, although the
information still has to be submitted to Medicine Advertisements Board for vetting (The
Star, 2005).

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2.12.6 Visa Regulations

In the year 2008 the visa for medical tourists to Malaysia has been extended from
30 days to 6 months and medical tourists are given a long stay and multiple entries in
their visas (New Sabah Times, 2008). This is another step to promote taken by the
government to promote health tourism in the country. This visa regulation also extends to
guest of the medical tourist provided that they have the necessary documents from the
hospital concerned.

2.12.7 Malaysia, My Second Home Programme

The Silver Hair Programme, first introduced in 1988, was originally conceived
as a scheme to lure wealthy elderly Europeans and Japanese aged 50 years and above to
the country. It was not a success, however, even when it was expanded in 1999 to all
countries except Israel and Yugoslavia, and by February 2001, only 482 tourists had
participated in the programme (MOH 2002b). The programme was then restructured into
Malaysia, My Second Home (MMSH), and the age limit removed. Participants younger
than 50 years old, however, need to show a fixed monthly income of at least RM 7,000
(single) or RM 10,000 (couple), as well as make a deposit of at least RM 100,000
(single), or RM 150,000 (couple), while participants aged 50and above need only fulfill
one of these criteria.
Under this programme, foreigners are given a five-year multiple entries visa, and
allowed to buy property above RM 150,000 (whereas other foreigners may only buy
property above RM 250,000). In contrast to the Silver Hair Programme, the MMSH
succeeded in drawing 2,834 applications from 2002 to early 2004 (New Straits Times,

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2004), and of the 3,000 or so participants (including those under the SHP), most come
from Britain, which has a historical link to Malaysia, and from other neighboring
countries such as China, Indonesia, Singapore, and Taiwan. The Chinese are a very recent
group to figure prominently in this programme. For example, out of a total of 1,332
MMSH applicants in 2003, 513 were from the Peoples Republic of China, constituting
the largest group, which was followed by Singaporeans (121), and then the British (105).
The MMSH is under the jurisdiction of the Ministry of Tourism and the Ministry of
Housing and Local Government, reflecting the two major motivations behind this
programme. The interests of the real estate industry behind this programme are clearly
enunciated, for example, in their many and detailed recommendations to the government
on ways to improve the MMSH programme (The Star, May 2004). Property developers
also promote the programme, particularly at the point when they are marketing a new
housing project.
Procuring medical tourists, therefore, is not a major objective of the MMSH
programme. MMSH participants, however, are required to have medical insurance, and
are considered potential medical tourists (MOH, 2002). Thus for example, in a
marketing programme structured for Japanese considering retiring in Penang, the
potential MMSH participants, besides being taken to condominiums and other places of
specific interest to long-stayers, are given a tour of one of the leading private hospitals,
where they are shown, among other things, the laboratories and state-of-the-art
equipment. The MMSH aside, it is possible that the stream of elderly seeking healthcare
abroad will grow in the future. The MOH, for example, includes, as one of the ways in
which the country can leverage itself, the provision of healthcare specifically aimed at the

65

elderly and retirees from overseas (MOH, 2003). Although the current linkage between
the medical tourism industry and the overseas retirement programme does not appear
strong, it is obvious that each could potentially gain from the other.
Whether or not elderly healthcare could become a lucrative medical tourism
branch industry in the future will of course depend on many institutional factors in source
countries, such as the adequacy of social security and health insurance, the portability of
health insurance, as well as state support and national policy. Even if the medical tourism
industry does not specifically target the elderly as a group in its marketing, it would still
gain from overseas retirement programmes and other long-stay programmes, considering
that this group of people would have a likelihood of needing healthcare, and when they
do, would most likely avail themselves of private healthcare.

2.12.8 Government linked companies (GLCs)

Government linked companies (GLCs) such as Kumpulan Perbadanan Johor
(KPJ), Sime Darby and even Petronas have ventured into the healthcare industry. KPJ
Healthcare was set up in the year 1979 and is a subsidiary of Johor Corporation. KPJ
Healthcare started operations in the year 1981 and is currently the biggest private hospital
in Malaysia. This hospital has more than 28 years experience in developing and
management of private hospitals in Malaysia, Indonesia, Bangladesh and Saudi Arabia
(Mujani et. al, 2012).
KPJ Healthcare is focused on the development and management of private
hospitals, allied health education and medical laboratory services. KPJ Healthcare also
has a dedicated team of trained nurses and professional medical officers who give their

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best service to patients. In the year 2010, the number of KPJ Healthcare personnel
worldwide totaled 680 medical consultants, 4,396 nurses and medical assistants (KPJ
Annual Report, 2010). KPJ has its own information technology system (HITS) which is
able to generate comprehensive reporting in determining the whole profile of a foreign
patient. KPJ also has a translator and coordinator for all Arab patients to facilitate
communication with the embassy. It is also active in promoting health tourism in West
Asia. Among the marketing activities conducted is participating in Health Exhibitions
such as Health Conference-Arab, Malaysian Exhibition Services (MSE) 2011 organized
by Malaysia External Trade Development Corporation (MATRADE), Medhealth and
Oman Wellness. KPJ also provides consultancy services maintained by MATRADE and
MHTC (Malaysia Healthcare Trade Council). KPJ also participates in congresses and
seminars such as Health Travel Congress exhibitions and conferences in cooperation with
MATRADE and MHTC and Wisma Malaysia. Furthermore, KPJ also promotes through
internet networking such as website, information dissemination through SMS, Facebook
or twitter. KPJ has made efforts in collaboration with health care and tourism providers in
medical tourism packages for West Asian health tourists. Some of the packages provided
cover heart operations, orthopedics, ophthalmology and dentistry.
Sime Darby is also actively involved in healthcare business under its wing known
as Sime Darby Healthcare. The Sime Darby Healthcare Group comprises five private
entities which are Sime Darby Medical Centre Subang Jaya (SDMC SJ) (tertiary care
with 393 bed hospital), Sime Darby Nursing & Health Sciences College, Sime Darby
Medical Centre Ara Damansara (SDMC AD) and Sime Darby Medical Centre ParkCity
(SDMC PC). In October 2009, Sime Darby Healthcare was accredited with JCI

67

recognition by the awarding body (AHPM, 2013). Besides the JCI accreditation, Sime
Darby Medical Centre Subang Jaya is also accredited to the Malaysian Hospital
Accreditation Standards. Sime Darby Medical Centre Ara Damansara (SDMC AD)
houses The Brain Centre which is the centre of excellence for brain, heart, spine and
joint. It features a full range of treatments and services designed to meet the needs of our
patients with brain and nervous system disorders. The centre has a comprehensive
Epilepsy Management Programme that includes an electroencephalogram or EEG studies
laboratory and state-of-the-art equipment for early diagnostic and treatment capabilities
The medical centre will also have a fully-equipped, rehabilitation facility which includes
neuro-spinal

rehabilitation

(stroke

and

spinal

injuries),

pediatrics

therapy,

musculoskeletal rehabilitation, occupational therapy, hydrotherapy and speech therapy. In

addition, the facility features a comprehensive multisensory room for sensory stimulation
for children with autism, learning difficulties, attention deficit disorder and hyper-active
disorder.
Prince Court Medical Centre is a 277 bed private healthcare facility located in the
heart of Kuala Lumpur and it is fully owned by PETRONAS, Malaysias national
petroleum company. In May 2013 it was named the top hospital for medical tourists in
the annual ranking by the Medical Travel Quality Alliance (MTQUA) (New Sabah
Times, 2013.) Such award from prestigious body that champions that medical tourism
industry worldwide shows that Malaysian private hospitals are in the right track to
expand the medical tourism further.

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