Healthcare and Medical Tourism Sabah 15062015

Centre for Public Policy Research, Kochi, undertook a study titled ‘Public and Private Healthcare Institutions: Preference and Expenditure Pattern’ in an attempt to identify the extent of and reasons for the user preference for the type of healthcare service and its resultant impact on expenditure pattern. The study was conducted among 85 households selected randomly in Panangad and Kaloor, a rural area and an urban centre, respectively. The study infers that most of the respondents (more than 70 per cent),even those from low-income groups, preferred private healthcare services to public healthcare services.The respondents depended on public healthcare for routine preventive healthcare and utilised the services of private healthcare institutions for acute illness, trauma, injury, poisoning etc. The study did not find any significant relationship between the age group, household income, the mode of expenditure, education etc of the respondents and their preference for private healthcare services. The study revealed access to advanced medical facilities under a single roof as the main reason for the respondents’ choice of private hospitals in both rural and urban areas. The second major reason for private healthcare preference is proximity of the healthcare facility in the rural area and approachability/friendly conduct of doctors and staff in the urban centre. While reliability is the third major reason in the urban centre,approachability/friendly conductof doctors and staff is the third reason in the rural area. In short, advanced medical facilities, reliability and approachability/friendly conduct of doctors and staffare the major reasons identified for the preference forprivate healthcare institutions. However, proximity is an equally important reason for the user preference for private hospitals in the rural area. The overall average medical expenditure of a household in Kaloor and Panangad is estimated to be Rs 4207 per month. The medical expenditure of a household on private healthcare services is almost 24 times higher than that on public healthcare services. The medical expenditure on private healthcare in the urban centre is almost 65 per cent higher than that of the rural centre. The combined average expenditure of a household on private and public healthcare services is Rs 4928 per month in Kaloor and Rs 2886 per month in Panangad. This shows that the healthcare expenditure in the urban area is almost 71 per cent higher than that of the rural area.The point to be noted is that the difference in expenditure incurred is not for treating the same type of diseases. It simply shows the expenditure borne by the households under different healthcare systems. The main source of healthcare expenditure is out-of-pocket expenses, which constitute 84 per cent of the total average expenditure. Governmental support (9 per cent), insurance claims (3 per cent), charity (1 per cent) and others (3 per cent)are the major sources of medical expenditure. The study reveals that low penetration of insurance coverage among the respondents is a cause of concern. Though 23 per cent of the respondents were insured, only 3per cent of the total health expenditure is met by way of insurance. The main obstacles for the high penetration of health insurance are expensive insurance policies, lack of awareness about the policies and complicated procedures. The first implication of the study is that policy makers should take necessary steps to improve the facilities and offer quality services in public hospitals so that more people would make use of the facility.Second, considering the growing trend of dependence onspecialist doctors, there is a need to redefine the role of Primary Health Centres and Block Primary Health Centres to suit the current context and environment. The scope of improving the healthcare system through efficient intervention of the Local Self Government institutions is tremendous. This can improve the efficiency and effectiveness and revive the long-lost glory of the State-sponsored healthcare system. Third,the government should push for more health insurance schemes,particularly among low-income groups, in order to lessen the financial burden arising out of treating critical illnesses/injuries.

Asian-Pacific Economic Literature, 2016

In Malaysia, a country that ranks among the world's most recognised medical tourism destinations, medical tourism is identified as a potential economic growth engine for both medical and non-medical sectors. A state-level analysis of economic impacts is important, given differences between states in economic profiles and numbers, origins, and expenditure of medical tourists. We applied input-output (I-O) analysis, based on state-specific I-O data and disaggregated foreign patient data. The analysis includes nine of Malaysia's states. In 2007, these states were visited by 341,288 foreign patients, who generated MYR1,313.4 m ($372.3 m) output, MYR468.6 m ($132.8 m) in value added, and over 19,000 jobs. Impacts related to non-medical expenditure are more substantial than impacts related to medical expenditure, and indirect impacts are a substantial part of total impacts. We discuss management and policy responses and formulate recommendations for data collection.

Global Social Policy, 2010

A striking feature of the medical tourist industry that has developed in Asia since the late 1990s is the involvement of States in supporting the private sector in marketing healthcare services to foreign patients. Malaysia and Singapore, two of the leading players in this field, have, since the 1980s, embarked on healthcare reforms, resulting in an enlarged private healthcare sector. The Singapore state, moving toward state corporatism, has advanced further in its healthcare reforms, and is therefore able to minimize the gap between government and private health services. The Malaysian state, fragmented and facing greater opposition, has not been able to advance as far in its healthcare reforms, and faces a growing gap between public and private health services. Nevertheless, both countries face a shortage of doctors in the public sector, and rising costs and user charges: problems that are exacerbated by a growing private market in healthcare to which the medical tourist industry contributes. As successful market economies, the cases of Malaysia and Singapore serve to illustrate the potential effects of healthcare reforms and commercialization of healthcare on social policy; particularly salient in the context of an emerging focus on trade in health services as a possible growth engine for countries' economic development.

With the ASEAN Economic Community coming into existence at the end of 2015, deeper integration of health services and trade in health services is likely. This study focuses on Malaysia, Singapore and Thailand and aims at (i) comparing the present role of the private hospital sector in the overall health system and for medical tourism in particular as well as the environment in which it operates, (ii) understanding the impact of medical tourism on destination countries' health systems, and (iii) examining company strategies related to medical tourism of major health care companies in Malaysia, Singapore and Thailand, the focus being on foreign direct investment. Data are collected through a review of available research, policy documents and secondary data as well as through in-depth interviews conducted with experts in Malaysia, Thailand and Singapore. The comparison of private hospitals indicates that there seems to be excess capacity which could be harnessed and that the private sector appears interested in contributing to a larger extent to medical education which could help ease shortages of medical professionals. While the impact of medical tourism on national health systems in the three countries is debated in the literature, there is a lack of rigorous analysis and the evidence to date is unclear. Although some governments have expanded their role in the "private or paying" healthcare market segment, the strategies of large private hospitals vis-à-vis the public system have remained largely unchanged. This study concludes that it is important to understand the business strategies of major health care companies in order to expand the role of the private sector in addressing key challenges in the healthcare sector and assess the need for redistributive financing mechanisms.

Health care services involve improving our health necessities. Public hospitals play a vital role to provide health services to the people. The private sector also comes forward and working with hand to hand with the government. This study investigates the reasons behind the patient's shift from public to private hospitals at Cumilla City Corporation (CuCC) in Bangladesh. This study has found that the total numbers of physicians are very few compared to demand in government hospitals which are why the time consideration to prescribe a patient is quite poor. The behavior of physicians, nurses and other staff accelerates the patient shift in private hospitals. The environmental quality of the public hospital is also an important reason for the patient's shift to private hospitals. Distance between household and public hospitals also a major barrier to adequate services of the public hospital. The current study contributes to assures the importance of public health care services to the stakeholders of the study. Contribution/Originality: This study is the first attempt to contribute in the literature by investigating the reasons behind the patient's shift from public to private hospitals at Cumilla City Corporation (CuCC) in Bangladesh.