New report provides lessons from Indonesian medical travellers going to Malaysia

The study concentrates on motivations, preparation and practices. Using 35 detailed interviews of Indonesians going to Malaysia for healthcare, it fleshes out how things work beyond the basics.  The authors asked about treatment, accommodation and transport, as well as length of stay.

One key point it highlights is that the idea of medical tourists traveling across the world for the cheapest care is out of date as most medical travel is regional, often between easy to reach nearby countries.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

The report also highlights that people from Laos go to Thailand mainly because it is a short trip across the border and they go there even for basic healthcare, as the Laos system is very poor. Rather than being welcomed, this cross-border trade is causing problems for some hospitals as many Laotians do not have the means to pay and hospitals are being over-burdened.

Regional medical travellers vary in terms of socio-economic group, medical condition, ability to travel, distance travelled, destination, length of stay, number of people with them and type of hospital they go to.

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

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

Two out of three travel to the state of Penang, a quarter to Melaka and the rest to Sarawak. The case studies were only of people going from Indonesian Borneo to hospitals in the Sarawak capital, Kurching. They can get there by air, sea or land.

In deciding where to go, many use a medical travel agent. Each of the three private hospitals in Kuching has official local representatives with offices in Pontianak that register customers, schedule their consultations and testing, and provide the hospitals with customers’ records and medical conditions. They may also provide payment options (allowing patients and their families to settle Malaysian hospital bills in Indonesian currency or transfer additional funds) and transport to and from Kuching (transport ticket purchase, own transport services, etc.). This type may receive a combination of base salary and commission from the hospitals for each customer served. Numerous commission-based agents arrange not only transport and accommodation but although they do not have medical training may conduct the investigation of customers’ ailments, identifying what they deem to be the appropriate specialist for their ailments, registering them and accompanying them to the consultations, even interpreting for doctors and their patients. Those not using an agent tended to be seasoned medical travellers; had friends and family in Kuching on whom they could rely; wished to avoid the extra fees charged; or desired greater independence in selecting facilities, doctors, transport and accommodation. Diagnostic, treatment and medication costs were widely regarded by medical travellers as similar across Indonesia and Malaysia. Care in Kuching entails the additional burden of transport and accommodation costs as well as sometimes temporarily closing their businesses or taking leave from work or care responsibilities to go abroad. Yet all travellers found the additional financial burden to be worth it: as it was better healthcare than they get at home.

Before travelling, they budgeted for consultations, treatment and medication as well as transport, lodging and food. As credit cards are rare and since only some hospital linked agents offer facilitated payment and money transfer options, cash payments are predominant. Travellers require time to amass the estimated amount and exchange currency before leaving Indonesia. Numerous hotels, guesthouses and private homes are available for rent by day, week or month, for travellers on tight budgets are near the private Kuching hospitals. Many low cost cross-border coach services compete with one another and as do freelance medical travel agents for patient custom. Indonesian and Malaysian low-cost airlines have even added new routes and additional flights to respond to medical travel demand. To minimise costs, most travellers opt for land transport (cross-border economy coach services, shared vans and taxis.). Most stay in low-budget accommodation of economical hotels, privately rented homes or guesthouses owned and run by Indonesian agents or at family and friends’ homes. It is common to secure accommodation in Kuching only after learning from their doctors how long they need to stay for testing and treatment.

Travelling with family and friends to Kuching allows patients to get logistical, physical and emotional support,

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

The authors argue that by concentrating attention on higher-status tourists that stay longer and spend more than conventional leisure tourists that authorities and hospitals miss that international medical travel is mostly intra-regional in character, and driven by local economic and political conditions in both their source and receiving locations.

The study suggests that much promotion and research into medical travel ignores the importance of unpaid care-giving travel companions, and how the ability of friends and relatives providing free accommodation influences where people go.

It points out the flourishing informal economy of unlicensed agents, the purchase of prescription medication in Malaysia for family and friends in Indonesia, and local travel enterprises are mostly ignored.

The study argues that proximity, cross-border support networks, and confidence in the quality of diagnoses, treatment and medication are much more important than price. Intra-regional medical travel becomes a feasible way to manage chronic health needs, with people commuting on a routine basis for treatments, check-ups and refills. But research and promotion on international medical travel is focused on long-haul journeys for expensive treatments and surgeries. The frequent, short-distance and typically outpatient medical commuting is a much bigger component of medical tourism than the vision promoted by national bodies of long-distance travel for cheap care. Politics, socio-economic factors and diverse geography are mostly ignored and make medical travel look much simpler than the reality is.