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Original Research (Original Article) 


Chiao-Wen Cheng et al, 2019;3(10):023–028.

International Journal of Medicine in Developing Countries

A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism

Chiao-Wen Cheng1, Cheng-Min Feng1, Chian Sem Chua2,3*

Correspondence to: Chian Sem Chua

*Western Medicine Division, Hospital Lam Wah Ee, George Town, Malaysia and Department of Medicine, Penang Medical College, Georgetown, Malaysia.

Email: gogochua [at] gmail.com

Full list of author information is available at the end of the article.

Received: 15 July 2019 | Accepted: 22 July 2019


ABSTRACT

Background:

Malaysia is the first and the only Asian county that has medical tourism under its Ministry of Health, implying that medical care is seen as the first priority of the medical tourism industry. Malaysia attracts overseas visitors because of its high level of health care and low medical treatment charges, and 60% of the revenue is received from the state of Penang.


Methodology:

This study was conducted to analyze the strengths, weaknesses, opportunities, and threats (SWOT), as well as suggestions are given based on the medical tourism business in Penang state. This study used a semi-structured questionnaire to survey opinions regarding the internal and external factors affecting the medical tourism industry in Penang state, Malaysia. A SWOT analysis was conducted to analyze the strengths, weaknesses, opportunities, and threats.


Results:

The achievements of further objectives are given based on the identified SWOT, to assist in the further evolution of medical tourism in the Malaysian.


Conclusion:

This study attempts to offers insights into challenges and prospects of the Malaysian medical tourism industry specifically, and the further objectives are given based on the identified SWOT, to assist in the further evolution of medical tourism in the Penang, Malaysia.


Keywords:

Penang, global healthcare, health policy, medical tourism, SWOT.


Introduction

Medical tourism has been burgeoning in South East Asia, with Singapore, Thailand, and Malaysia all offering medical services for foreign clients [1]. People seek medical care outside their own countries for many reasons, such as hospital waiting times, cost, the quality of medicine, and tourism. Most patients are seeking elective health care services, including fertility treatments, cosmetic surgery and health screening [2]. The Malaysian government has strongly been supporting the medical tourism industry, and is the first country in Asia to place medical tourism under the Ministry of Health. In the 2018 Malaysian budget, the government allocated RM 30 million to the Malaysia Healthcare Tourism Council (MHTC) to elevate Malaysia’s image as a health tourism destination [1]. From 2011 to 2016, the number of foreign patients in Malaysia increased from 641,000 to 921,000, a dramatic annual growth of 16%–23% [1]. In 2017, MHTC reported that medical tourism had serviced one million health travelers and had attained profits of RM 1.3 billion. With the support of the Malaysian government, MHTC aims to increase medical tourism industry returns to RM2.8 billion by 2020 [3]. Over recent years, Malaysia has developed its medical skills and aims to become the cardiology and fertility hub of Asia [1,3]. Malaysia has also launched a Flagship Medical Tourism Hospital Program focused on patient safety, high quality medical treatment, management, and services to promote its hospitals as global medical tourism icons, with the aim of raising Malaysia’s profile further as a global medical tourism destination and increasing Malaysia’s competitiveness with other world-class medical tourism hospitals. The two major Malaysian cities of Penang and Kuala Lumpur are involved in the medical tourism business. The 2015/2016 Penang Economic and Development Report revealed that Penang’s medical tourism brings in more than RM 360 million each year, with the Penang private hospital sector earning more than 62% in medical tourism. Furthermore, medical tourism is the main sources of income in Penang [4]. The 2017 Penang tourist survey found that health tourist expenditure was around RM 2,500.98 per visit, the average stay was 8.32 nights, 73.1% of health tourists were repeat visitors, and there was a 100% revisit intention [5]. This study aimed to analyze the strengths, weaknesses, opportunities, and threats (SWOT). Suggestions are given based on the medical tourism business in Penang state to assist in the further evolution of medical tourism in Malaysia.


Subjects and Methods

This study used a semi-structured questionnaire to survey opinions regarding the internal and external factors affecting the medical tourism industry in Penang state, Malaysia. Seven participants, four women and three men, were involved in the study, four of whom were medical management personnel, two were government personnel, and one was a research scholar (Table 1). The interviews were conducted between February 2017 and December 2018. The data were used for research purposes and participation was anonymous. A SWOT analysis was conducted to analyze the strengths, weaknesses, opportunities, and threats in the medical tourism business in Penang state. Although SWOT studies are unable to directly inform on the achievement of competitive benefits, they can be used as references to make more informed policy decisions. A good policy is based on strengths, recognizes opportunities, is aware of threats, and makes efforts to overcome weaknesses [6]. The questionnaire was adapted from Mohezar et al. [7], and the questions were adapted to better analyze the internal and external environments of the Penang medical tourism industry (Table 2). The SWOT analysis was used to analyze the internal and external features, identify positive and negative elements influencing the development of the medical tourism industry in Penang, maximize strengths and opportunities, minimize external threats, allow for the conversion of weaknesses into strengths, and implement changes when opportunities are recognized. Therefore, it was decided that a SWOT analysis would be the ideal research method to gain valuable information regarding medical tourism in Penang [8,9].

Table 1. Expert basic information.

Participants Gender Background Seniority
1 F Malaysia Healthcare Travel Council 6
2 F Hospital medical personnel 12
3 M Hospital medical personnel 21
4 F Hospital medical personnel 16
5 M Hospital medical personnel 9
6 F Scholar 11
7 M Penang Global Tourism 3

Results

Strengths

Focus on infertility and cardiology specializations

Malaysia has started to focus on particular healthcare specializations [1], with additional resources being added to hospitals for developing fertility and cardiology departments to support the medical tourism industry. Penang currently has a fertility and cardiology department in its main hospital and has also established a private fertility center and a private cardiology clinic.

Low labor costs in Malaysia

As the median monthly salary in Malaysia is RM 2,160 and the mean monthly income is RM 2,880 [10], compared to Singapore, Malaysia can provide less expensive medical services to foreign patients; therefore, less expensive tourism and medical expenses attract foreign visitors to Malaysia for both medical care and tourism.

Established tourist destination

Penang is already recognized as a prime Malaysian tourist destination, especially after it became a UNESCO World Cultural Heritage Site in 2008 and was listed as one of the best cities for travel in the 2017 and 2019 by CNN Travel because of its special mixed Asian characteristics [11].

Transparent information and rules

Malaysia provides transparent information on medical charges to all the patients [12], and laws have been promulgated and regulations implemented to protect patient care standards, services, and privacy.

Multilingual ability of healthcare workers

Malaysia is a multi-racial, multi-cultural, multifaith country. Therefore, in Penang, most people and especially healthcare workers speak more than one language, including English, Mandarin, Malay, Tamil, Hindi, and Chinese dialects, which makes it easier for the healthcare workers to communicate with patients and their families.

Delightful climate

Because of its tropical weather, Penang has a relatively stable climate with few dramatic changes in temperature, which is ideal for the elderly and infirm. Patients, therefore, feel comfortable as there is less likelihood of deterioration from disease from extremely cold or extremely hot weather compared to other countries.

Table 2. Interview questions.

Factors Questions
Internal Which advantageous items those contribute to the development of the medical tourism industry (ie, medical profession, industry cost, national image, policy)?
What are the factors supporting the medical tourism industry?
What difficulties hinder the progress of medical tourism?
Which projects in the current medical tourism industry are inefficient or not doing well?
What are the factors that need to be strengthened?
What is the real weakness in the medical tourism industry chain?
External What unique characteristics will attract interest from medical tourists?
Which world trends are in line with the development of the local medical tourism industry?
Which policies and regulations are timely adjusted to meet the development of medical tourism?
The irresistible natural disasters and public health issue will affect medical tourism?
What changes in social or demographic structure have a negative impact on medical tourism?
Do investors have a willingness to cooperate with the participation of medical tourism?
Does the revision of policies and regulations have a negative impact on the development of medical brigades?

Tax benefits

To encourage the medical tourism industry, the government has extended the double tax deduction for approved expenses of ambulatory care centers and dental clinics. It also does not levy a sales and service tax on medical bills [3], and has extended the tax incentives for investment in high standard hotels.

Visa approvals

To encourage medical tourism, Malaysia is providing a social visit pass for patients and their families seeking medical treatment in this country.

Weaknesses

Lack of impressive promotional activities or customer service

Malaysia needs to focus on attracting patients by publicizing the benefits more widely and emphasizing why Malaysia (rather than Singapore or Thailand) is the best place for medical tourism. Therefore, more impressive promotional activities are needed that pay special attention on the quality and unique characteristics of the medical tourism industry in Penang rather than just the price advantages.

Poor informatics systems in the hospitals

In this big data era, informatics systems are vital to efficient hospitals as they ensure that all information is available and secure, which in turn facilitates effective work flow in the hospital and results in shorter patient waiting periods. Up-to-date information management systems collect patient data and ensure that the best medical decisions are made.

Lack of suitable service departments and hotels

Providing suitable pre- and post-hospital visit accommodation is important for medical tourists; therefore, a variety of hotels and service departments need to be aligned with the medical tourism requirements for both the potential patient and their supporting family. However, currently in Penang, there is a shortage of suitable accommodation, and even though there has been an increase in the number of hotels, motels, clubhouses, hostels, non-rated hotels, and service departments, unlicensed hotel and service departments continue to be a problem [4]. Patients concern public services, including nutritional services, hospital transportation, facilities, clean environment, companions’ accommodation, and shopping [13]. Accommodations that fulfill patient needs such as wheelchair facilities, easily accessible accommodation, free shuttle services to the hospital, and long-stay requirements need to be specifically developed to support the medical tourism industry [14].

Lack of international accreditation

Joint Commission International (JCI) is the largest health care standard accrediting body and represents the gold standard for international health care safety and patient care. JCI accreditation, however, has only been approved for three hospitals in Penang: Gleneagles Penang, the Penang Adventist Hospital, and the KPJ Penang Specialist Hospital [15].

Opportunities

Islamic hub tourism

As Malaysia’s official religion is Islam, it is a well-known and popular Islamic tourist destination. Therefore, as Penang not only attracts Islamic patients from Indonesia but also from the Middle East. All hospitals in Penang follow Islamic customs. In 2022, the first Islamic hospital in the northern regions of Malaysia, the Penang Islamic Hospital, is planned to open [16]. Therefore, the Islamic medical tourism market is another opportunity for Penang.

Increasing fertilization requirements

The in vitro fertilization success rate has been quite high in Malaysia as compared to other countries. As China has announced its two-child policy, the MHTC is focusing on couples in China who may have problems conceiving naturally [17].

Signing an international cooperation MoU

Apart from the signing of a MoU with Indonesia AirAsia to supply cheaper flight tickets to Penang [18], cooperating with overseas insurance companies and especially international insurance companies for foreign patients could also assist in promoting medical tourism in Penang. For example, the US has sponsored some government servants to receive medical treatment from other countries [19], and the UK has outsourced part of their medical contracts to India [20], and with the world famous Chang Gung Memorial Hospital has established cooperation with a hospital in Penang and also signed an MoU with the University of Malaya [21].

Threats

Crime

Crimes, such as purse snatching, pickpocketing, smashand grab thefts from vehicles, and residential burglaries, have been increasing in Malaysian urban centers. In fact, incident of thieves carrying knives and slashing victims are also on the rise [22].

Table 3. SWOT analysis.

Strengths Weaknesses
Internal
  • Focus on Infertility and cardiology specialty
  • Low Labor Cost in Malaysia
  • Established Tourist Destination
  • Transparent information and Rules
  • Multilingual ability of healthcare workers
  • Delightful climate
  • Tax offer
  • Visa obtain
  • Lack of impressive
  • promotional activities and customer service
  • Poor informatics system in Hospital
  • Lack of suitable service department and hotel
  • Lack of International accreditation
Opportunities Threats
External
  • Islamic hub tourism
  • Increasing requirement for fertilization
  • Signing an international cooperation MoU
  • Crime
  • Natural Disaster
  • Outbreak of Infectious Disease

Natural disasters

Every year from August to October (dry season) in Sumatra and Kalimantan there are forest and peat fires, which result in damaging haze and severe air pollution in Malaysia. Even though Penang is in the north of Malaysia, this is still an issue for many tourists. Flash flooding following heavy downpours have been increasing in Malaysia not only during monsoon season but also in other extreme weather events. Penang experienced a massive flash flood in 2018 and 70% of the city was flooded, which affected both the tourism and medical tourism industries.

Outbreak of infectious disease

The rise in cases of dengue fever in Penang has become a significant issue, especially as the mortality rate has also been increasing. However, the state government is taking action to decrease the spread of the disease [23]. In 1966, Malaysia was the first country to isolate the Zika virus carried by the Aedes aegypti mosquitoes. [24]. Consequently, there have been few reported cases of Zika infections since 2014 [25]. Rabies has also become a concern since the July 2015 outbreak of canine rabies in northern Malaysian states of Perlis, Kedah, and Penang. Serial vaccinations and the culling of stray dogs have been undertaken by the state government to prevent the further spread of this disease [26].


Discussion

Penang Island is currently undertaking a large landfill project for the development of Gurney Wharf, which provides excellent opportunity for the development of a special medical tourism village that would include a hospital and accommodation for medical tourists as well as their families. As Gurney is one of the most famous tourist destinations in Penang, there are already many hotels in this area. Therefore, hospitals could seek cooperative agreements with local hotels to develop accommodation and tourism plans for patients and their families. Another significant project on Penang Island is the Island Medical City development, which is the first medical hub in Malaysia that combines hotels, medical suites, and hospitals [27]. As periodic health examinations have been recommended by the American Medical Association, apart from infertility and cardiology, health screening could be developed for patients and their families in Penang. Penang has been mentioned as a well-known destination for longstay tourists and for foreign retirement by Condé Nast Traveler [28]; therefore, geriatric nursing care and rehabilitation could be a possible new direction. Taiwan’s New Southbound Policy, which is associated with the world famous Chang Gung Memorial Hospital has established cooperation with hospitals in Penang and also signed an MoU with the University of Malaya [21], which will allow for the sharing of experiences with the Chang Gung Health and Culture Village for retired people [29]. Taiwan’s medical services are well known in the world. [30], with nine of its hospitals now listed in the top 200 hospitals in the world. As Taiwan has highly trained doctors, advanced medical equipment, and diverse specialties, “Twin town agreements” could be sought with Taiwanese cities to facilitate health care communications as a part of Taiwan’s New Southbound Policy. Penang is one of the 19 recommended travel cities by CNN Travel, and George Town has been listed as a UNESCO World Cultural Heritage Site. Furthermore, as the city has a wide Asian mix, the combination of quality medical care and unique heritage city culture could make Penang the most attractive city for medical tourism in the world [11].


Conclusion

This study attempts to offers insights into challenges and prospects of the Malaysian medical tourism industry specifically, and the further objectives are given based on the identified SWOT (Table 3), to assist in the further evolution of medical tourism in the Penang, Malaysia. Most of the other countries’ medical tourism are on individual standards and without suitable rules manage the industry; this will affect the customers’ confidence of the medical treatment [7]. The SWOT analysis may become out of date, since the external and internal environments is keep changing. As the industry is governed by the government, future quantitative study is necessary to support this exploration. The signature feature of medical tourism in Malaysia is that it is regulated under the Ministry of Health, which clearly indicates that medical services are the main purpose for medical tourism. Therefore, medical tourism in Penang, Malaysia is expected to grow in more popular.


List of Abbreviations

MHTC Malaysia Healthcare Tourism Council
SWOT Strengths, weaknesses, opportunities, and threats

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Ethics approval is not applicable,as it does not use human samples.


Authors’ contribution

Chiao-Wen Cheng drafted the article and involved in conception, design, acquisition of data, analysis and interpretation of data. Chian Sem Chua edited the article and revised it critically for important intellectual content. Cheng-Min Feng and Chian Sem Chua finally approved the manuscript for publication.


Author details

Chiao-Wen Cheng1, Cheng-Min Feng1, Chian Sem Chua2,3

  1. Department of Transportation Logistics Management, National ChiaoTung University, Hsinchu, Taiwan
  2. Western Medicine Division, Hospital Lam Wah Ee, George Town, Malaysia
  3. Department of Medicine, Penang Medical College, Georgetown, Malaysia

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How to Cite this Article
Pubmed Style

Cheng C, Feng C, Chua CS. A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism. IJMDC. 2019; 3(10): 23-28. doi:10.24911/IJMDC.51-51-1558514391


Web Style

Cheng C, Feng C, Chua CS. A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism. http://www.ijmdc.com/?mno=50098 [Access: October 18, 2019]. doi:10.24911/IJMDC.51-51-1558514391


AMA (American Medical Association) Style

Cheng C, Feng C, Chua CS. A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism. IJMDC. 2019; 3(10): 23-28. doi:10.24911/IJMDC.51-51-1558514391



Vancouver/ICMJE Style

Cheng C, Feng C, Chua CS. A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism. IJMDC. (2019), [cited October 18, 2019]; 3(10): 23-28. doi:10.24911/IJMDC.51-51-1558514391



Harvard Style

Cheng, C., Feng, . C. & Chua, . C. S. (2019) A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism. IJMDC, 3 (10), 23-28. doi:10.24911/IJMDC.51-51-1558514391



Turabian Style

Cheng, Chiao-Wen, Cheng-Min Feng, and Chian Sem Chua. 2019. A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism. International Journal of Medicine in Developing Countries, 3 (10), 23-28. doi:10.24911/IJMDC.51-51-1558514391



Chicago Style

Cheng, Chiao-Wen, Cheng-Min Feng, and Chian Sem Chua. "A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism." International Journal of Medicine in Developing Countries 3 (2019), 23-28. doi:10.24911/IJMDC.51-51-1558514391



MLA (The Modern Language Association) Style

Cheng, Chiao-Wen, Cheng-Min Feng, and Chian Sem Chua. "A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism." International Journal of Medicine in Developing Countries 3.10 (2019), 23-28. Print. doi:10.24911/IJMDC.51-51-1558514391



APA (American Psychological Association) Style

Cheng, C., Feng, . C. & Chua, . C. S. (2019) A new breakthrough of global healthcare in Penang—an indicator policy in medical tourism. International Journal of Medicine in Developing Countries, 3 (10), 23-28. doi:10.24911/IJMDC.51-51-1558514391