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Medical Tourism Alive And Well

Positive uptake in international patients since reopening of borders

PETALING JAYA: Medical tourists are returning to Malaysia in full force and are expected to surpass the pre-Covid-19 pandemic level in 2019 thanks to the reopening of borders, quality healthcare and competitive pricing.

The top countries of origin for these travellers include Australia, Bangladesh, China, India, Indonesia and Japan.

Based on data provided by the Malaysia Healthcare Travel Council (MHTC), the number of healthcare travellers showed an increasing trend, reaching a peak of 1.22 million individuals in 2019.

ALSO READ: Johor medical tourism promotion to go into high gear

However, there was a significant decline in 2020, with only 689,000 healthcare travellers recorded. This downward trend continued in 2021, with the number further decreasing to 561,000.

The figure picked up to 850,000 last year, contributing RM1.3bil in revenue to the country.

Among the top treatments sought after in the county are general health screening, cardiology, fertility, oncology and orthopaedics, including medical and surgical-related as well as cancer treatments.

ALSO READ: Attracting tourists year-round to Johor

"The industry is projected to make a full recovery, potentially setting a record high for industry achievement," said acting CEO Farizal Jaafar, adding that in the first half of this year, Malaysia's healthcare travel industry recorded a revenue of over RM900mil.

"The healthcare travel industry is well on its way to achieving post-pandemic recovery, having reached 76% of its pre-pandemic performance of RM1.7bil in 2019," he added.

The Association of Private Hospitals Malaysia president Datuk Dr Kuljit Singh (pic) said high-quality medical care at an affordable cost compared with other countries within the region is among the reasons for tourists reaching the country's shores.

ALSO READ: Selling Malaysia amid an evolving tourism landscape

"Our doctors are well trained both locally and overseas, with English as the main language during treatment. Also, other costs like hotels and food are affordable with great service. They also enjoy other tourist attractions while they are here," he told The Star.

TMC Life Sciences Bhd group chief executive officer Nadiah Wan said the demand for healthcare services has increased post-pandemic following a significant increase in revenue that the group recorded between 2021 and 2022.

"Since the reopening of our borders, we have seen a positive uptake in international patients, particularly in the South-East Asia region," she said, adding that the group has also seen growth through its recent expansion into Vietnam.

ALSO READ: Private health facilities can now hire foreign nurses without post-basic qualification

Nadiah, who is also the CEO of Thomson Hospital Kota Damansara, noted that a shortage in manpower and competition from neighbouring countries were among the challenges in the healthcare industry.

Lawyer Vincent Kwok, 50, from Hong Kong, said he visited Malaysia for health screenings because hospitals here offer quick and affordable medical services.

"In Hong Kong, it costs thousands of dollars at private hospitals. Specialist appointments need to be scheduled, and surgeries also involve a long waiting time," he said in an interview.

ALSO READ: Melaka govt hopes to set up healthcare cooperative to boost medical tourism

Likening the cost of a medical check-up in Hong Kong to the expenses of a four-day, three-night holiday trip to Malaysia, Kwok heaped praise on the hospitality he receives in the country.

"My experience in Malaysia is that medical reports are available very quickly, costs are reasonable, and service is excellent," he added.

Kwok said he typically preferred health screening packages in Kuala Lumpur hospitals, such as the Prince Court Medical Centre.

ALSO READ: Sabah can be prime medical wellness tourism destination, says Liew

"These packages generally cost around RM2,000, including travel insurance and other expenses.

Businessman Paulus, 45, from Bengkalis in Indonesia, said he travelled with his father by ferry to Melaka for treatment and follow-up at a private hospital.

"My dad had heart surgery at the hospital in 2019, and he was supposed to return for a follow-up the following year.

"However, the pandemic stopped that, and we only travelled to Melaka last year when Malaysia's borders reopened," he said.

Paulus said his father, 75, preferred the medical services in Melaka.

I Went To Istanbul For Medical Tourism!

A year and a half ago, I developed a strange pain in the big toe of my right foot. It persisted longer than expected, and it finally became difficult to walk. So when Michael and I happened to be getting medical checkups in Bangkok last year, I had it examined by a podiatrist.

I learned I had something called hallux rigidus: essentially, arthritis of the big toe, caused by "bone spurs" — that is, little growths in the nearby bones of my foot.

The pain was very unlikely to ever go away, my doctor said, but he explained my various options, including surgery. The price for this surgery (at one of Bangkok's top hospitals) was $5600 USD.

At the time, I was on SafetyWing's Nomad Insurance — travel insurance for only "medically necessary" procedures, true, but being able to walk seemed to be fairly necessary to me.

Infuriatingly, SafetyWing refused to give me an answer about whether they'd pay for the surgery. (And three months later, they also denied payment for even that initial consultation with the foot doctor. So the answer was clearly, "No, this procedure is not covered." Which you'd think they could've just, you know, said.)

But in all the time it took to get a clear answer from SafetyWing, a strange thing happened: the pain in my foot mostly went away. I could walk again!

I ultimately came to the conclusion that I had subconsciously changed the way I walked — a testament to how amazing and complicated the human body is.

Plus, I bought different shoes.

The big takeaway is I went on with my life.

But by the end of 2023, some of the pain had come back. Worse, I realized that I had become so cautious that I was avoiding activities I had previously enjoyed. Michael and I are extremely active — mostly because we enjoy it, but also because we like how this increases the odds of our being able to stay active for as long as possible.

Michael and me being active all over the world! (Michael Jensen)

Last month, I knew that we were going to be in Istanbul, Turkey — a city that is known to have excellent (and affordable) medical care. So I said to Michael, "I think I should finally have that surgery on my foot."

Michael agreed, and what follows is the story of what happened.

Spoiler alert: if I had to do it all over again, there are a few things I'd do differently.

Istanbul is famous for its "medical tourism." There's lots of first-rate medical facilities, which often cater directly to tourists. But the cost of living here is much lower than in many Western countries, making everything a relative bargain for people like Michael and me.

In fact, he and I lived in Istanbul for almost three months in 2021 (and loved it), and it was extremely common to see foreigners out and about sporting bandages — often, for cosmetic surgeries like nose jobs, face-lifts, and hair implants.

We also have friends who had previously had surgical work done here, and we knew one who had used a "medical advocate" to help them arrange everything.

They highly recommended that advocate, so I contacted her and explained what I needed done. I sent her my x-rays from Bangkok, and she found the right doctors, and then spelled out two different options:

If I paid via credit card, the operation would cost $6500 USD, and it would take place at Acibadem International Hospital.

If I paid cash, it would cost $4000, and it would take place at Kolan Hospital.

Kolan Hospital, Istanbul. (Michael Jensen)

We liked these prices. My research suggested that in America, the surgery would cost anywhere from $8000 to $70,000. My gut told me that in our hometown of Seattle, it would be at least $20,000.

I still keep a "full" insurance policy back in America, but despite my $9000 annual premium, it has a ridiculously high deductible of $6000 — and also 20% on any "specialist" care after that. And since the American healthcare system is clearly insane, I was assuming there would be "hidden" costs — co-pays, for example, and my paying for expensive prescriptions and outrageously priced convalescent equipment — that would push our post-insurance costs to at least $10,000, or maybe way beyond that if there was any kind of ridiculous "out of network" issue.

And since SafetyWing had ultimately declined to cover the surgery back in Bangkok, I assumed that our current travel insurance provider, Genki, would not cover it in Istanbul either.

But what was this deal about the two different hospitals — and the steep discount for paying in cash? Our advocate had assured us that it would be the same two doctors either way, but we wouldn't get a receipt at the cheaper hospital. This seemed a bit dodgy: was it legal? And how would we get that much cash in a foreign city?

Our independent investigation confirmed that paying in cash is, in fact, a very common practice in Turkey (and also nearby Greece).

I asked the advocate if the quality of medical care would be the same in both hospitals, and she assured me it would be.

Again, our independent investigation confirmed this. Our medical advocate was of the opinion that unless we needed a receipt for insurance purposes, we'd be crazy to pay $2500 more for the exact same surgery by the exact same doctors.

In the end, we agreed to go with the cash option. We scheduled the initial consultation with the doctors for a little less than a week after our arrival, with the actual surgery two days after that. I figured that would give me time to get that much cash — either Turkish lira or US dollars.

We had committed no money at this point, and Michael and I planned to use that initial consultation to decide for sure whether we'd ultimately go through with the surgery. In addition to the "cash" issue, we were also a little concerned that the doctors had decided the exact surgery I needed, even before an examination, just based on some screen-shots of x-rays from Thailand the year before.

Even apart from its medical care, Istanbul is very worth seeing — easily one of the most fantastic cities on Earth. (Denis Shevchuk via Getty Images)

We arranged for an Airbnb fairly close to the hospital, but once in Istanbul, getting $4000 cash turned out to be more difficult than anticipated. My American credit union had advised me to raise my daily ATM limit, and then simply go into any local bank for the money. But we tried three different Turkish banks, and none allowed this.

Meanwhile, cash machines in Turkey do sometimes give US dollars: since the lira has been so unstable and inflationary, many locals prefer dollars. But these cash machines also have ridiculously high fees — anywhere from six to ten percent — and they often have their own daily limits.

We solved this problem by raising the daily limit with my credit union, then going to a shopping mall, which had a variety of cash machines with high daily limits. We ended up paying a six percent fee, which added $240 to our cost. I also wasn't thrilled about carrying that much cash, or even keeping it in our apartment for a few days.

Istanbul has plenty of malls, but you're a fool if you don't visit the Grand Bazaar and the endless warren of shops that surrounds it! (ioanna_alexa via Getty Images)

We were planning to meet with the doctors on Monday, but on the Saturday before, we had dinner with a very tuned-in Turkish friend, Farouk, and we told him all about why we were in town.

He listened and said, "I am very sorry to say that Kolan is not a great hospital. It is second or even third-tier."

I instantly began freaking out. This was my worst nightmare coming true! Had I made a huge mistake in trusting our advocate? But Farouk did say that the hospital where my doctors typically worked — Acibadem — was one of the best in the city.

That night, I relayed our conversation with Farouk to our medical advocate via text. She assured me once again: it was all perfectly fine, and I had nothing to be worried about.

I was still worried. That Monday meeting with the doctors was now more important than ever. If anything at all seemed off, we planned on simply walking away — and then scheduling another appointment at one of the hospitals Farouk had recommended. After all, we're nomads, which gives us great freedom: we were already planning to be in Turkey for almost three months.

But the meeting with my two doctors, who happen to be brothers, went great. They spoke decent English and seemed extremely professional. They examined my foot and subsequently explained away some of my specific concerns: they weren't just working from x-rays — I had forgotten I also sent them the previous doctor's full report. Plus, they were going to take more x-rays at the hospital before the surgery.

They also explained how there were three different levels of surgical intervention for my kind of problem, and they were quite sure that the simplest one would work for me. I got no sense whatsoever they were trying to pressure me into a more expensive procedure. But given that I had tried everything else, this did seem to be my only option.

They also gave me their personal phone numbers and told me to call or text them at any time about anything.

They had won my trust, so Michael and I decided to go ahead with the surgery. But we still hadn't paid anyone anything, and once again, we told ourselves: if anything seemed odd about the hospital on Wednesday — if there were any red flags at all — we could still simply walk away.

But on Wednesday, the hospital also looked fine — modern and clean. I immediately noted that the other patients seemed to be middle class professionals, although they did all look Turkish.

In short, this appeared to be an upper-end hospital, but a local one. And sure enough, no one except our doctors spoke much English (but, of course, everyone had Google Translate).

I was, however, surprised and concerned that our medical advocate had not shown up in person — although she did frequently check in via text, monitoring my progress. Someone from the doctor's office was there to guide us in person, but her English was quite weak.

We did the long check-in, signing a zillion forms — many in Turkish, although I was able to at least scan them with Google Translate. It all seemed very typical.

Up in my private hospital room, the doctors met with me, and I met the anesthesiologist, who also spoke very good English. The plan was for me to have an epidural, which is a procedure often used in childbirth, rather than a general anesthetic.

Me (right), before my Istanbul surgery. (Michael Jensen)

The doctors all left, and the doctors' assistant finally asked us for the $4000 in cash, which we handed over. A small part of me expected her to thank us and casually excuse herself, and then all of these so-called "doctors" would simply vanish, leaving Michael and me alone in a Turkish hospital — and $4000 poorer.

"If that happens," I'd said to Michael earlier, "I'll be annoyed, but I'll also be genuinely impressed that they managed to pull off such an intricate and complicated long-con."

But once we'd paid the cash, we didn't get kicked out of the hospital. In fact, recognizing Michael was with me, the staff brought him lunch and even suggested we change to a room with two beds, so he'd be able to spend the night with me.

I never felt any weirdness about our being a gay couple — but then, I never have in any of the many Muslim countries we've visited or lived in. In general, I've found Muslims to be some of the most hospitable people on Earth. When it comes to LGBTQ folks, the vast majority practice a kind of "Don't Ask, Don't Tell."

Then again, these folks often have a vested financial interest in keeping "rich" Westerners like Michael and me happy, and things might be very different if we were gender-nonconforming. Also, we are often assumed to be brothers.

After some waiting, the nurses took me to surgery. I confess, once in the operating room, several things immediately gave me pause.

First, the surgical room was smaller than I expected — much smaller than even my hospital room. And while it was all very clean, there was a clear plastic canister nearby with something decidedly bloody inside, as if it had just been sucked out of someone in a previous surgery. This did not seem normal.

Maybe all operating rooms are small? I'd only ever seen them on television. (SbytovaMN via Getty Images)

Then once they were preparing me for the actual surgery, one of my doctors asked me, "Would you like the general anesthetic?"

"Uh, I want what you recommend," I said. "And back at the office, you recommended an epidural!" Maybe he was reacting to the anxiety on my face, thinking I might now want to be completely out for the procedure, but offering to change strategies this late in the game didn't seem normal either.

But at this point, with a team of eight or so scrubbed and assembled, and me mostly naked on a table, it really was too late to back out.

I ended up having the epidural, which cut off all feeling below my waist. I was awake for the whole surgery, and the doctors kept checking in, as did the very kind nurses; it's incredible what difference a gentle smile makes at a vulnerable time like that.

But I was still uneasy that everyone was speaking Turkish — and I'm pretty sure only the doctors and the anesthesiologist spoke English.

Back in my hospital room, the doctors quickly appeared to tell Michael and me that everything had gone great. The plan was for me to spend the night — something I seriously doubt would have happened in America (nor, I think, would they have given us a double room and let Michael stay all night — with meals! — at no extra cost).

Post-surgery. (Michael Jensen)

A nurse had inserted a catheter right before the surgery — without explanation, since she didn't speak English. Frankly, it had surprised me. Now as the epidural wore off, I did feel increasing pain "down there." Plus, Michael and I both noticed my catheter bag was quite pink in color, indicating a fair bit of blood in my urine.

At this point, my doctors had left the hospital, with a promise to return later that night. But I wanted answers NOW, so Michael tracked down the nurses. It was awkward and frustrating having to explain everything with Google Translate.

The nurses finally took photos of the catheter bag, which they sent to my doctors, who assured us it was a normal amount of bleeding.

But as the epidural wore off, the pain was increasing fast too. I had already been given a liquid form of paracetamol in my IV-drip, but it didn't seem to be making much of a difference.

This time, rather than deal with the nurses, Michael contacted the doctors directly via Whatsapp, and the nurses soon arrived with something much stronger.

Finally, right before midnight, the doctors showed up again, and declared everything fine. With painkillers and Xanax — and Michael being so attentive and great — I slept fairly well.

The next morning, the doctors visited again, and reported that everything looked as it should. My foot felt okay, but that catheter had really done a number on me. A nurse had taken it out the night before, but there was still blood in my urine — and a lot of pain in an area where I really don't want any pain at all. The doctors assured me this was normal too.

Before leaving, I was given various painkillers and antibiotics, and we scheduled four follow-up visits at their office for the ten-day recovery period.

They also said that, if necessary, they could come to our apartment — something I am absolutely sure would never ever ever EVER happen in America in 2024.

My x-rays, before and after. See the "bone spurs" in the one on the left? On the right, they're GONE! (Michael Jensen)

The follow-up visits went great, and while I did get fairly stir-crazy in our apartment during the ten-day recovery, I'm now able to walk mostly normally again.

The original pain in my foot? Well, there's still a little pain from the surgery, so it's too soon to know, but my doctors assured me that I should be fully healed in another month or so, and my situation was caught early enough that this particular surgery was almost certain to work. But in twenty years? I could possibly need some kind of surgery again.

Since the operation, Michael and I have thought and talked a lot about the experience. What did we think? And what would we do differently?

In the "pro" column:

I loved my doctors; I was lucky to have them. Plus, Muslim hospitality in general is an amazing thing.

I wasn't concerned about being in a different culture — and Turkish/Muslim culture is fairly different from the West; Istanbul is a fairly liberal city, and very sophisticated, but there are also large pockets of extreme conservatism. Then again, Michael and I have been traveling for many years now: seven years ago, this same experience might have felt very different to me, more "alien" and off-putting.

When it comes to medical care, there is always some degree of uncertainty. In America, I would have understood the process a bit more, but the cost would have been much more opaque, causing a different kind of anxiety.

In America, that cost also would have been much higher, even with my insurance. The total in Turkey was $4240 (including ATM fees), and that was for everything: the surgery, an overnight hospital room (and a bed for Michael), meals, prescriptions, post-op equipment, and five out-of-hospital visits (and even the promise of an at-home visit, if necessary). But if you're thinking about medical tourism and you're not a nomad, you'd obviously also have to factor in the cost of your transportation and recovery lodging. (Comfortable digs can be had for $1800-$3000 USD a month, and we'll have an upcoming article discussing the pros and cons of Istanbul's various neighborhoods.)

Also: in America, I seriously doubt I would have spent the night in the hospital for this particular procedure. And I doubt my doctors would have checked in on me so much, and given me their phone numbers. I felt very, very much that this whole process was about me and what I needed — not what would cost the insurance company or hospital the least amount of money. (But I also recognize that this is the way Turkish doctors treat Westerners, not necessarily the way they treat their own poorer residents.)

I asked around to a few friends who have had "medical tourism" done in Istanbul. Here is what they said:

Friend one: "All in — pre-visit with doc, pre-surgery labs, surgery, four great hospital meals, interpreters, amazing private room with a fantastic view and overnight hospital stay et al: $6,700! I have a $2,500 annual deductible, but still, it was worth every penny. I didn't want to leave [Liv Hospital]. Everyone was so amazing, giving me hugs as I walked out the door. I need to write their five-star review which I keep forgetting to do. It was an amazing experience: first time I've been in a hospital since I was born!"

Friend two (who had the same doctors I did): "The surgical experience was one of the best medical experiences I've had. The surgeons were excellent and flawless with the procedure and the entire process. The best part of the process was the follow up; the surgeons made absolutely certain I made a full recovery."This man's wife: "It is essential you have someone to continue home care physical therapy after some ortho surgeries. As his home caregiver, I got excellent training and continued periodic house-call visits from the therapist."

Me and my doctors, during one of my recovery visits. (Michael Jensen)

All that said, if I had to do medical tourism in Istanbul over again, here is what I would do differently:

I would use a different medical advocate. It turns out mine had recently moved away from Istanbul and was working remotely, and if I had known that, I would've gone with someone else. Also, I think she was wrong — and our friend Farouk was right — about Kolan Hospital: it's not the equivalent of Acibadem.

Even better, I would skip an advocate and just go through one of the following Istanbul hospitals, which are all considered "top," and also cater to Westerners. They will also sometimes either arrange nearby lodging for you or put you in contact with someone who can.

Acibadem International Hospital

Amerikan Hastanesi

Memorial Şişli Hastanesi

Liv Hospital Ulus

Istanbul Florence Nightingale Hospital

In Istanbul, I would personally insist on one of the above hospitals, or something similar, even if it meant paying more. Regular readers know that I love myself a bargain, but I would never want to risk my or Michael's life even slightly just to save a little money. And there were a couple of things that did give me pause about Kolan Hospital, especially the language issue. I wish more of the staff had spoken English. It was weird and stressful to rely on Google Translate for something like this.

Even at a better hospital, I would also want a translator available at all times. What if something really serious had happened?

But if it's an option at one of these hospitals, I would still pay in cash. It really is widely accepted as a means of doing business here, and it was an incredible bargain, saving Michael and me over $2000.

That said, before paying in cash, I would consider the importance of a receipt. We Americans can often write off medical care on our taxes. And regarding this procedure not being covered by travel insurance, having recently researched the issue, I now suspect that while SafetyWing denied me, our current provider, Genki, might have paid out; they're more liberal in payments in general, and after six months, they cover some pre-existing conditions. If nothing else, I wish I had asked.

More than anything, I'm happy to finally have this thing done, and I can't wait for Michael and I to resume our regular activities — walking, hiking, romping, and meandering to different places all over the world!

Brent Hartinger and Michael Jensen·Yahoo Creator

We're Brent and Michael — a longtime couple — who decided in 2017 to sell our house in Seattle and travel the world as "digital nomads." Subscribe to our newsletter to come along to the places we're going next!

Medical Tourism Report 2024: Top 25 Source Country Analysis And Where They Are Today

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Dublin, April 08, 2024 (GLOBE NEWSWIRE) -- The "Medical Tourism - Top 25 Source Countries" report has been added to ResearchAndMarkets.Com's offering.

Medical Tourism - top 25 global destinations examines why the top 25 source countries are where they are today.

Global medical tourism is increasing annually. What is changing rapidly is each where medical tourists come from and why they go abroad.

The report highlights those countries that are or are becoming major sources and why. This report investigates current and potential opportunities for medical tourism by analysing outbound numbers by country, and revenue.

Most medical tourism reports are out of date by the time they are published, so this one works in a new way. Using a global medical tourism database that is updated weekly, the bespoke report is compiled within 5 working days using the latest information available.

Key Benefits

Every country and organisation needs to update and refine its medical tourism strategy and to do that they need to know the latest on which countries are doing well, who goes there, the treatment they seek and why they go there.

This report is essential reading to any organisation serious about medical tourism.

Country Specific Details Include:

Overview

Potential

Medical tourism numbers out

Medical tourism outbound spending

Where medical tourists go

Why outbound medical tourists go abroad

Health insurance and medical tourism

For more information about this report visit https://www.Researchandmarkets.Com/r/v3neax

About ResearchAndMarkets.ComResearchAndMarkets.Com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

CONTACT: CONTACT: ResearchAndMarkets.Com Laura Wood,Senior Press Manager press@researchandmarkets.Com For E.S.T Office Hours Call 1-917-300-0470 For U.S./ CAN Toll Free Call 1-800-526-8630 For GMT Office Hours Call +353-1-416-8900

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