This thesis examines the shifting relationship between the state and its subjects with regard to responsibility for and entitlement to care. Using Malaysia as a case study the research engages with international medical travel (IMT) as an outcome of the neoliberal retrenchment of the welfare state. I offer a critical reading of postcolonial development strategies that negotiate the benefits and challenges of extending care to non-national subjects. The research draws from relevant media, private-sector and governmental documents and 49 semi-structured, in-depth interviews with IMT proponents and critics representing federal, state and urban governmental authorities, professional associations, civil society, private medical facilities and medical travel agencies in Malaysia’s principal IMT regions (Klang Valley, Penang and Malacca). Across four empirical chapters, the thesis demonstrates how ‘Malaysia’ gets positioned as a destination within a range of imagined geographies of care through a strategic-relational logic of care and hospitality. I argue that this positioning places ‘Malaysian’ subjects and spaces into lucrative global networks in ways that underscore particular narratives of postcolonial hybridity that draw from Malaysia’s ‘developing country’, ‘progressive, moderate Islamic’ and ‘multiethnic’ credentials. In considering the political logics of care-giving, I explore how the extension of care can serve as a place-making technology to re-imagine the state as a provider and protector within a globalising marketplace in which care, increasingly commodified, is tied to the production of new political, social, cultural and economic geographies.

Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-03, page: 1499. Adviser: Shelton Brown. Includes bibliographical references.

醫療旅遊，一種旅遊業中的利基市場，目前愈來愈受到全球的注意。 當年因為亞洲金融風暴的影響，一些亞洲國家的私立醫院幾乎不再有 病患光顧，於是另覓客源，開創了國際觀光醫療的新局面。至今，這 種新興行業正蓬勃發展且具有莫大潛力。造就這種局勢的原因主要為 歐美國家某些手術的等待時間過長，高昂的醫療費用，一些第三世界 國家醫療品質的提升，以及全球化的自然演進趨勢。 本論文以質性研究為主，初級資料由深入訪談的問答中取得，次級資 料則使用既有的資源，大量資訊由研究學術文獻、書籍、報章雜誌以 及網路搜尋的方式蒐集而得。 本論文分為以下幾個部分：研究台灣是否具備發展醫療旅遊的競爭力， 亞洲國家醫療旅遊發展概況及各別優勢及特色，在亞洲地區中發展旅 遊醫療，且具競爭優勢的醫療機構之一為泰國康民醫院，以4C架構研 究泰國康民醫院發展觀光醫療的成功因素，然後以對本地政府及醫療 機構的建議為結論。 / Medical tourism, a niche market of tourism, is a concept that is getting more attention nowadays. Actually, medical tourism in Asia is brought on in the aftermath of the Asian Financial Crisis, that lets first private hospitals in some Asian countries to seek alternative revenue sources. The business of medical tourism is thriving nowadays and with great potential. Factors contributing to this phenomenon include long waiting lists for certain surgeries and costly healthcare in some advanced countries, improvements on health care standards in the third world, and the natural progression of globalization. The study was primarily performed by qualitative methods. Primary data was obtained by the answers from some questions via the in-depth interview; secondary data was obtained through the use of existing sources , large quantities of information were obtained through academic articles, books, newspapers, magazines and the internet. The structure of the thesis is divided in several parts: 1) This paper sets out to examine the competency of developing medical tourism in Taiwan in terms of cost and quality. 2) Figure out the status of medical tourism industry in Asian countries, and sort out the salient points and features of each one. 3) One of the established medical tourism destinations with strong medical and tourism capabilities is Bumrungrad Hospital International in Thailand, the effective factors for attracting medical tourists to this hospital were then determined via 4C structures. 4) The thesis was concluded as certain recommendations were given for Taiwan government and local hospitals.

Doctor of Philosophy / Department of Geography / Bimal K. Paul / Medical tourism comprises a phenomenon where over five million patients a year are traveling across international borders to obtain various forms of health care. Most of these patients travel from developed countries to developing countries, seeking highly invasive medical treatments to less invasive and recreational medical procedures. By the year 2012, the medical tourism industry generated over $100 billion with over 50 countries making it a priority in trade for their country. With active government promotions, India has become one of the leading destinations for medical tourism. The objective of this research was to answer the questions: 1) how do the attitudes and behaviors of patients towards the concept of medical tourism influence their decision to become a medical tourist; 2) why do medical tourists seek treatment in India; and 3) what are the issues and challenges they face before coming to India as well as while in India. Interviews of thirty-four foreign patients were conducted in six sites spread across the South-Indian cities of Bangalore, Hyderabad, and Chennai which revealed useful information in addressing the research objectives. The three most important reasons that these medical tourists chose India for their treatments were: 1) the high quality of the doctors and medical facilities in India, 2) the affordable cost of treatments, and 3) the availability of specific treatments that might not have been available in their home countries. Patients also researched the topic thoroughly before they came to India. Knowledge was gained primarily from the Internet, print media, television shows and friends. Overall, the patients had very positive attitudes towards medical tourism. Most of them felt that they could get treatment because of their positive opinion on medical tourism, their ability to get treatment if they desired, and support from their families and loved ones.

L’association des concepts de tourisme et de santé, est marquée par une opposition qui découle de la nature des deux concepts. Le lien entre ces deux domaines de la vie des sociétés est protéiforme, et s’inscrit dans l’histoire, les pratiques sociales et l’actualité. Cette relation se décline sous la forme du thermalisme de l’Antiquité, à la création des premiers hôpitaux pour héberger les pèlerins du Moyen Âge, et l’organisation du premier voyage à forfait par Thomas Cook en 1841, dans une campagne contre l’alcool en Angleterre. Aujourd’hui la médecine du voyage et ses recommandations pour les séjours dans les pays tropicaux, de même que les récentes épidémies de portée mondiale, et leurs incidences sur l’économie touristique, ajoutent de nouveaux démembrements à la relation entre la santé et le voyage. Mais c’est par le biais du tourisme médical que cette étude tente d’approfondir le rapport entre les deux concepts. Forme de migration moderne, on découvre un secteur économique rapportant en 2013, près de 60 milliards de dollars, et un modèle économique que tentent de dupliquer de nombreuses destinations. Dans les préalables de ce phénomène, il y a pour ces destinations, une économie touristique efficace, et un secteur de la santé irrigué par un système d’assurance santé, sous son trait universel. Enfin le tourisme médical, dévoile sa face controversée, celle de l’Ethique re-questionnée dans la PMA, ou pour les suites médicales de la pratique, avec les problèmes post-opératoires. Mais c’est surtout sous la forme d’une nouvelle mise en valeur des territoires urbains, que pèse désormais le tourisme médical, en France et ailleurs aussi. / Tourism and health are two concepts, at first sight in opposition. If tourism "is not based on any necessity," health, "engages the lives of individuals and societies." By scrutinizing the two concepts, it emerges a protean relationship that fits into history, social practices and current events. Despite the progress made in medicine, some tourist destinations, for specific epidemiological reasons are still destinations at risk. The current context of globalization, has influences in the field of health. The recent epidemics, H1N1 flu, Coronavirus etc., are today a threat to the planet. These experiences have shown the subjection of the tourism sector to the epidemiological state of the world. At this first connection between health and tourism, there is the one that makes health a consumer good, a design on which medical tourism is based. Medical tourism is a phenomenon brought to life by the media. The ambiguity of the term leads us to confess at the epistemological level of an inappropriate formula. However, it refers to a phenomenon that brings in nearly $ 60 billion in global revenue a year.These economic spinoffs support the expansion of the practice: Asia, Eastern Europe, North Africa, Latin America, and North America. The cost of care on these destinations, mostly emerging countries, Are much lower than in the countries of origin of patients. Legislation on certain medical acts is also important in medico-tourist motivations. PMA, transplants, abortion, participate motivations of medical tourism. However, the observations show a correlation between the emergence of this economic model, and the existence on the one hand, on the one hand, of a rich tourist activity, and on the other,of health insurance mechanism, covering the majority Population. In France we find the conditions for the development of a medical-tourist activity. However, the contribution of the Hexagon to this segment of the world economy is below its capacity, although it must be admitted that some cities are famous for hosting foreign patients. In city marketing, hospital facilities also define the importance of agglomerations. On this fact the cities of Paris, Marseille and Lyon, each has a medical-tourist activity. This study analyzes this segment in each of these cities, with their tourist and sanitary features.Thus, medical tourism is emerging as a new form of development of the territory, in France and elsewhere as well.

The thesis charts the development and importance of medical tourism. The goal is to analyze the market of medical services for foreign clients in selected destinations especially in the Czech Republic and Germany. The thesis explains the basic terms related to health oriented tourism, consists of the information on target medical tourism destinations around the world, analyze the position of the Czech Republic and Germany in the market of health services for foreign clients. The practical part finishes with information on the operation of the particular agency that deals with incoming health tourism in the Czech Republic.

Une littérature de fond sur le tourisme médical a été attribuée aux motivations des touristes médicaux. Des académiciens ont étudié les expériences des touristes médicaux et leur niveau de satisfaction. Néanmoins, le lien entre ces deux concepts a rarement été examiné dans la littérature sur le tourisme médical. Ainsi, cette étude examine les motivations des touristes médicaux destinées pour le tourisme médical et l’effet de ces motivations sur leur perception de la qualité, de la satisfaction, et de l’intention de revisiter. En outre, l’étude vise à explorer les différentes caractéristiques des touristes médicaux qui rendent à des classements différents. L'objectif est d'étudier les caractéristiques qui attirent les touristes médicaux vers la destination, pour améliorer leurs expériences et leurs satisfactions en matière de tourisme médical. De manière empirique, cette étude privilégie la destination touristique médicale, au niveau commercial et national pour un niveau mondial, en abordant les motivations et les perceptions des touristes médicaux. Les fondements théoriques sont tirés de la théorie «push» et «pull», du processus de prise de décision en cinq étapes, en plus des théories issues de la qualité de perception des services et la satisfaction de la littérature. Un cadre conceptuel a été développé pour illustrer la relation entre les variables de l’étude. Les motivations ont été classées en attirer «push» et pousser «pull». Les motivations d'attirer ont été classées en motivations associées à la destination, aux attributs médicaux, à la commodité et au prix. La qualité perçue a été classée en médecine et touristique. Méthodologiquement, l’étude incorpore une approche de triangulation où les données primaires ont été collectées auprès de fournisseurs impliqués dans le tourisme médical via des entretiens et auprès de touristes médicaux via une enquête. Huit entretiens ont été menés avec des fournisseurs de tourisme médical dans les pays d’étude, afin d’obtenir des informations approfondies sur le sujet et de procéder à une vérification plus approfondie du développement des connaissances quantitatives. Au total, 212 réponses ont été obtenues à partir de l’enquête pour vérifier le modèle quantitatif en utilisant le modèle d’équation structurel. D'autres techniques d'analyse des données ont été utilisées, principalement l'Analyse Factorielle Exploratoire et l'Analyse Factorielle Confirmatoire. Les résultats apportent un soutien à certaines relations hypothétiques. Les motivations d'attraction associées aux attributs médicaux affectent la qualité médicale perçue et les motivations d'attraction associées à la destination, aux attributs médicaux et à la commodité affectent la qualité touristique perçue. La qualité perçue à la fois médicale et touristique influe sur la satisfaction, tandis que la satisfaction affecte l’intention de la visite. Les constatations étendent également les applications des théories sous-jacentes pour expliquer le comportement des consommateurs dans le tourisme médical. Les principales théories comprennent un processus de prise de décision en cinq étapes et une théorie de la qualité du service de désaccord. Les implications de la recherche s'étendent au niveau de l'entreprise et au niveau national. Les résultats peuvent aider les gestionnaires impliqués dans les entreprises de tourisme médical, notamment les cliniques, les centres médicaux, les hôtels et les agences de voyages, à réaffecter leurs ressources et à mettre en œuvre les pratiques recommandées susceptibles d'améliorer leurs performances et d'attirer d'autres touristes. Au niveau national, les conclusions sont importantes pour les décideurs clés dans les domaines du tourisme et de la santé. Les résultats et les recommandations peuvent aider à accroître l’attractivité de la destination et à améliorer l’expérience du tourisme médical, ce qui se traduirait par des avantages économiques pour la destination dans son ensemble. / A substantive literature of medical tourism has been attributed to medical tourists' motivations. Academicians have studied medical tourists' experiences and resulting satisfaction level. Nevertheless, the link between these two concepts has seldom been examined in medical tourism literature. Thus, this study examines medical tourists’ motivations for medical tourism destination, the effect of those motivations on their perception of quality, satisfaction and intention to revisit. In addition, the study aims to explore the various characteristics of medical tourists which yields in classifying them into different segments. The objective is to investigate the attributes that attract medical tourists to the destination as well as possible ways to enhance their medical tourism experience and satisfaction. Empirically, the study aims to promote the medical tourism destination at business and national levels to a world-class level by addressing the motivations and perceptions of medical tourists. Theoretical foundations are drawn from push-pull theory, five steps decision-making process, in addition to theories from service perceived quality and satisfaction literature. A conceptual framework was developed to illustrate the relationship between the study variables. The motivations were classified into push and pull. Pull motivations were classified into motivations associated with the destination, medical attributes, convenience and with price. Perceived quality was classified into medical and touristic. Methodologically, the study incorporates a triangulation approach where primary data were collected from suppliers involved in medical tourism via interviews and from medical tourists via survey. Eight interviews were conducted with suppliers of medical tourism in destination of study to obtain an in-depth insight into the subject matter as well as for further verification of quantitative knowledge development. A total of 212 responses were obtained from the survey for verification of the quantitative model using Structural Equation Modeling. Other data analysis techniques were employed, primarily Exploratory Factor Analysis and Confirmatory Factor Analysis. The findings provide support to some hypothesized relationships.The pull motivations associated with medical attributes affect perceived medical quality and the pull motivations associated with destination, medical attributes and convenience affect perceived touristic quality. Both medical and touristic perceived quality affect satisfaction while satisfaction affected intention to revisit. The findings as well extend the applications of the underpinned theories in explaining consumer behavior in medical tourism. The main theories include five steps decision-making process and disconfirmation service quality theory. The implications of the research extend to business level and national level. The results can help managers involved in medical tourism businesses including clinics, medical centers, hotels and travel agencies to reallocate their resources and implement the recommended practices that can improve their performance and attract additional medical tourists. On a national level, the findings are significant to key decision makers in the fields of tourism and healthcare. The outcomes and recommendations can assist in increasing the attractiveness of the destination and improving the medical tourism experience which would result in economic benefit to the destination as a whole.

This thesis concerns Swedes’ medical tourism to Poland with an indication of  travelling for beauty treatments. Its goal is to study Swedes travelling to Poland because of aesthetic medicine purposes. Trips with medical background, e.g. surgeries, dental treatments or spa/wellness tourism were not taken into account in this assignment. However, in many aspects, some of this data were also included because of the unavailability of more precise sources. The aim has also been to try to reach an insight in what kind of factors and motivations cause that more and more Swedes choose to seek medical help in Poland. The goal has been also to show how the future of this kind of tourism could look like. The study is based on qualitative interviews with clinics and medical centres performing those treatments and patients/customers with such an experience. The theoretical framework concerns laws and regulations, also personal motivations and needs. I came to the conclusion that there are several reasons for people to travel to Poland for medical services: relative low costs of treatment, high quality of service and technology, short waiting periods, insignificant cultural differences and geographical proximity of both of the countries.

No description available.

Les services reproductifs transfrontaliers (SRT) réfèrent au déplacement d'une juridiction à une autre, de personnes ou de matériel reproductif dans le cadre d'un projet de procréation assistée (PA). Ce phénomène a été observé dans de nombreux pays, mais le système de PA mondialisé canadien, ou reproscape, demeure sous-étudié. Ce manque de connaissances nuit au développement normatif en matière de PA. En adoptant un cadre conceptuel issu de l'anthropologie médicale, l'objectif général de cette thèse était de décrire et comprendre le reproscape canadien. Pour alimenter la réflexion éthique et juridique et la prestation des services de PA, nous avons réalisé une enquête ethnographique clinique multisite combinant : (1) une revue de la littérature, (2) l'observation participante et non participante de deux cliniques de fertilité (Québec et Ontario), d'une agence d'importation de gamètes et d'une dizaine de congrès scientifiques, ainsi que (3) des entrevues semi-dirigées avec 45 actrices et acteurs des SRT : personnes utilisatrices, personnel médical et intermédiaires. Les données ont fait l'objet d'une analyse qualitative inductive, assistée du logiciel NVivo 11. Trois dimensions émergent de nos résultats. (1) Le Canada se caractérise par une mosaïque de lois et de règlements locaux, fédéraux et provinciaux qui influencent de façon paradoxale les SRT. L'obligation de don altruiste, établie par la Loi sur la procréation assistée (LPA), joue un rôle prédominant sur le reproscape canadien. (2) Au niveau de l'expérience des SRT, la simplicité de certains SRT intégrés à la pratique clinique, comme l'importation de sperme ou d'ovocytes, contraste avec la complexité des voyages vers l'étranger auxquels les personnes utilisatrices se sentent souvent contraintes. (3) Interrogées sur leurs perspectives éthiques, quatre positions principales ressortent des entrevues: (a) le respect de leur autonomie reproductive, (b) les risques individuels et (c) sociaux des SRT, dont celui d'exploitation des gestatrices et des donneuses d'ovules, ainsi que (d) les incohérences de la LPA quant à sa capacité d'atténuer ces risques. En conclusion, le reproscape canadien se caractérise, entre autres, par une situation de " sous-traitance reproductive " : une reconnaissance institutionnelle des SRT, combinée à une délocalisation des risques moraux et médicaux hors des frontières nationales. Les conclusions de notre étude mettent en évidence le caractère inextricable du local et du global en PA et comment le reproscape mondial fonctionne par vases communicants. / Abstract : Cross-border reproductive care (CBRC) refers to the movement from one jurisdiction to another of persons or reproductive material as part of assisted reproductive technology (ART) treatment. This phenomenon has been observed in many countries, but the Canadian globalized ART system (or "reproscape") remains understudied empirically. This lack of data undermines the normative development in terms of ART. The aim of this dissertation is to describe and understand the Canadian reproscape in order to support ethical and legal reflection. To achieve this goal, we conducted a multi-site clinical ethnography combining (1) literature reviews, (2) participant and non-participant observation in two fertility clinics (Quebec and Ontario), a gamete importation and distribution agency and a dozen scientific congresses, (3) as well as semi-directed interviews with 45 actors of CBRC: users, medical professionals and intermediaries. The data were analyzed by inductive qualitative analysis assisted by NVivo 11 software. Three dimensions emerge from our results. (1) Regarding the legal and clinical contexts of ART, Canada is characterized by a local mosaic of laws and regulations that paradoxically influence CBRC. The altruistic obligation established by the Assisted Human Reproduction Act (AHRA) plays a predominant role on the reproscape. (2) In terms of the experience of the main actors, the simplicity of CBRC integrated to the clinic, such as the import of semen or oocytes, contrasts with the complexity of journeys abroad for which users often feel constrained. (3) When asked about their ethical perspectives, the actors mentioned four main positions: (a) the respect for their reproductive autonomy, (b) the individual and (c) social risks of CBRC, including the exploitation of egg donors as well as gestational surrogates, and (d) AHRA inconsistencies in its ability to mitigate these risks. Our conclusion is that the Canadian reproscape is characterized, inter alia, by a situation of "reproductive outsourcing." This concept is characterized by an institutional recognition of CBRC combined with a relocation of moral and medical risks outside national borders. The results of our study underline the inextricable local and global nature of ART and how CBRC works as communicating vessels.