Chan Chee Khoon

Medical tourism in Malaysia: how can we better identify and manage its advantages and disadvantages?

Following the identification of medical tourism as a growth sector by the Malaysian government in 1998, significant government sector and private-sector investments have been channeled into its development over the past 15 years. This is unfolding within the broader context of social services being devolved to for-profit enterprises and ‘market-capable’ segments of society becoming sites of intensive entrepreneurial investment by both the private sector and the state. Yet, the opacity and paucity of available medical tourism statistics severely limits the extent to which medical tourisms impacts can be reliably assessed, forcing us to consider the real effects that the resulting speculation itself has produced and to reevaluate how the real and potential impacts of medical tourism are – and should be – conceptualized, calculated, distributed, and compensated for. Contemporary debate over the current and potential benefits and adverse effects of medical tourism for destination societies is hamstrung by the scant empirical data currently publicly available. Steps are proposed for overcoming these challenges in order to allow for improved identification, planning, and development of resources appropriate to the needs, demands, and interests of not only medical tourists and big business but also local populations.

Re-inventing the Welfarist State? The Malaysian Health System in Transition

Abstract This paper begins with a theoretical perspective on privatisation which links it with systemic tendencies towards over-accumulation in the global capitalist economy. To analyse health system dynamics, the health system is conceptualised as an articulation of component sub-systems (provision, financing, treatment accessories, support services, research and product development, education and training, etc.). These sub-systems are increasingly brought within the circuit of capital, in the process re-configuring the fine structure of the system along with its built-in incentives and disincentives which interactively modulate the systems overall operating characteristics. The rest of the paper provides an update on the evolving role of the Malaysian state as provider, as financier, as investor and as regulator of the health system.

Donor leverage: towards more equitable access to essential medicines?

In early 2007, the Indonesian government decided to withhold its samples of the avian influenza (‘bird flu’) virus from WHOs collaborating centres, pending a new global mechanism for virus sharing which would provide better terms for developing countries. The 60th World Health Assembly held in May 2007 subsequently resolved to establish an international stockpile of avian influenza vaccines, and to formulate mechanisms for equitable access to these vaccines. The article asks whether there are there analogous opportunities for study volunteers or donors of biological materials to exercise corresponding leverage to advance health equity.In early 2007, the Indonesian government decided to withhold its samples of the avian influenza (‘bird flu’) virus from WHOs collaborating centres, pending a new global mechanism for virus sharing which would provide better terms for developing countries. The 60th World Health Assembly held in May 2007 subsequently resolved to establish an international stockpile of avian influenza vaccines, and to formulate mechanisms for equitable access to these vaccines. The article asks whether there are there analogous opportunities for study volunteers or donors of biological materials to exercise corresponding leverage to advance health equity.

Patents or patients? global access to pharmaceuticals and social justice

Innovation, vaccine development, and world-wide equitable access to necessary pharmaceuticals are hindered by current patenting arrangements and the orientation of pharmaceutical research. Plausible alternatives exist, including instituting the right of national or international agencies to act in the public interest and to buy patents selectively with a view to innovation and equitable access. Alternatives could partly or wholly finance themselves and lower pharmaceutical prices globally. Countries, individuals or groups of patients could help promote alternatives by calling into question the current emphasis on commercialization and profit, and by demanding globally equitable arrangements when sharing data that are important for research or when individuals or communities volunteer as research participants.

Healthcare entitlements for citizens and trans-border mobile peoples in Southeast Asia

This chapter focuses on transborder issues shaping transitions in Southeast Asian countries’ health systems. In section 1, we address the regionalisation of health governance by examining economic and social policies and charters affecting health and healthcare within ASEAN. We look specifically at sovereignty concerns and shifts in national and sub-national responsibility/accountability, the circulation of health workers within the scope of the AEC, and the ‘emptiness’ of multi-lateral commitment on public health issues (e.g., tobacco and pollution). In section 2, we focus on the privatisation/commoditisation of health care, giving attention to the status of universal health coverage in select Southeast Asian countries as well as the growth in transborder flows of investment/ownership and health care provision/pursuits. Section 3 is dedicated to questions of vulnerability, health equity, rights and justice. It explore the effects of the issues described in sections 1 and 2 on different citizen/non-citizen and internal/international populations (e.g., economic migrants, refugees/asylum-seekers, environmental displacees, etc.).

Renegotiating the Social Contract: Challenges to Health and Social Policy in Japan

128 Chan Chee Khoon is professor of epidemiology and health policy in the Development Studies Program at the School of Social Sciences, Universiti Sains Malaysia. This is a significantly revised and updated version of an article that was posted in September 2005 on Japan Focus, an e-journal. The author acknowledges support from the Nippon Foundation. The Japanese Economy, vol. 33, no. 4, Winter 2005–6, pp. 128–45.