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BMC Health Services Research
Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | Research

Medical tourism among Indonesians: a scoping review

Authors: Gregorius Abanit Asa, Nelsensius Klau Fauk, Caitlan McLean, Paul Russell Ward

Published in: BMC Health Services Research | Issue 1/2024

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Abstract

Background

International medical travel or medical tourism is not a new phenomenon in many countries, including among Indonesians. Indonesia is reported as a major source of patients from the lower, middle, to upper classes for its neighbouring countries. This scoping review aims to synthesise evidence on supporting factors for Indonesians taking medical tourism and what needs to be improved in Indonesia’s health system.

Methods

We conducted a scoping review guided by a framework provided by Arksey and O’Malley. We systematically searched existing literature from 5 databases, including MEDLINE, PubMed, Scopus, ProQuest, and Wiley. Data were extracted based on study details, study design, characteristics of participants and results. Analysis followed the three-stage procedure outlined by Thomas and Harden: (1) coding the text line by line, interpreting the data and identifying concepts or themes; (2) developing descriptive themes by grouping similar concepts in theme and subtheme and (3) generating analytical themes by reviewing preliminary themes and discussing the addition or revision of themes.

Results

A total of 25 articles were included in this review. The review highlights a broad range of facilitators for medical tourism among Indonesians: (i) availability of health services, medical specialities, and person-centred care, (ii) region adjacency, transport, and health agency, (iii) affordability of medical treatment, (iv) religious and socio-cultural factors, and (v) reasons patients reported distrust in Indonesian doctors.

Conclusion

The findings indicate improvements in the Indonesian health system are necessary if the increasing rates of international medical tourism by Indonesian people are to change. Addressing the factors identified in this scoping review through avenues including policy may increase people’s satisfaction and trust towards health care and treatment in Indonesia, thereby reducing the number of Indonesian people taking medical tourism.
Appendix
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Literature
1.
An D. Understanding medical tourists in Korea: cross-cultural perceptions of medical tourism among patients from the USA, Russia, Japan, and China. Asia Pac J Tourism Res. 2014;19(10):1141–69.CrossRef
2.
Birch DW, Vu L, Karmali S, Stoklossa CJ, Sharma AM. Medical tourism in bariatric Surgery. Am J Surg. 2010;199(5):604–8.PubMedCrossRef
3.
Abubakar AM, Ilkan M. Impact of online WOM on destination trust and intention to travel: a medical tourism perspective. J Destination Mark Manage. 2016;5(3):192–201.
4.
Ben-Natan M, Ben-Sefer E, Malka Ehrenfeld R. Medical tourism: a new role for nursing? Online J Issues Nurs. 2009;14(3):B1.CrossRef
5.
Cook P. What is health and medical tourism? Reimagining Sociology. 2008:1–13.
6.
Lee M, Han H, Lockyer T. Medical tourism—attracting Japanese tourists for medical tourism experience. J Travel Tourism Mark. 2012;29(1):69–86.CrossRef
7.
Connell J. Contemporary medical tourism: Conceptualisation, culture and commodification. Tour Manag. 2013;34:1–13.CrossRef
8.
Crooks VA, Kingsbury P, Snyder J, Johnston R. What is known about the patient’s experience of medical tourism? A scoping review. BMC Health Serv Res. 2010;10(1):1–12.CrossRef
9.
Keckley P, Underwood H. Medical tourism: update and implications. Washington, DC: Deloitte Center for Health Solutions; 2009.
10.
Ganguli S, Ebrahim AH. A qualitative analysis of Singapore’s medical tourism competitiveness. Tourism Manage Perspect. 2017;21:74–84.CrossRef
11.
12.
Whittaker A, Chee HL. Perceptions of an ‘international hospital’in Thailand by medical travel patients: cross-cultural tensions in a transnational space. Soc Sci Med. 2015;124:290–7.PubMedCrossRef
13.
Cham T-H, Lim Y-M, Sia B-C, Cheah J-H, Ting H. Medical tourism destination image and its relationship with the intention to revisit: a study of Chinese medical tourists in Malaysia. J China Tourism Res. 2021;17(2):163–91.CrossRef
14.
Teh I. Healthcare tourism in Thailand: Pain ahead? Asia-Pacific Biotech News. 2007;11(08):493–7.CrossRef
15.
Connell J. Medical tourism: Sea, sun, sand and… Surgery. Tour Manag. 2006;27(6):1093–100.CrossRef
16.
Leng CH. Medical tourism and the state in Malaysia and Singapore. Global Social Policy. 2010;10(3):336–57.CrossRef
17.
Chee HL, Whittaker A, Yeoh BS. International medical travel and the politics of transnational mobility in Asia. Asia Pac Viewp. 2017;58(2):129–35.CrossRef
18.
19.
Purwanto H. 550,000 Indonesians go to Malaysia for medical treatment per year. 2015.
20.
Abd Manaf NH, Hussin H, Jahn Kassim PN, Alavi R, Dahari Z. Country perspective on medical tourism: the Malaysian experience. Leadersh Health Serv. 2015;28(1):43–56.CrossRef
21.
Musa G, Thirumoorthi T, Doshi D. Travel behaviour among inbound medical tourists in Kuala Lumpur. Curr Issues Tourism. 2012;15(6):525–43.CrossRef
22.
Yeoh E, Othman K, Ahmad H. Understanding medical tourists: Word-of-mouth and viral marketing as potent marketing tools. Tour Manag. 2013;34:196–201.CrossRef
23.
Mahendradhata Y. Proceed with caution: potential challenges and risks of developing healthcare tourism in Indonesia. Glob Public Health. 2019;14(3):340–50.PubMedCrossRef
24.
25.
Pocock NS, Phua KH. Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia. Globalization and Health. 2011;7(1):1–12.CrossRef
26.
27.
28.
29.
30.
Ormond M. Solidarity by demand? Exit and voice in international medical travel - the case of Indonesia. Social science & medicine (1982). 2015;124:305– 12.
31.
Gray HH, Poland SC. Medical tourism: crossing borders to access health care. Kennedy Inst Ethics J. 2008;18(2):193–201.PubMedCrossRef
32.
Turner L. Cross-border dental care:‘dental tourism’and patient mobility. Br Dent J. 2008;204(10):553–4.PubMedCrossRef
33.
Howze KS. Medical tourism: symptom or cure. Ga L Rev. 2006;41:1013.
34.
Horowitz MD. Medical tourism-health care in the global economy. Phys Exec. 2007;33(6):24.
35.
Whittaker A, Chee HL, Por HH. Regional circuits of international medical travel: prescriptions of trust, cultural affinity and history. Asia Pac Viewp. 2017;58(2):136–47.CrossRef
36.
Bennett L, Pangestu M. Regional reproductive quests: cross-border reproductive travel among infertile Indonesian couples. Asia Pac Viewp. 2017;58(2):162–74.CrossRef
37.
Abdullah AR, Cheah S, Mulia VB, Abdul Fatah I. Factors attracting Indonesian medical tourists to Penang. African Journal of Hospitality, Tourism and Leisure, GCBSS Special Edition. 2019:1–10.
38.
Kumar J, Hussian K. Factors affecting medical tourism destination selection: a Malaysian perspective. J Global Bus Insights. 2016;1(1):1–10.CrossRef
39.
Durham J, Blondell SJ. A realist synthesis of cross-border patient movement from low and middle income countries to similar or higher income countries. Globalization and Health. 2017;13.
40.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.CrossRef
41.
Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:1–9.CrossRef
42.
Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(1):1–10.CrossRef
43.
Asa GA, Fauk NK, Ward PR. Traditional male circumcision and the risk for HIV transmission among men: a systematic review. BMJ Open. 2023;13(5):e072118.PubMedPubMedCentralCrossRef
44.
Ormond M. En route: transport and embodiment in international medical travel journeys between Indonesia and Malaysia. Mobilities. 2015;10(2):285–303.CrossRef
45.
Ormond M, Sulianti D. More than medical tourism: lessons from Indonesia and Malaysia on South–South intra-regional medical travel. Curr Issues Tourism. 2017;20(1):94–110.CrossRef
46.
Chee HL, Whittaker A. Moralities in international medical travel: moral logics in the narratives of Indonesian patients and locally-based facilitators in Malaysia. J Ethnic Migration Stud. 2020;46(20):4264–81.CrossRef
47.
Md Zain NA, Connell J, Mohd Zahari MS, Hanafiah MH. Intra-regional Medical Tourism demand in Malaysia: a qualitative study of Indonesian medical tourists’ rationale and preferences. Malays J Med Sci. 2022;29(2):138–56.PubMedPubMedCentral
48.
Chee HL, Whittaker A, Por HH. Sociality and transnational social space in the making of medical tourism: local actors and Indonesian patients in Malaysia. Mobilities. 2019;14(1):87–102.CrossRef
49.
Ormond M. Solidarity by demand? Exit and voice in international medical travel–the case of Indonesia. Soc Sci Med. 2015;124:305–12.PubMedCrossRef
50.
Budiwan V. The understanding of Indonesian patients of hospital service quality in Singapore. Procedia-Social and Behavioral Sciences. 2016;224:176–83.CrossRef
51.
Manaf NHA, Hussin H, Kassim PNJ, Alavi R, Dahari Z. Medical tourism service quality: finally some empirical findings. Total Qual Manage Bus Excellence. 2015;26(9–10):1017–28.CrossRef
52.
Saragih HS, Jonathan P. Views of Indonesian consumer towards medical tourism experience in Malaysia. J Asia Bus Stud. 2019;13(4):507–24.CrossRef
53.
Angela J, Suryono IB, Wijaya S. Profiling Indonesian medical tourists: a motivation-based segmentation study. Petra Christian University; 2020.
54.
Nasution NH, Aulia D, Siregar FA. Comparation of direct and indirect costs for medical tourism patient to Penang Island Malaysia in 2019. 2020.
55.
Widiyastuty F, Suryawati C, Arso SP. Mengapa Masyarakat Kecamatan Entikong Kabupaten Sanggau Berobat Ke Sarawak, Malaysia. Jurnal Kesehatan Komunitas. 2023;9(1):115–21.CrossRef
56.
Adiwidjaja I, Dhuhaniyati L. Implikasi Pelayanan Prima (Service Excellence) Dan Paket Agenda Reformasi Layanan Kesehatan: Pelajaran Menarik Dari Singapura Dan Malaysia Bagi Indonesia. Reformasi. 2012;2(2).
57.
Kwary ML. Pengaruh Faktor Motivasi Dan Reputasi Rumah Sakit terhadap behavioral intention Kunjungan Medis Ke Malaysia. Agora. 2019;7(2).
58.
Morissan M, Gan GGG. Motivation and loyalty of Indonesian medical tourists toward Malaysian health services. International Journal of Research in Business and Social Science (2147–4478). 2021;10(6):295–305.
59.
Ratnasari RT, Gunawan S, Pitchay AA, Mohd Salleh MC. Sustainable medical tourism: investigating health-care travel in Indonesia and Malaysia. Int J Healthc Manag. 2022;15(3):220–9.CrossRef
60.
Nuryani A. Indonesian medical travel and Wedhang Corona: an international webinar review. Int J Spa Wellness. 2020;3(1):56–9.CrossRef
61.
Bell D, Holliday R, Ormond M, Mainil T. Transnational healthcare, cross-border perspectives. Soc Sci Med. 2015;124:284–9.PubMedCrossRef
62.
Budiwan V, Efendi. The Understanding of Indonesian Patients of Hospital Service Quality in Singapore. Procedia - Social and Behavioral Sciences. 2016;224:176–83.CrossRef
63.
Durham J. Cross-border patient movement from the Lao PDR and the interplay between social networks and economic and cultural capital: a qualitative study. Asia Pac Viewp. 2017;58(2):175–89.CrossRef
64.
Ediansyah, Arief M, Hamsal M, Abdinagoro SB. Interplay between Networking Capability and Hospital Performance in Indonesia’s Medical Tourism Sector. Int J Environ Res Public Health. 2022;20(1).
65.
Booth A. Health challenges in Indonesia. J Community Med Health Solut. 2023;4:007–9.CrossRef
66.
Efendi F, Chen CM, Nursalam N, Andriyani NWF, Kurniati A, Nancarrow SA. How to attract health students to remote areas in Indonesia: a discrete choice experiment. Int J Health Plann Manag. 2016;31(4):430–45.CrossRef
67.
Seeberg J, Pannarunothai S, Padmawati RS, Trisnantoro L, Barua N, Pandav CS. Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand. Soc Sci Med. 2014;102:49–57.PubMedCrossRef
68.
Kanchanachitra C, Lindelow M, Johnston T, Hanvoravongchai P, Lorenzo FM, Huong NL, et al. Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services. Lancet. 2011;377(9767):769–81.PubMedCrossRef
69.
Asa GA, Fauk NK, Mwanri L, Ward PR. Understanding barriers to the access to healthcare and rehabilitation services: a qualitative study with mothers or female caregivers of children with a disability in Indonesia. Int J Environ Res Public Health. 2021;18(21):11546.PubMedPubMedCentralCrossRef
70.
71.
Asmaningrum N, Kurniawati D, Tsai YF. Threats to patient dignity in clinical care settings: a qualitative comparison of Indonesian nurses and patients. J Clin Nurs. 2020;29(5–6):899–908.PubMedCrossRef
72.
73.
Gan LL, Frederick JR. Medical tourism facilitators: patterns of service differentiation. J Vacation Mark. 2011;17(3):165–83.CrossRef
74.
Dalstrom M. Medical travel facilitators: connecting patients and providers in a globalized world. Anthropol Med. 2013;20(1):24–35.PubMedCrossRef
75.
Ekawati FM, Claramita M, Hort K, Furler J, Licqurish S, Gunn J. Patients’ experience of using primary care services in the context of Indonesian universal health coverage reforms. Asia Pac Family Med. 2017;16:1–10.
76.
Fauk NK, Seran AL, Raymond C, Merry MS, Tahir R, Asa GA, et al. Why do we not follow lifesaving rules? Factors affecting nonadherence to COVID-19 prevention guidelines in Indonesia: healthcare professionals’ perspectives. Int J Environ Res Public Health. 2022;19(14):8502.PubMedPubMedCentralCrossRef
77.
Ward P. To trust or not to trust (in doctors)? That is the question. BMJ Publishing Group Ltd; 2018. pp. 718–20.
78.
Asa GA, Fauk NK, Gesesew HA, Foley KM, Lunnay B, Ward PR. Understanding public perceptions in social media responses to posts about acute severe hepatitis of unknown etiology in Indonesia: a qualitative study. BMC Infect Dis. 2023;23(1):306.PubMedPubMedCentralCrossRef
79.
Mutiarasari D, Demak IPK, Bangkele EY, Nur R, Setyawati T. Patient satisfaction: Public vs. private hospital in Central Sulawesi, Indonesia. Gac Sanit. 2021;35:186–S90.CrossRef
80.
Handayani PW, Hidayanto AN, Ayuningtyas D, Budi I. Hospital information system institutionalization processes in Indonesian public, government-owned and privately owned hospitals. Int J Med Informatics. 2016;95:17–34.CrossRef
Metadata
Title
Medical tourism among Indonesians: a scoping review
Authors
Gregorius Abanit Asa
Nelsensius Klau Fauk
Caitlan McLean
Paul Russell Ward
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-023-10528-1

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