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This paper articulates the function of Malaysia Healthcare Travel Council (MHTC) in developing the Health
Tourism Industry. Focus was given in identifying the challenges faced by MHTC, understanding the
competitiveness of the industry and proposing a suitable value chain framework for the industry. Total of 12
organizations have been identified, which were including private and public organizations. Conclusions of
findings have been derived and few recommendations made at the end of this article.
Keywords: Health tourism, medical tourism, competitive, leisure services and value chain

Published in: Business
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  1. 1. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 58 INVESTIGATING CRITICAL SUCCESS FACTORS OF VALUE CHAIN IN HEALTH TOURISM INDUSTRY IN MALAYSIA Noorainie Saadiah Mohd Salleh Malaysian External Trade Development, Malaysia Syed Jamal Abdul Nasir Syed Mohamad Universiti Teknologi MARA, Malaysia Siti Syairah binti Taib Malaysian Oxigen, Malaysia ABSTRACT This paper articulates the function of Malaysia Healthcare Travel Council (MHTC) in developing the Health Tourism Industry. Focus was given in identifying the challenges faced by MHTC, understanding the competitiveness of the industry and proposing a suitable value chain framework for the industry. Total of 12 organizations have been identified, which were including private and public organizations. Conclusions of findings have been derived and few recommendations made at the end of this article. Keywords: Health tourism, medical tourism, competitive, leisure services and value chain Introduction Medical Tourism or Health Tourism essentially refers to the practice of traveling to another country for medical treatment. Reasons for doing this vary from the poor quality medical services in patient‟s home country to high prices in more developed countries. Other countries also cover a wide array of services, which are not available at the home country. Other than that, some of the procedures are restricted at home country due to culture, religion or regulatory factors. Most of the foreign patients traveled outside their home country to seek for better standard of healthcare services and enjoy more competitive procedure pricing. Other than that, long waiting time in the home country has become another reason for them to travel abroad. Asia is expected to generate USD 4.4 billions by year 2012. As at 2007, the industry had grown 4 to 6 percent in general travel bookings, with the number of medical tourist visits to many countries swelling by 20 to 30 percent (Placidway). Malaysia is ranked among the best in the world for its medical expertise and becoming the preferred regional healthcare hub due to highly competitive medical charges and hospitalization costs compared to those in many developed countries. Foreign patients who sought treatment in Malaysian private hospitals were from Indonesia, Japan, Europe, India, China, USA, Australia, Singapore and Korea (Association of Private Hospital Malaysia). Malaysia‟s health tourism offers a winning combination of health and leisure services, which aim to be an unbeatable combination of sophisticated healthcare hub and world-famous tourist heaven. It is now becoming one of Malaysia‟s most important sectors, which generate significant revenue for the country. One of the efforts taken by the Malaysian government to attain the objective was to establish Malaysia Healthcare Travel Council (MHTC) on the 21st December 2009 which brought together the synergistic efforts of significant players in the Malaysian healthcare travel industry, both in government and private sector. The vision is to posit Malaysia as the preferred destination for world class healthcare services while the missions are to promote global awareness of Malaysian healthcare facilities and facilitate the development of the Malaysian healthcare industry. According to Mr. Alhadi (Personal communication on the 5.3.2010,) the Assistant Secretary from Malaysia Healthcare Travel Council (MHTC), the council will incorporate public-private sector collaboration to formulate strategic plans for the development and promotion of health tourism services. MHTC is the focal point or „one-stop-centre‟ on all matters related to health tourism and facilitates enquiries on policies and promotional programmes related to health tourism development and can contribute to the growth of the country and also raise Malaysia's international profile as a country that provides quality healthcare services. Thirty five private hospitals have been identified as promoters of medical tourism in Malaysia. Kuala Lumpur, Penang and Melaka are three cities, which have
  2. 2. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 59 become major centers of medical treatment for overseas visitors (Association of Private Hospital Malaysia). According to the Association of Private Hospitals of Malaysia (APHM), in 2008, total numbers of foreign patients were 374,063 which contributed up to RM299.08 millions revenue to the country. Given the huge revenue potential and growing interest in Malaysia, the government has decided to increase their focus on this segment of the tourism and medical industries. Table 1: Statistics of foreign patients in Malaysia Source: Association of Private Hospital of Malaysia (APHM) According to Mr. Alhadi, the Assistant Secretary from Malaysia Healthcare Travel Council (MHTC), rival countries such as India, Thailand and Singapore have made a name for themselves in the health tourism industry. The council main focus is transforming Malaysia to an international reputation for excellence in the provision of healthcare. In competing with the rival countries, the main issue is how to achieve competitive advantage of the industry? The value chain framework should assist MHTC in identifying and creating additional competitive the advantage of the industry. Therefore, the objectives of the study are:  To identify the opportunities and threats faced by MHTC.  To determine Health Tourism Industry‟s competitiveness.  To propose a value chain framework for the Malaysia Health Tourism Industry to MHTC Research Methodology This research was conducted using mix method approach which the exploratory research design was undertaken on this study as there was very minimal information available and further information is needed for developing the value chain of the industry. While Quantitative analysis was used to analyze the impact and competitive profile matrix of the MHTC.Extensive interview sessions have been conducted to obtain information and at the same to enhance researcher understandings with regard to the Malaysia Health Tourism Industry. The interviewee is an integral part of the investigation (Merriam and Associates, 2002). The timeframe of collecting data is based on the cross-sectional studies and interview sessions were conducted over a period of one month, from month of March to April 2010. The sample for this study covered from 4 representatives from ministry and government agencies, 1 from association, and 7 private hospitals Year No of Patients Receipts (RM mil) 2003 102,946 58.90 2004 174,189 104.98 2005 232,161 150.92 2006 296,687 203.66 2007 341,288 253.84 2008 374,063 299.08
  3. 3. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 60 in Klang Valley and Putrajaya, which have been identified as the Health Tourism promoter. The lists of the organizations selected are as below: i) Malaysia Healthcare Travel Council (MHTC) ii) Ministry of Health (MOH) iii) Tourism Malaysia iv) Malaysia External Trade Development Corporation (MATRADE) v) Association of Private Hospitals of Malaysia (APHM) vi) KPJ Healthcare Berhad vii) Pantai Hospital Bangsar, Kuala Lumpur viii) Prince Court Medical Centre, Kuala Lumpur ix) Sime Darby Medical Centre, Selangor x) National Heart Institute, Kuala Lumpur xi) Gleneagles Intan Medical Centre, Kuala Lumpur xii) Tropicana Medical Centre, Kuala Lumpur Three analysis theory or models which are SWOT analysis, Porter‟s 5 Forces and Value Chain analysis have been identified as the main tools for this research. All these models were used to answer the objectives of this study. Apart from that, findings from these three models were used to draw a conclusion and suitable recommendations to MHT xiii) Findings and Analysis SWOT Analysis of MHTC SWOT analysis has been conducted to answer objective number 1 which relates to MHTC‟s current challenges and opportunities. Strength S1 - MHTC is strongly supported by the Malaysian Government and established under Ministry of Health Malaysia. S2 - MHTC is working closely with Association of Private Hospital Malaysia (APHM), Government promotion agencies (MATRADE and TOURISM Malaysia) and healthcare service provider to promote the Health Tourism Industry. SWOT ANALYSIS PORTER’S 5 FORCES ANALYSIS VALUE CHAIN ANALYSIS VALUE CHAIN FRAMEWORK OF HEALTH TOURISM INDUSTRY
  4. 4. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 61 Weaknesses W1 – Shortage of human resources. Since the end last year, the council is only represented by three people. W2 – Lack of coordination among the key industry players due to NIL in house programme organized by MHTC since last year. W3 – Lack of exposure about MHTC‟s roles and function to healthcare service provider Opportunities O1 – Malaysia is looking into market diversification. Increasing trend of foreigners to travel to developing countries and trend is expected to continue. The target markets are Indonesia (existing), USA and European countries. O2 – Direct airlines connectivity, especially from the low cost/ budget airlines which will assist to attract Malaysia as a destination of choice. O3 – Expanding international network with collaboration of APHM, Tourism and MATRADE. The association and government agencies are aggressively organizing events related to healthcare industry. APHM will be organizing medical tourism conferences in Malaysia, while Tourism and MATRADE will be organizing international mission to foreign countries. Threats T1 – With current economic turmoil, Government‟s budget for promotional activities is very limited. With very limited budget from the government, aggressive promotion activities may be hindered. T2 – There will be concerns about potential inequalities developing access and quality of healthcare available to tourist versus what is available to local people. T3 – Emergence of new players such as Taiwan and Philippine. These countries are aggressively promoting their health tourism industry. Health Ministry of Taiwan has launched “International Flagship Program for Medical Services” to further boost the industry. All these have government Remarks (+) denotes that a strength that company possessed would help it to take advantage (-) denotes that strength would be reduced by the environmental changes (0) indicates that current strength or weaknesses would not be affected by the environmental changes Based on the impact analysis (Table 2), it suggested that MHTC main strength is that the council is fully supported by the Government. This is because, with strong support by the Government it enables MHTC to further expand the International network, to further expand the market for Health Tourism sector and to able to resolve the misconception or of the public with regard to inequality of the services offered to domestic and foreign patients. All these are further supported by the close working relation with other Government agencies such as MATRADE, Ministry of Health, APHM and Tourism Malaysia. The main threat faced by MHTC is contributed by the limited funds available which hindered MHTC from organizing any promotional programme to the industry players. This is a further burden by very limited resources available (workforce) that further hindered MHTC to rigorously promoting the industry. Since there are nil promotion programmes, the market diversification of the industry is also delayed, and MHTC is unable to attract patients with direct Airlines connectivity and frequent flights availability. The scores in the environmental impact, in terms of successfulness of MHTC to promote the Malaysia Health Tourism Industry do not look very promising, with aggregated negative scores against each of the likely environmental changes. This suggests that strengths of MHTC are likely to be offset by existing weaknesses as mentioned earlier backed health tourism programs and are trying to catch up fast.
  5. 5. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 62 Table 2: Impact Analysis for Malaysia Healthcare Travel Council (MHTC) Porter Five Forces This analysis model has been used to answer objective no 2 with regard to identify the competitiveness of the industry. Table 3: Summary of Evaluation of External Forces to Health Tourism Industry External Forces Evaluation Treat of Substitutes Moderate Barrier of new entry High Buyers bargaining power High Supplier bargaining power Low Competitive rivalry High Based on the summary findings (Table 4), it indicated that the Health Tourism Industry in Malaysia is very competitive. The competitive rivalry is High as there are 35 hospitals have been appointed as the Health Tourism promoters. The buyers also have high bargaining power as they are looking at better standard of care, efficiency in services and competitive procedures pricing. The substitute power is moderate as TCM is yet to be promoted under Health Tourism industry. Barrier of new entry is high as there are few stringent requirements that must be met by the new private hospitals before it can be part of the Health Tourism promoters. On the other hand, Supplier bargaining power is low thus it is crucial for every hospital to extensively promoting their services through rigorous promotional activities. MHTC must come out with a strategic plan to promote Malaysian hospitals and at the same time to brand Malaysia as a destination of choice. Opportunities / Threats Market Diversificati on Airlines Connection Internationa l Network Limited budget Inequality Emergence of new player Strengths Supported by the Government +3 +3 +5 -3 +2 -1 Close Working Group +3 +1 +3 0 +1 -1 Weaknesses Shortage of human resource -2 0 -2 -3 -1 -2 No export promotion programme -3 -3 -3 -5 0 -2 Lack of exposure of MHTC‟s function -1 0 -1 0 -1 -1 Environmental Impact Scores +6 +4 +8 - +3 - -6 -3 -6 -11 -2 -7
  6. 6. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 63 Finding - Key Success factors of the Industry Identifying CSFs is important as it allows organizations to focus their efforts on building their capabilities to meet the CSFs, or even allow organizations to decide if they have the capability to build the requirements necessary to meet critical success factors.  Competitive pricing The main key success factor is the medical services pricing. Competitive or rather low pricing with high quality assurance will attract more foreign patients to come. It is very crucial in ensuring medical services pricing is at a very competitive level in comparison to other reputable countries in promoting medical tourism.  Accreditation Accreditation by the government or certified body such as Malaysia Society for Quality in Health (MSQH) and ISO is very important in ensuring the success of the industry. International accreditation such as International Joint Commission (JCI) is very important as well as most of the insurance company will only allow patients to seek treatment abroad at a hospital which accredited by JCI only.  Technology Advancement State-of the art machines/equipment and facilities are another element in the key success factors of the industry. All medical tourism promoters must ensure that all the machines/ equipment used are latest and support facilities such as a physiotherapy centre or health screening centre are equipped with excellence amenities.  Skills and Capabilities Well trained workforce such as medical practitioners, doctors and nurses are also very important (Noorlalia. et el, 2011). Doctors and nurses must be able to communicate in second language such as English. The ability to speak in other languages such as French and Japanese would be an added advantage to the hospital. Competitive Profile Matrix The competitive profile matrix is developed to further support the Porter‟s 5 Forces in answering the objective no 2. This matrix was formed to view the industry competitiveness in comparison to the closest rival which is Singapore, Thailand and India. All these countries were evaluated based on the key success factors of the industry. The findings in the key success factors of the industry have been used in this profile matrix. The competitive profile matrix (CPM) identifies industry‟s major competitors and their particular strengths and weaknesses in relation to a sample industry‟s strategic position. (David, 2001). Under the competitive profile matrix (Table 4), four countries have been chosen namely Malaysia, Singapore, Thailand and India. Weight and rating were assigned for each factor. 4 key success factors have been used as the key of evaluation. They are: 1. Competitive pricing 2. Accreditation 3. Technology Advancement 4. Skills and Capabilities On overall, India scores the highest at 4.3, followed by Thailand at 3.7, Malaysia at 3.5 and Singapore at 3.2 scores. The scores indicated that India is the most competitive country for the Health Tourism Industry. Based on the scores, Malaysia is at 3rd position behind Thailand which conquered the 2nd place. India scored highest (5) in pricing. Thailand scores fairly high (4) in the accreditation, technology advancement and skills and capabilities of the medical practitioners and nurses. Malaysia on the other hand, scored fairly high (4)
  7. 7. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 64 in pricing (second behind India) and average (3) in terms of technology advancement and skills and capabilities. In the overall, Malaysia‟s attractiveness is not really far behind Thailand and better than Singapore. In conclusion, Malaysia offers very competitive pricing in major procedures and hospital cost and catching up fast to compete with the closest rival in the Health Tourism Industry. Table 4: Competitive Profile Matrix MALAYSIA SINGAPORE THAILAND INDIA Key Success factors Weight Rating Scores Rating Scores Rating Scores Rating Scores Competitive Price 0.3 4 1.2 3 0.9 3 0.9 5 1.5 Accreditation 0.2 2 0.8 4 0.8 4 0.8 4 0.8 Technology Advancement 0.2 3 0.6 3 0.6 4 0.8 4 0.8 Skills and Capabilities 0.3 3 0.9 3 0.9 4 1.2 4 1.2 Total 1 3.5 3.2 3.7 4.3 Rating: 5-major weaknesses 5-major strength Finding – Competitive Advantages of Malaysia Health Tourism Industry MHTC, MATRADE and TOURISM Malaysia based on the interview sessions had identified three competitive advantages of Malaysia Medical Tourism Industry.  Competitive Procedures Pricing Malaysia offers very attractive and competitive pricing in most major procedures. In comparison to the neighborhood country such as Thailand, Singapore and India, Malaysia offers competitive pricing of medical treatment/procedures. Pricing comparison as per table below: Procedures Malaysia Singapore Thailand India Heart Bypass 11 16 11 10 Knee replacement 8 11 10 8 Hip replacement 10 9 12 9 Spinal fusion 6 9 7 5 Source: Patient beyond Borders  International accreditation Malaysia is taking serious effort in ensuring the best and high quality medical services from the private hospital in Malaysia. All private hospitals must be minimum accredited with MSQH. Up to date, 6 out of 35 private hospitals in Malaysia (medical tourism promoters) have been accredited by Joint Commission International (JCI). The hospitals are Penang Adventist, Sime Darby Medical
  8. 8. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 65 Centre, Pantai Hospital, International Specialist Eye Centre, National Heart Institute and Prince Court Medical Centre.  Multicultural / Multi Language Malaysia is a multicultural, multiethnic and multi lingual country. English is widely spoken in Malaysia. All doctors and nurses are highly trained and speak fluent English. Other than that, some of the doctors and nurses can also speak in other languages such as Tamil, Cantonese, Hokkien and other Chinese dialect. Value Chain Analysis This analysis model has been used to answer objective no 3, which is to propose Malaysia Health Tourism Industry‟s aValue Chain to MHTC. Since the nature of the industry is very competitive thus this value chain framework is very important for MHTC to identify the key players of the industry in order to upgrade its strategy and generate commitment from the proposed players (Za‟faran Hassan, 2010) Table 5: The Conventional Framework for the Malaysia Health Tourism Industry In this framework, four main activities have been identified. They are:  Promotions The main players identified were the healthcare facilitators and tour operators. Healthcare promotion programmes were organized by the support players such as Ministry of Health (MOH), MATRADE, APHM and Tourism Malaysia. There is no specific agency are looking into Health Tourism Industry. MOH and MATRADE are promoting the healthcare services which include hospital management, clinical waste management, Health Tourism and others. APHM is only organizing International Domestic Healthcare Conference and Exhibition, while Tourism is focusing in getting general visitors to the country.  Inbound As for inbound activity, the movement of foreign patients to Malaysia is through Airlines connectivity as highlighted by MHTC. This is because countries within the region are separated by water, the fastest and the most economical way of traveling is by air traveling. ActivitiesPromotions Inbound Treatment Outbound Healthcare Facilitator Tour Operators Healthcare Service Provider Airlines ASSOCIATION OF PRIVATE HOSPITALS OF MALAYSIA (APHM) Airlines R E V E N U E M A I N S U P P O R T MINISTRY OF HEALTH MALAYSIA EXTERNAL TRADE DEVELOPMENT CORPORATION (MATRADE) MALAYSIA TOURISM BOARD
  9. 9. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 66  Treatment As for the treatment, the main players are the healthcare services providers (private hospitals). The support players for the private hospitals are the MOH, APHM, MATRADE and Tourism Malaysia.  Outbound The outgoing movement of foreign patients is also through Airlines connectivity as inbound activity. In the newly improved version of value chain framework (Table 6), there are two new proposed segments, which are Operators and Enabler. The operators in this value chain framework are the main players of the industry which consists of organizations that directly liaise with the foreign patients. They are the front players of the value chain. In this case, the enablers consist of MHTC, Government agencies, Associations and others, which are related to the industry. Seven main significant activities of the value chain have also been identified and proposed by researchers in this new value chain framework. They are:  Promotions The significant operator under this activity is the Healthcare Facilitators (Agents) and Tour agents. Healthcare facilitators will in-charge of the promotion and recruitment of the foreign patients. These agents can be owned by the private hospitals in Malaysia or appointed agents by the hospitals. The other player is of course the normal tour agent.  Inbound Inbound activity defined as the incoming movement of foreign patients to Malaysia. MHTC only highlighted Airlines as the main players (operator). However, in this value chain framework researcher had incorporated Land Transportation and Sea Transportation as the key player for inbound activity. The enabler for inbound activity is the Immigration Department. Foreign patients are now able to enjoy the privileges under the fast track clearance and extension of length of stay which are facilitated by the Immigration Department.  Accommodation The main operators are the Hotels and Resorts. Researchers also added in hospital‟s lodging as part of the accommodation. This is because; some hospital such as Tropicana Medical Centre and Sime Darby Medical Centre provides in-house accommodations for family and relatives of the patients. It is similar like any other hotel room, but it is situated in the hospital. The commitment from enabler is crucial to ensure hotels and resorts in Malaysia is properly maintained and managed. The proposed enabler is the Tourism Malaysia to oversee the accommodation facilities and ensure it meets the requirement of international standard.  Treatment The key operators are the healthcare service providers (Malaysian private hospitals). Other than that, researchers also added in support from the language translator (enabler) under this process. This is to ensure, challenges in terms of language barriers can be solved especially to non English speaking patients.  Recovery Similar key operators as accommodation process are being proposed. After treatment or while waiting for follow up treatment, foreign patients may wish to recuperate at hotels or resorts in Malaysia. The proposed enabler is APHM. APHM on the other hand, could assist in providing healthcare support services such as hospital support services, healthcare informatics and ancillary services.
  10. 10. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 67  Leisure Patients are welcome to indulge to the wellness facilities available in Malaysia such as SPAs and Wellness Centre. Spa and wellness programmes in Malaysia that combine traditional methods alongside modern ones in a designer ambience can offer a delightful experience. In this activity, researchers added in the Malaysian Traditional Complementary Medicine (TCM) Treatment as part of leisure activities. To further enhance these services, support from enabler such as Association of Malaysia SPA (AMSPA) and MOH is important to ensure the level of services is aligning with international standard.  Outbound The main players are Air, Sea and Land transportation to take the foreign patients back to their hometown. The enabler for outbound activity is also the Immigration Department.  Core Enabler Throughout this value chain framework, the core enabler for this value chain is MHTC. This is very crucial as the MHTC is the council established to enhance the development and promotion of healthcare services. MHTC will be the focal point or channel between Government and healthcare service providers. Table 6: Proposed Value Chain framework for the Malaysia Health Tourism Industry Conclusion In 2009, Malaysia Health Tourism Industry has grown tremendously despite the global economic downturn. Based on the findings and analysis, we can conclude that the Health Tourism Industry is a very competitive industry. Prominent countries such as Singapore, India and Thailand are rigorously promoting their health tourism industry. Competitive pricing, international accreditation and technology advancement has been identified as the key success factors of the Health Tourism Industry. With the introduction of the industry‟s value chain framework, it is hope that MHTC is able to further identify areas of improvement and at the same time to come out with a strategic plan of growth of the industry. Adding the of number of hospitals to be promoted under health tourism would provide opportunities for more private hospitals to tap into the Promotions LeisureInbound Accommodation Treatment Recovery Outbound Healthcare Facilitator Tour Operators Healthcare Service Provider Airlines Land transport Shipping MHTC TOURISM MATRADE APHM MEDIA Airports Emigration Airports Emigration MALAYSIA HEALTHCARE TRAVEL COUNCIL (MHTC) Hotel and Resorts Hospital’s Lodging Hotel and Resorts Hospital’s lodging Spa Wellness Centre TCM Malls Travel Agencies Airlines Land transport Shipping AMSPA MOH MOH APHM Translator Insurance TOURISM APHM TOURISM R E V E N U E O P E R A T O R S E N A B L E R S Proposed Activities
  11. 11. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 68 ever growing health tourism market and further enhance the health tourism industry of the country. This would also encourage the current registered hospitals to continuously improve their services and quality, to remain competitive in the industry. Recommendations Recently, the Malaysian Government has outlined five (5) incentives to further boost the growth of the country's Health Tourism industry and make private hospitals more export-driven. The Government would provide a tax exemption equivalent to 100 per cent of qualifying capital expenditure incurred for a period of five years for the construction of new hospitals or for expansion, modernization or refurbishment of existing hospitals. Setting up of the International Patients Unit in these hospitals also qualify for this incentive.  Policies and Regulations Policies and regulations relating to provision of medical services and professional ethics and restriction for advertising created inflexibilities to healthcare providers in their marketing efforts. It is highly proposed that oversight committee to refurbish all restrict acts and regulations to further assist Malaysian medical service providers to prop up their proficiency and ability in providing excellent medical service to patients. On top of that, foreign equity restriction in private hospital should also be further liberalized since the collaboration or partnership with Malaysia private hospital in directly encourages more foreign patients to travel to Malaysia. Currently, Services Export Fund under MATRADE is the only reimbursable grant available for the promotional effort (participation in international exhibition, promotional materials and others) by service providers. However, due to a very encouraging request, the grant has been suspended by mid 2009. It is recommended for MHTC to propose to the government for special grant for the healthcare service provider for development of the industry. Apart of it, double tax deduction should be also being considered to those hospitals which have successfully obtained their Global Quality Accreditation such as a Joint Commission International (JCI) certificate.  Public Infrastructure Further enhancement to the public infrastructure should also be considered. For example, the establishment of “medical lounges” for concierge services at a major immigration entry point. Other than that, to encourage “value added” services, consideration should also be given to allow ambulance and hospital vehicle to “pick up” medical patients at the airport or ports and take them directly to the chosen hospital for the treatment.  Centre of Excellence Establishment of Centre of Excellence at each health tourism hospital such as “Cancer Centre” or “Burn Unit” is recommended as this will help to promote the niche practice of each hospital. Other than that, the establishment of the centre of excellence could attract alliances with global brand hospitals such as Apollo Hospital in India and others. This is also considered as an effort of expanding Malaysian hospitals‟ referral network.  Support Services Supporting services such as tertiary education and training should be considered as important components in health tourism as to ensure that local nurses and medical practitioners are well trained and certified. Ministry of Higher Education (MOHE) with collaboration of Ministry of Health (MOH) must review the quality training for nurses and Allied Health Professional (APHs) as in the future it will assist in promoting Malaysia as Education and Clinical Research hub around the world.  Traditional and Complementary Medicines (TCM) It is also recommended for MHTC to certify Traditional and Complementary Medicines (TCM) as part of Health Tourism services. In the value chain framework proposed, TCM was placed under Leisure as
  12. 12. Business & Management Quarterly Review, 2(3), 59-69, 2011 ISSN 2180-2777 69 currently TCM is not covered under MHTC. TCM is currently under Traditional and Complementary Medicines Unit under Ministry of Health. For the past decades, traditional medicine had made a significant contribution to the health care of Malaysians. Traditional medicine continues to be patronized by the community to treat diseases and maintain good health. Today‟s trend indicates growing numbers of people who are opting for TCM, which is believed to be the substitute for modern medicine limitations.  Collaboration with Global Insurance Company To further promote the Health Tourism Industry, another approach proposed is through collaboration with Global Insurance Company such as ING Insurance, Great Eastern Insurance and the others. This is because; foreign patients especially from USA are usually insured for their medical. According to, the U.S. health care services market is the largest in the world, worth about, $1.2 trillion. Thus, through collaboration and negotiation from Health Tourism Hospitals and Insurance companies, it is hope that Malaysia will be recognized as one of the healthcare destinations for their patients. References Association of Private Hospital [on-line] Available at Backman, M. and Butler, C. (2003). Big in Asia: 25 strategies for business success.New York: Palgrave Macmillan. Brown, L. (1997), Competitive Marketing Strategy, Nelson, Melbourne. Didaskalou, E.A and Nastos, P. (2003). The role of Climatic and Bioclimatic Conditions in The Development of Health Tourism Product, Anatolia, 14(2), 107-126. Gee, C.Y. (1996), International Tourism: A global perspective. Madrid, Spain:World Tourism Organization. Aniza, I. (2009). Health Tourism in Malaysia: The Strength and Weaknesses. Journal of Community Health. 15(1), 7-14 Iftikhar, Mubbashir (2009). Destination of Medical Toursim and Health Tourism: Medical Tourism, destination Malaysia . Retrieved from mubbashir-iftikhar/malaysia-top- destination-of-medical/ Kay, John (1995). Foundations of corporate success: How business strategy adds value. Oxford University Press. Loverseed, H. (1998). Health and spa tourism in North America. Travel and tourism Analyst, (1). 46-61. Retrieved April 10, 2004 from Placidway. Medical Tourism in Asia. “Creating a Successful Branding For Your Hospitals” [on-line] available at Healthcare-2008--- Medical-Tourism-in-Asia Porter, M.E. (1980), Competitive Strategy: Technique of Analyzing Industries and Competitors, New York: The Free Press. Porter, M.E. (1981), The contribution of industrial organization to strategic management, Academy of Management Review, 6, 609-620. Malaysia Gets Serious About Promoting Health Tourism. (2010). Health Holidays in Malaysia, 1, 6-7 Merriam, S.B. and Associates (2002). Qualitative Research in Practice. San Francisco: Jossey Bass. Noorlala Yunus (2011). An Inquiry into impact of HR architecture on Human Capital Tool. Business and Management Quarterly Review. 2(1), 1-10 Za‟faran Hassan et el (2010).The Influence of Training in Supply Chain Management on Competitiveness. Business and Management Quarterly Review. 1(2), 14-28