ASEAN: Regional Trends in Economic Integration, Export ... - USITC

Only a few countries export large volumes of healthcare services, although all ASEAN
countries trade at least some small amount of medical services. 27 Many ASEAN
governments are promoting their healthcare exports (i.e., their medical travel industries).
Governments in Malaysia, the Philippines, Singapore, Thailand, and Vietnam have all
announced initiatives to promote their healthcare industries to foreign patients. 28
However, of the ASEAN countries, Singapore, and Thailand are the most competitive in
the global healthcare services market, as measured by numbers of foreign patients they
receive, although Malaysia’s industry has exhibited rapid growth in recent years.
Singapore and Thailand’s largest competitors are largely in Southeast Asia, as the global
market is fragmented regionally and consumers prefer local care. 29 Outside of the region,
India is Asia’s largest exporter of healthcare services, based on the number of foreign
patients treated, followed by South Korea. China and Taiwan, too, are working to
increase their exports of healthcare services. 30
While it is difficult to compare the competitiveness of ASEAN healthcare providers with
extra-ASEAN providers, 31 anecdotal evidence and accreditation statistics suggest that
ASEAN providers, particularly Singapore and Thailand, are making strides in becoming
globally competitive. Accreditation statistics reported by the Joint Commission
International (JCI) (table 6.2), which list the hospitals that have voluntarily pursued an
international standard of hospital quality, indicate that as of 2010, 31 hospitals in the
ASEAN region have received JCI accreditation, including 13 in Singapore and 9 in
Thailand. 32 These statistics also illustrate the rapid growth of healthcare services in other
developing regions; for example, the Middle East increased its number of JCI-accredited
hospitals from 7 in 2005 to 76 in 2010. However, industry representatives indicate that
although the Middle East has vastly improved its healthcare infrastructure, Middle
27 As mentioned above, healthcare services can be traded via four modes; however, each of these four
modes is captured by discrete and incomparable trade data, where such data exist. For the purposes of this
report, exports of healthcare services will refer to consumption abroad (medical treatment provided to foreign
patients by healthcare facilities, often referred to as medical travel). Medical travel is a primary focus of the
ASEAN integration efforts and of national governments. Trade via mode 3, or commercial establishment, is
closely related to investment, and so will be addressed in the investment discussion of this report. Data for the
other two modes of trade in healthcare services do not exist, and so, where necessary, will be discussed
anecdotally. For example, data on cross-border trade in healthcare services in the ASEAN region, if captured,
falls under trade in information services. Similarly, statistics on the volume or value of services provided by
foreign medical personnel to patients in their (patient’s) home country (mode 4) do not exist; instead, trade
through movement of professionals is captured through data on the number of foreign professionals operating
in a country. This data will be presented where relevant to the discussion.
28 International Medical Travel Journal, “Malaysia,” September 8, 2009; Arunanondchai and Fink,
“Trade in Health Services in the ASEAN Region,” March 2007, 13; Chee, “Medical Tourism in Malaysia,”
January 2007, 10, 13, 18.
29 There are some exceptions to this, such as travel by U.S. citizens to Thailand or India specifically for
healthcare services. However, the majority of healthcare exports are provided to foreign patients from
neighboring countries, and industry representatives indicate that only a minority of patients are outside a 6–7
hour flight radius from the healthcare facility. Industry representative, interview with USITC staff, Singapore,
March 8, 2010.
30 Industry representatives, interview with USITC staff, Singapore, March 8 and 9, 2010; eTurboNews,
“Medical Tourism Health Travel Magazine Launched in Thailand,” August 27, 2009.
31 There is no international body that governs the private healthcare industry, and due to the combination
of public and private provision, there is no specific indicator for competitiveness across the global market.
32 The Joint Commission International (JCI) is the international division of Joint Commission Resources,
the U.S. hospital accreditation body. JCI accreditation is considered an indicator of quality, as accreditation
indicates a facility has met baseline safety and quality standards for international care. Other standards and
accreditations used throughout the hospital industry include those set by the International Organization for
Standards (ISO) 9000. Joint Commission International Website, “About Joint Commission International”;
Timmons, “The Value of Accreditation,” October 17, 2007.
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