Medical travel facilitators, private hospitals and international medical travel in assemblage

Abstract

International medical travel may be viewed as an ‘assemblage’ of various components such as infrastructure, hospitals, finance, transport, technologies, staff, facilitators and patients. In this paper, we focus on the articulations of medical travel facilitators (MTFs) and private hospitals in producing international medical travel in the context of the neoliberalising processes that had led to the rise of corporate hospital care in Malaysia in the 1990s. We draw from three hospital case studies for a comparative perspective. We highlight the shifting, unstable and contingent relations and interactions of the MTFs, as one component of the assemblage of international medical travel, with hospitals and medical travellers. We identify the practices of MTFs in providing patients with information and advice about hospitals and doctors as efforts to shape patients' choices in the selection of health‐care providers and in decision‐making. The assemblage approach allows us to see how the MTFs emerge and stabilise as a collective identity for individuals and companies performing particular functions through their multifarious articulations with other components in various sites of assemblage.

Going for brokerage: strategies and strains in commercial healthcare facilitation

“…Best documented is the intermediary role for facilitation companies in cross-border travel for healthcare: these companies seek to attract potential clients through glossy websites and personal referrals [31,32], an active social media presence [13], and partnering with medical insurance companies and large employers [33]. They offer information and arrange travel, alongside more socially attuned and customisable support like accompanying users to offer advice on how to act, travel, eat and speak [9,19] and companionship and moral support [10]. Facilitation companies are approached by, and approach, providers with whom to partner [18], often at the large trade events that have emerged [34,35], and seek to develop a range of possible packages and destinations to offer to prospective clients [36].…”

“…The emergence of commercial facilitation services has been a notable feature of healthcare in recent decades, as individuals and companies offer to organise and mediate access to healthcare in return for payments. Often the focus of these activities has been to cater to the growing number of people who cross borders to search of care: one study identified 208 web-based facilitation companies globally [8], and many more operate on an informal basis in countries such as Mexico [9], Malaysia [10] and India [11]; while some focus on global markets for specific services such as assisted reproduction [12][13][14] or cosmetic surgery [15]. There are also small but growing markets for facilitation services in a domestic context, for example the high-end 'concierge' services being offered in some countries [16].…”

The role of professional facilitators in cross-border assisted reproduction

“…Within the broader field of study of medical travel, most empirical studies have addressed facilitator websites ( Cormany and Baloglu, 2011 , Lee et al, 2014 , Lunt and Carrera, 2011 , Maguire et al, 2016 , Mason and Wright, 2011 , Penney et al, 2011 , Sobo et al, 2011 , Turner, 2012 ) or other promotional materials such as brochures ( Crooks et al, 2011 ). A handful of studies have surveyed medical travel facilitator companies ( Alleman et al, 2011 , Peters and Sauer, 2011 ) or have interviewed facilitators ( Chee et al, 2017 , Dalstrom, 2013 , Holliday and Bell, 2015 , Johnston et al, 2011 , Lunt et al, 2014a , Lunt et al, 2014b , Snyder et al, 2011 , Speier, 2011 , Speier, 2015 ). Perhaps unsurprisingly, researchers have found that facilitator companies emphasized the benefits of medical travel rather than the risks ( Lee et al, 2014 , Mason and Wright, 2011 , Penney et al, 2011 ), and reported that facilitators did not consistently provide information about legal liability, regulatory oversight, emergency arrangements or financial ties ( Lunt and Carrera, 2011 , Maguire et al, 2016 ).…”

“…Perhaps unsurprisingly, researchers have found that facilitator companies emphasized the benefits of medical travel rather than the risks ( Lee et al, 2014 , Mason and Wright, 2011 , Penney et al, 2011 ), and reported that facilitators did not consistently provide information about legal liability, regulatory oversight, emergency arrangements or financial ties ( Lunt and Carrera, 2011 , Maguire et al, 2016 ). In general, researchers have analysed medical travel facilitators as businesses, often characterizing them as a sub-set of tourism or a mode of travel agency, or alternately analysing their operations as part of a system of information flow and, more recently with increasing complexity, as dynamic networks ( Hanefeld et al, 2015 , Lunt et al, 2014a , Lunt et al, 2014b ) and international ‘assemblages’ ( Chee et al, 2017 ).…”

“…Building on a feminist relational approach, rather than examining facilitators of fertility travel as a form of business or web-based marketplace, this study sought to understand their roles within this frame of relational labour. This frame immediately prompts questions about to whom the facilitator owes allegiance or professional duties, most especially when the interests and needs of the relevant parties – patients seeking surrogacy or egg donation, reproductive contributors or ‘assistors’ providing eggs or surrogacy ( Inhorn and Birenbaum-Carmeli, 2008 ), and other professionals providing elements of the service ‘assemblage’ ( Chee et al, 2017 ) – are in actual or potential conflict. Thus, this analysis sought to understand the operations of those facilitating or providing cross-border reproductive services as a form of professional practice based within a web of commercial and personal relationships that form relational labour.…”