<u>United States $23,938 $1,351</u> <u>Source:</u> Abidin, Alavi, and Kamaruddin (2005) For a number of medical treatments, hospitals from Malaysia, Thailand, and Singapore directly compete with each other. The price comparisons in Table 8 suggest strong competition, in particular, between Thailand and Malaysia. At the same time, hospitals in these three countries are differentiated by their medical expertise, the type of patients to which they cater, and certain ancillary services. For example, in order to attract foreign patients, some operators in Malaysia have started to offer integrated healthcare packages, involving not only medical treatment, but also transportation from and to the patient’s home country, accommodation for family members and certain entertainment services.

Interest in developing the health tourism industry has also emerged in the Philippines. While health service exports are still in their infancy, the country benefits from a pool of well-qualified and English-speaking medical professionals. The Philippines have also developed expertise for certain specialized medical operations, such as cosmetic and laser eye surgeries. Hoping to build on these advantages, the Government included health tourism in its 2004 Investment Priorities Plan and is in the process of developing a business plan for the industry.

As for the low-income ASEAN countries, Vietnam also exports health tourism services, mainly to neighboring Cambodia. The number of foreign patients treated in Vietnam is thought to be small, but no precise statistical information is available. Indeed, most Cambodian patients seeking treatment abroad choose hospitals in Thailand and Singapore. Interestingly, several private hospitals in Cambodia make a business of facilitating treatment in foreign hospitals. Similar services are also provided by independent agents at Cambodia’s borders.

# _Mode 3: Commercial presence_

Health services in ASEAN countries are predominately provided by domestic medical institutions. Nonetheless, some foreign participation in the private sector healthcare segment can be found in six of the seven ASEAN countries studied (Laos being the only exception). Foreign service providers typically account for small shares of the healthcare market. For example, in Indonesia foreign hospitals are estimated to account for only one percent of total hospital beds (Timmermans, 2002). In the Philippines, only 2 of 19 health maintenance organizations (HMOs) are foreign-owned. In Thailand, foreign investors hold equity stakes in a number of hospitals, but they do not have a controlling interest, reflecting restrictions on foreign equity ownership (see Section III). Foreign investment is estimated to account for only 3 percent of total investment in private hospitals in Thailand. Some foreign presence also exists in Cambodia and Vietnam, though no information is available on the market shares of foreign hospitals. Across all countries in the region, foreign-owned healthcare facilities cater to the middle and upperincome population segments and are mostly found in urban areas.

Little comprehensive information exists on the origin of foreign investors. However, foreign investment appears to originate both from within and from outside the ASEAN region. In Cambodia, most foreign hospitals are of Chinese origin. Among AESAN countries, Singapore and Thailand, in particular, have emerged as outward investors in the healthcare sector. For 13