Malaysia's relative success in managing the Covid-19 pandemic has led to a gradual reopening of its borders to medical tourism, as the country prepares to make a comeback as the world's top spot for such travellers.
The country's governing body for medical tourism, the Malaysian Healthcare Travel Council, is proposing to allow patients from specified nations to arrive on commercial flights and enter via green zones, but subject to clearance and permission from their own governments.
Six countries have been identified for such green zone entry: Australia, Brunei, Japan, New Zealand, Singapore and South Korea, Ms Sherene Azli, Malaysian Healthcare Travel Council's chief executive told The Straits Times.
The move, if approved by the government, would effectively create a small travel bubble that could act as a precursor to a general tourism travel bubble for Malaysia, which is looking to its healthcare sector to revive its tourism industry.
"While medical tourists are slowly coming back, the numbers are still far from pre-Covid days," said the senior resident medical officer of Pantai Hospital Kuala Lumpur's Emergency Department, Dr Mohd Ridzuan Abdul Razak.
Situated in the heart of Kuala Lumpur, the hospital is a prime destination for medical tourists drawn especially by the country's medical expertise and lower costs.
"We are on a par with world standards. Doctors in Malaysia are mostly trained in Western countries. So, patients know there is quality," said Dr Ridzuan.
"Now, they also know it is safe and we have the support of the government."
Before the pandemic, Pantai Hospital Kuala Lumpur treated about 120 international patients a day, including medical travellers. Now, there are fewer than 10 such patients a day.
Part of the reason for the steep drop is the country's strict standard operating procedure for medical tourism.
Since June 19, only foreign patients with serious illnesses are allowed into the country to receive treatment.
Also, they must fly in on private charter or medical evacuation flights and are confined to the hospital during the duration of their stay. And they are not allowed to be a tourist after their treatment.
Ms Sherene noted that most of these "high-yield patients" are cancer victims.
Malaysia positioned itself as a medical tourism destination about 10 years ago when it launched the Malaysian Healthcare Travel Council under the Health Ministry.
It has since grown exponentially, at a compound annual growth of 15 per cent since 2011.
Malaysia's medical tourist arrivals are almost three times that of its South-east Asian neighbours. And, in the past two years, it is ranked No. 1 globally for having the highest volume of medical tourist arrivals: 900,000 in 2018 and 1.3 million last year. Thailand takes the No. 2 spot.
The vast majority of these patients are from the region, and they tend to suffer from cancer or cardiovascular diseases.
Medical tourism has also bolstered Malaysia's tourism industry, which is now its third-largest gross domestic product contributor. Before the pandemic, it was contributing nearly 10 per cent to the tourism economy, the Malaysian Healthcare Travel Council had said.
Healthcare travel revenue - from hospital receipts alone - more than tripled in a decade, hitting RM 1.7 billion (S$560 million) last year, and contributing RM8 billion to the economy.
For this year, the Malaysian Healthcare Travel Council is aiming for RM500 million in hospital receipts and RM2 billion in contributions to the economy.
But the progressive opening up of the medical tourism industry has caused some concern in Malaysian states such as Penang. Last month, the state said it will no longer allow medical tourists to enter.
The decision was prompted by new Covid-19 cases in the state after almost three months of not having even a single case.
The new infected cases coincided with the arrival of three medical tourists from Indonesia, where most of the medical tourists are from.
Ms Sherene, however, is confident these tourists pose the lowest risk, given the strict standard operating procedure of the Malaysian Healthcare Travel Council.
"With the SOP we have put in place, they are the lowest risk (in terms of breaking quarantine orders)," she said, pointing out that medical tourists will be taken directly to their hospitals where they will undergo quarantine with their treatment.
Dr Ridzuan agreed: "We don't need to worry, we are not letting them in freely. All our guidelines are based on clinical evidence, and Health Ministry directives."