Malaysia’s national oil company, Petroliam Nasional Bhd (Petronas), responsible for Malaysia’s most symbolic landmark (and, albeit briefly, the world’s tallest building), the Petronas Towers, came under fire in the summer of 2008 after the government significantly raised consumer petrol prices. Calls were made for transparency about its spending of revenue generated from the country’s natural resources. The spotlight turned to Petronas’ broad range of investments, including its development and ownership of the luxurious ‘five-star’ Prince Court Medical Centre (PCMC), situated on premium real estate ceded by royalty in Kuala Lumpur’s Golden Triangle, not far from the Towers themselves.24 The company justified an expenditure of MYR 1.2 billion (GBP 248 million) of ostensibly public money on a private hospital catering mostly to Petronas employees and a 30% foreign patient load, among them many regional elite and expats, by explaining that it was contributing to the nation’s international medical travel (IMT) destination aspirations, and that, as part of its corporate social responsibility initiative, ‘the aim of setting up Prince Court Medical Centre was to provide Malaysians with health services of international standard’ (Bernama 25/06/2008).
IMT to Malaysia did not begin with its official inclusion in Malaysian development policy in 1998. To be sure, many Asians and Westerners had been going to Malaysia for a range of medical procedures long before. Yet, in considering what the ‘extension of caring’ (Barnett and Land 2007: 3) via the provision of private healthcare to non-citizens accomplishes and for whom, I argue that it was with its inclusion in this development framework that a new discursive space of IMT came into being, coming to play a prominent role in the country’s development imaginary that extends well beyond its own economic contribution.25 IMT has been cast in national and state-level development plans as a prime locus for government and private sector cooperation (EPU 2000: 498, 2005: 413; Rohaizat 2004: 35), present in a broad range of economic growth strategies that hinge on attracting foreign capital into the country. In these strategies, it is consistently conceived of as a ‘catalyst’ for the ‘optimisation’ of the country’s related services, industries and human resources. It is regarded as a ‘high-end’ service that attracts ‘high quality’ foreign visitors and, as such, is used to justify the further expansion of the country’s private healthcare system, the acquisition by private hospitals of cutting-edge technology and the need for training more medical professionals in Malaysia (EPU 2000, 2005; MITI 2006; Khazanah 2007). This move has signalled what Chee (2008: 2147, emphasis
24 See Bunnell (2006) on the ‘lavish monumentality’ of the Petronas Towers and Putrajaya.
25 While the government has great expectations for IMT’s continued contribution to the national economy, forecasting that it will generate MYR 390 million in annual earnings by 2010, though foreign patient numbers grow steadily, the average hospital expenditure per capita remains low (Frost and Sullivan 14/04/2010).
added) refers to as ‘a new phase in the development of private sector medicine… marked by a joint effort between government and private hospitals to market healthcare as a nationalenterprise’.
The national development agenda has positioned the sites/sights of IMT as nodes whose inherently transnational nature contributes to the enterprise of ‘postdevelopmental’ nation-building (Ong 1999). These nodes are cast as symbolic of the future in medical care, mobilised by the state to underscore the discursive ‘inevitability’ of neoliberal globalisation coming from outwith Malaysia to which the country must adapt in order to survive, with national success judged by the country’s ability to attract foreign patient-consumers. The state’s framing of IMT as an engine of development not only supports a homogeneous image of high-tech, high-quality medical care to better attract foreign exchange but also contributes towards the construction of an ‘ideal’ health-seeking subject. IMT is used to alter how private medical care is perceived within the country itself, part of ‘strategies developed for the nation’s vision of health’ (NST 18/05/2002) that hinge on greater privatisation of healthcare.
This chapter focuses on IMT’s contribution towards the reconfiguration of the national therapeutic landscape. I argue that the state’s espousal of IMT should not be considered an outward-looking respite for Malaysians from the polemics of domestic neoliberal reform but rather a strategic platform from which to launch and entrench further systemic change to healthcare within the country at a moment in which the state has encountered obstacles to its domestic healthcare privatisation agenda. While ostensibly meant to bring the healthcare system’s offerings on par with those in ‘developed nations’ (Cruez and Soosayraj 14/04/2004), I suggest that foreign patient- consumers involved in IMT, cast as model neoliberal healthcare subjects embodying the values of ‘flexibility, mobility and entrepreneurialism’ (Ong 2006: 501), serve as symbolic capital for industry players also seeking to ‘re-educate’ domestic subjects, by steering them away from reliance on a developmental state’s public healthcare infrastructure and towards active engagement as responsibilised healthcare consumers in a postdevelopmental context.
To frame this argument, I first offer a reading of transformations in state discourse on healthcare, identifying three phases of care in Malaysia’s history that have (re)imagined and (re)configured spaces of intervention and governable subjects in distinct ways. I start with healthcare in colonial Malaya, where a public hygiene and healthcare infrastructure set up by the British fed into a colonial hierarchy that reinforced ethnic and class-based divisions. I move on to the expansion of state-provided universal healthcare following independence, considering the ways in which healthcare provision was bound up with a broader postcolonial nation-building project that contributed to the developmental state’s biopolitical construction of national borders and citizens. I then follow the state’s retreat from the direct provision of healthcare through privatisation, public
healthcare finance reform and the shift in focus from the ‘healthy citizen’ to the ‘healthcare consumer’. These three phases provide the context out of which IMT emerges onto the agenda, linking healthcare consumption with a new phase of nation-building that is articulated through acquiring international recognition.