Are Indonesians travelling as medical tourists to Malaysia helping the destination country at the expense of the Indonesian healthcare system? According to a new academic paper by Meghann Ormond, ’Solidarity by demand? Exit and voice in international medical travel’, just published in Social Science & Medicine, the volume of Indonesians traveling to Malaysia for healthcare does not help the struggling Indonesian healthcare system and has measurable micro and macro economic and social impact. It also suggests that medical tourism is not a benign commercial animal but is a form of political engagement that effects healthcare, economy and social attitudes in both home and destination countries. Following on the identification of medical tourism as a growth sector by the Malaysian government in 1998, over the last 15 years significant governmental and private sector investment has been channeled into the development of the industry. This development is unfolding within the broader context of social services being devolved to for-profit enterprises and market-capable segments of society becoming sites of intensive entrepreneurial investment by both the private sector and the state. The paper attempts to meaningfully assess medical travel’s real and potential economic and healthcare equity impacts in Malaysia with attention to the Malaysian government’s multiple roles as funder and provider of public-sector healthcare, regulator and pre-eminent investor in commercial healthcare. Notwithstanding their diverse engagements with the Malaysian government, medical travel industry and healthcare providers and users, the author acknowledges that both industry and healthcare equity perspectives are hamstrung by the scant empirical data currently publicly available for medical travel. Steps are proposed for overcoming these challenges in order to allow for improved identification, planning and development of resources appropriate to the needs, demands and interests of all those with a stake in medical travel. Globally, more patients are said to be intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel’s impacts on the people and places that receive medical travellers, study of its impacts on medical travellers’ home contexts has been negligible and largely speculative. While proponents praise the potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it, as a way to further de-politicise the satisfaction of healthcare needs. This paper draws from work on political consumerism, health advocacy and social movements to argue for a reframing of medical tourism not as a one-off statement about or an event external to struggles over access, rights and recognition within medical travellers’ home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved as care recipients, formal and informal care-providers, intermediaries, promoters and policymakers. Evidence from the review and case study suggests that medical tourism may effect political and social change within medical travellers’ home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the home country. Impacts are conditioned by the ideological foundations underpinning home political and social systems; the status of a medical traveller’s ailment or therapy; and the existence of organised support for recognition and management of these in the home context.