Meghann Ormond of Wageningen University has presented an academic paper, on Academia.edu:“Intermediaries, facilitators, agents, guides: Steering international medical travel to Malaysia” and presented it at the World Congress of Sociology in Yokohama in July. The thesis is that Malaysian authorities desire for medical tourists from higher-income countries and the medical tourism infrastructure being developed to cater to them exists in contrast to the actual everyday flows of intra-regional lower-income medical tourists and what people actually want and get. Key points from the paper: “Medical tourists going to Malaysia for non-invasive procedures or cosmetic surgery are more likely to undergo procedures or consultations at the same time as their accompanying family members or friends. Medical tourism agents have a responsibility to provide practical local help for solo who undergo major surgery and may be dependent for long periods. The practice of organizing opportunities for customers to meet and support one another may not be as good as an agent taking patient-clients out for meals and drinks. Some agents ensure that clients have Skype-enabled devices and mobile phones at their disposal to easily reach family and friends back home. Most commonly, they either provide personal service or support from paid destination managers who are similar to travel reps. In spite of the dominant role of Malaysia’s Ministry of Health in the promotion of medical travel, one Australia based agent commented; “They do not properly stress the seriousness of what we are doing. The perception is that Malaysia is a tourist destination and not so much a health destination.” If the quality and price of a routine procedure are perceived to be equal across different destinations, some medical tourists will select a destination based on its recreational potential. In particular, those with longer periods of recovery who are travelling with family members or friends routinely ask agents to include time to recuperate at beach resorts (Penang and Langkawi ) in their travel packages. Agents suggest that not all clinics or agents stress that when combining treatment with a holiday that doctors’ permission must be granted and patients advised what they can and cannot do. As one Australia-based agent observed, “You say to them that they must not swim but they want their spa and their wellness and they want to be pampered." Indonesian medical tourists are widely acknowledged by agents to be principally focused on receiving speedy, value-for-money medical care and want nothing else as they can get that at home, but still a few set aside time for sightseeing and shopping. The paper concludes that it is wrong to compare medical tourism to normal leisure tourism, because medical is niche. So the ways to promote it, the ways to get customers, the ways to handle these customers- are different from tourism. Agents and hospitals need to be capable of handling situations with the customers. They will need to be trained, to be taught the right things to say, because patients are very sensitive, they demand a lot of things, and sometimes they think the agent has the knowledge of a doctor. Agents are learning and adapting to the different needs of those from various countries. Australians and Malaysians may be most aware of legal risks. Agents from Indonesia tend to work more closely with customers and more personally involved in medical care, transport, accommodation and leisure services While there are no officially licensed agents there is a growing demand for training and professionalism. Some agents accept that they need real help to establish professional standards within a fragmented, volatile and easily tarnished industry. It is essential to further study the important ways in which informal care and support are provided by medical travellers’ family and friends either traveling with the patients themselves or managing things from back home One possible solution is to develop the US method of patient navigation. This ensures patients get timely access to treatment and follow-up care. This is achieved by helping them overcome health system barriers by- •Coordinating diagnostic or treatment care from multiple providers, assisting with paperwork, scheduling and attending appointments, •Constant communication; access and discuss information about their medical conditions, test results and treatment/care options. •Help patients with resolving personal financial, social and educational barriers to accessing treatment/care. •Provide psycho-social support, either directly or by referring patients to trained providers and support groups. Patient navigation is not case management or patient advocacy, as these are focused on improving individuals overall health over long periods of time and with improving the care systems in which patients are embedded. The work of patient navigators is similar to agents as it is targeted and finite with a focus on improving the outcomes of a specific medical concern. Many come from nursing, social work or health education; others are former patients or survivors themselves or their family members. Just like medical tourism agents, navigators are paid rather than volunteers or family members; may operate independently or be affiliated or an employee of a medical institution; and no licensing requirements exist, so navigators have no specific training. Transforming medical travel agents into transnational patient navigators can help to de-ghettoize them from being regarded as a marginal niche of intermediaries in the travel industry. Placing agents in a more mainstream healthcare and patient-centric context recognizes the significance of what they actually do and has the potential to better link them up long-term with the broader healthcare sector, with medical tourism just part of what they can offer to patients.”