外文翻譯---從醫(yī)療旅游的角度看馬來(lái)西亞的經(jīng)驗(yàn)（節(jié)選）

1、<p>　　1900單詞，10500英文字符，2700漢字</p><p>　　出處： Abd Manaf N H, Hussin H, Jahn Kassim P N, et al. Country perspective on medical tourism: the Malaysian experience.[J]. Leadership in Health Services, 2015, 28(

2、1):43-47.</p><p><b>　　原文 </b></p><p>　　Country Perspective on Medical Tourism: The Malaysian Experience </p><p>　　NH Abd Manaf，H Hussin，PN Jahn Kassim，R Alavi，Z Dahari&l

3、t;/p><p>　　Introduction </p><p>　　The purpose of this paper is to explore dimensions of medical tourism in a destination country with actual patient data, and perception of the medical tourists on

4、overall satisfaction, perceived value and future intention for repeat treatment and services. This paper also explores the predictors of overall satisfaction and future intention, and also the relationship between overal

5、l satisfaction and future intention. </p><p>　　Medical tourism has taken both policy-makers and researchers by surprise, an industry that was never comprehended to be as vibrant as it is today, for the simpl

6、e reason that almost always, patients would rush to the nearest medical facility for treatment. Health care has often been regarded as the most “l(fā)ocal” of the service sector. But medical tourism, which is the practice of

7、 patients seeking medical treatment in another country, may not necessarily be termed “tourism” altogether, for the heal</p><p>　　Riding on the medical tourism wave, the Malaysian government has identified t

8、he health travel industry as one of the strategic opportunities under the Healthcare NKEA (new key economic areas). This will see medical tourism as a key driver of economic activity that has the potential to contribute

9、significantly to the country’s economic transformation plan. The country already has the right infrastructure due to its strong health-care delivery system, and tight control over quality assurance of it</p><p

10、>　　Accreditation of hospitals is also well structured in the country, which is carried out by the Malaysian Society for Quality in Health (MSQH). The MSQH standards also addresses strategies identified under the WHO W

11、orld Alliance on Patient Safety, and the MSQH Hospital Accreditation Standards has also been certified by ISQua Accreditation Council, which also certifies the Joint Commission International (JCI) accreditation standards

12、. Thus, Malaysia already has a strong footing in the accreditation</p><p>　　The government has also established the Malaysian Healthcare Travel Council (MHTC), which is a one-stop centre to promote the count

13、ry’s medical services abroad. Although a relative newcomer to the industry, the intensification of the industry can already be seen from the increasing number of international patients into the country. In 2002, the numb

14、er of health tourists was 84,585 with a revenue of RM35.9 million; but by 2011, the number of international patients had reached 581,308 with a total</p><p>　　Literature review </p><p>　　A revie

15、w of the literature indicates that medical tourism is not a new concept borne out of the forces of globalisation. In fact, travelling abroad for health has had a long history where the wealthier social classes would seek

16、 spas, mineral baths and innovative treatment in favoured destinations such as Switzerland and Austria. Apart from the spas and health resorts, the tendency then was for patients from less developed countries to seek med

17、ical treatment in Europe or the USA, where the health</p><p>　　The recent phenomenon in the crisscrossing and globe-trotting behaviour of patients is unfathomable. For example, Thailand, a strong contender i

18、n the industry, has received more than one million foreign patients who sought treatment ranging from executive health tests to invasive surgeries (Connell, 2006). In 2008, Thailand generated USD1.5 billion from its medi

19、cal tourism industry (NaRanong and NaRanong, 2011). Apart from Thailand, other countries which are reaping the benefit of the fallout of</p><p>　　To assure potential patients on the standard of quality of ca

20、re, medical tourism hospitals in this region leverage on their outcome measures. Singapore’s National Healthcare Group, for example, which is a conglomerate of acute care and specialist hospitals, regularly publishes res

21、ults on outcome measures which are of international standards. Among others, it reports a 100 per cent rate for dispensing aspirin at discharge for acute myocardial infarction and 0.6-2.2 per cent 30-day mortality rate &

22、lt;/p><p>　　For the patients, the motivation for medical tourism is multi-faceted. In the case of American health travellers, getting medical treatment in another country is a viable option for the uninsured or

23、 underinsured American patient. While Americans enjoy the highest standard of care, the country’s health-care delivery system is awed by excessive costs and issues of inequity and access. The recent Obamacare debacle tha

24、t led to the shutdown of US federal government attests to this. The US health-care</p><p>　　While cost, long wait list and better quality of care maybe the motivating factors for health tourists to travel ab

25、road for medical treatment, other push factor factors have also been cited. Crooks et al. (2010) quoted patients wanting access to procedures that are illegal or unavailable in the home country such as stem cell or surro

26、gacy, and the ease of air travel, as other motivating factors. The impact of marketing, particularly Web-based marketing has also been cited by Sarwar et al. (2012) </p><p>　　A review of the literature also

27、indicates that medical tourism is a widely researched topic at the conceptual level (Arellano and Annette, 2007; Connell, 2006; Cuddehe, 2009; Douglas, 2007; Leahy, 2008; York, 2008; Schroth and Khawaja, 2007). This is u

28、nderstood since medical tourism is a recent phenomenon and not much field work has been carried out in the area, although there has been some published empirical work. For example, Chen et al. (2012) studied the willingn

29、ess and barriers of potentia</p><p><b>　　譯文 </b></p><p>　　從醫(yī)療旅游的角度看馬來(lái)西亞的經(jīng)驗(yàn)</p><p>　　作者: Zainurin Dahari</p><p><b>　　引言 </b></p><p>

30、　　本文的目的是探索醫(yī)療旅游目的地的維度與實(shí)際的病人數(shù)據(jù),以及感知醫(yī)療游客的整體滿(mǎn)意度、感知價(jià)值和未來(lái)打算重復(fù)治療和服務(wù)的意愿。本文還探討了整體滿(mǎn)意度和未來(lái)意愿的預(yù)測(cè)因子,以及整體滿(mǎn)意度和未來(lái)意愿的之間的關(guān)系。 </p><p>　　醫(yī)療旅游的出現(xiàn)讓決策者和研究人員感覺(jué)出乎意料,這個(gè)行業(yè)從來(lái)沒(méi)有像今天一樣充滿(mǎn)活力,原因很簡(jiǎn)單,患者幾乎總是會(huì)到最近的醫(yī)療機(jī)構(gòu)接受治療。醫(yī)療保健通常被認(rèn)為是最“地方的”服務(wù)部門(mén)。但是，

31、醫(yī)療旅游是患者在另一個(gè)國(guó)家尋求醫(yī)學(xué)治療的實(shí)踐,它不一定被稱(chēng)為“旅游業(yè)”,對(duì)今天的健康旅行者來(lái)說(shuō)，境外游不僅僅是為療養(yǎng)度假和健康水療，也是為到離家?guī)浊в⒗锏牡胤綄で筢t(yī)療和服務(wù)，包括侵入性治療如髖關(guān)節(jié)置換手術(shù)、冠狀動(dòng)脈旁路手術(shù)甚至如肝臟移植這樣的器官移植 (維賈雅,2010)。對(duì)行業(yè)的經(jīng)濟(jì)潛力估計(jì)表明,這是一個(gè)不容忽略的現(xiàn)象。引用一個(gè)經(jīng)常被引用的德勤(2008)報(bào)告對(duì)亞洲醫(yī)療旅游行業(yè)的估計(jì)，這一行業(yè)將會(huì)以每年增長(zhǎng) 20%的速度增長(zhǎng)，其價(jià)值在

32、亞洲約為 40 億美元。萊希(2008)估計(jì)其全球產(chǎn)業(yè)價(jià)值將突破 600 億美元。 </p><p>　　在醫(yī)療旅游浪潮中，馬來(lái)西亞政府將醫(yī)療旅游行業(yè)確定為醫(yī)療保健經(jīng)濟(jì)改革中的戰(zhàn)略機(jī)遇(新的關(guān)鍵經(jīng)濟(jì)領(lǐng)域)。這將表明，醫(yī)療旅游作為經(jīng)濟(jì)活動(dòng)的關(guān)鍵驅(qū)動(dòng)因素，有可能對(duì)國(guó)家經(jīng)濟(jì)轉(zhuǎn)型計(jì)劃做出顯著貢獻(xiàn)。由于其強(qiáng)大的醫(yī)療保健系統(tǒng)，嚴(yán)格控制醫(yī)療服務(wù)的質(zhì)量保證，這個(gè)國(guó)家已經(jīng)有了合適的基礎(chǔ)設(shè)施。國(guó)家獨(dú)立以來(lái)實(shí)施的醫(yī)療保健策略已成功地提

33、高了馬來(lái)西亞人口的健康狀況。這個(gè)國(guó)家也有大量受過(guò)西方教育的醫(yī)生，馬來(lái)西亞護(hù)士也受到了高度重視。醫(yī)學(xué)教育和實(shí)踐井然有序,衛(wèi)生部密切監(jiān)督公共和私人保健服務(wù)。馬來(lái)西亞的衛(wèi)生指標(biāo)如嬰兒死亡率和預(yù)期壽命也在與大多數(shù)發(fā)達(dá)國(guó)家水平一致。作為一個(gè)可信的衛(wèi)生保健提供者，這已經(jīng)建立起了國(guó)家的聲譽(yù)。 </p><p>　　馬來(lái)西亞衛(wèi)生品質(zhì)協(xié)會(huì)(MSQH)認(rèn)為，獲得資格認(rèn)證的醫(yī)院組織良好。馬來(lái)西亞衛(wèi)生品質(zhì)協(xié)會(huì)按照世界衛(wèi)生組織安全聯(lián)盟的標(biāo)

34、準(zhǔn)實(shí)施戰(zhàn)略,馬來(lái)西亞衛(wèi)生品 質(zhì)協(xié)會(huì)醫(yī)院評(píng)審標(biāo)準(zhǔn)也得到了國(guó)際健康照護(hù)品質(zhì)協(xié)會(huì)認(rèn)證委員會(huì)和聯(lián)合委員會(huì)國(guó)際(JCI)的認(rèn)證。因此,馬來(lái)西亞已經(jīng)有一個(gè)強(qiáng)大的基礎(chǔ)通過(guò)馬來(lái)西亞衛(wèi)生品質(zhì)協(xié)會(huì)的認(rèn)證。 </p><p>　　馬來(lái)西亞政府還建立了醫(yī)療旅游委員會(huì)(MHTC),這是一個(gè)促進(jìn)該國(guó)海外醫(yī)療服務(wù)的一站式服務(wù)中心。盡管這一行業(yè)是新興起來(lái)的, 產(chǎn)業(yè)的集約化發(fā)展使得越來(lái)越多的國(guó)際患者進(jìn)入這個(gè)國(guó)家。2002 年，醫(yī)療游客的數(shù)量是 8

35、4585，創(chuàng)造了 35.9 百萬(wàn)的收入，到了 2011 年,國(guó)際病人的數(shù)量已經(jīng)達(dá)到了 581308，年總收入超過(guò) 500 百萬(wàn)(馬來(lái)西亞醫(yī)療旅游委員會(huì),2012)。馬來(lái)西亞的第九個(gè)計(jì)劃中，醫(yī)療旅游的目標(biāo)收入設(shè)定為 2 億 (經(jīng)濟(jì)策劃單位,2006)。 </p><p><b>　　文獻(xiàn)綜述 </b></p><p>　　回顧相關(guān)文獻(xiàn)表明,醫(yī)療旅游不是一個(gè)新概念，它證實(shí)

36、了全球化的力量。事實(shí)上，為了健康出國(guó)旅游有著悠久的歷史,在那里，較富裕的社會(huì)階層將在瑞士和奧地利等青睞的目的地尋求水療、礦物浴和創(chuàng)新的治療。除了水療和療養(yǎng)地,當(dāng)時(shí)的趨勢(shì)是病人從欠發(fā)達(dá)國(guó)家到歐洲或美國(guó)，那里有更精良醫(yī)療衛(wèi)生設(shè)施和更先進(jìn)的技術(shù)。(馬尼夫，2011)。然而，近年來(lái)這樣的趨勢(shì)有了逆轉(zhuǎn)，從發(fā)達(dá)國(guó)家如美國(guó)和英國(guó)病人前往泰國(guó)和印度等發(fā)展中國(guó)家尋求醫(yī)療服務(wù)的人越來(lái)越多(沃爾斯,2008)。融合全球標(biāo)準(zhǔn)的醫(yī)療保健促進(jìn)了病人的運(yùn)動(dòng)。在那種程

37、度上, 美國(guó)醫(yī)院協(xié)會(huì)高級(jí)副總裁里克?韋德說(shuō),“他不會(huì)懷疑一些國(guó)際醫(yī)院與美國(guó)醫(yī)院一樣擁有高醫(yī)療水平”(弗里德和哈里斯,2007)。 </p><p>　　最近縱橫交錯(cuò)的現(xiàn)象和環(huán)球旅行的病人是深不可測(cè)的。例如,泰國(guó),這個(gè)行業(yè)一個(gè)強(qiáng)有力的競(jìng)爭(zhēng)者,獲得了超過(guò)一百萬(wàn)名外國(guó)患者尋求治療，從執(zhí)行健康測(cè)試到侵入性手術(shù)(康奈爾,2006)。2008 年,泰國(guó)的醫(yī)療旅游行業(yè)產(chǎn)生了 15 億美元的收益 (納拉瑯，2011)。除泰國(guó)外,

38、其他獲得利益的國(guó)家包括馬來(lái)西亞、新加坡和印度亞洲,東歐的匈牙利和波蘭;地中海的馬耳他和塞浦路斯;中美洲的哥斯達(dá)黎加、巴西、墨西哥和古巴;中東的迪拜和約旦(倫特,2010)。 </p><p>　　為了保證潛在患者的醫(yī)療質(zhì)量標(biāo)準(zhǔn),這個(gè)地區(qū)的醫(yī)療旅游醫(yī)院利用他們的成果措施。例如，新加坡的國(guó)家醫(yī)療集團(tuán)是一個(gè)急癥護(hù)理和專(zhuān)科醫(yī)院集團(tuán),它會(huì)定期發(fā)布符合國(guó)際標(biāo)準(zhǔn)的結(jié)果措施。雖然，這些醫(yī)院發(fā)布的健康結(jié)果可能是出于營(yíng)銷(xiāo)目的,然而,

39、研究也強(qiáng)調(diào)了其積極的結(jié)果。埃森和卡森(2013)定性研究了泰國(guó),墨 西哥、東歐、哥斯達(dá)黎加和印度的醫(yī)療游客，各種各樣的醫(yī)療服務(wù):骨科手術(shù),皮膚病咨詢(xún),減肥手術(shù),心臟保健，輔助生殖過(guò)程,耳鼻咽喉科手術(shù)，牙齒護(hù)理和衛(wèi)生,結(jié)腸鏡檢查,乳房 x 光檢查,篩查實(shí)驗(yàn)室和診斷成像,眼部護(hù)理和免費(fèi)醫(yī)療保健——從參與者范本中成功地報(bào)道了積極的體驗(yàn)。 </p><p>　　對(duì)患者來(lái)講,醫(yī)療旅游的動(dòng)機(jī)是多方面的。美國(guó)健康的旅行者, 若

40、沒(méi)有保險(xiǎn)或保額不足，在另一個(gè)國(guó)家看病是一個(gè)可行的選擇。而美國(guó)人享受醫(yī)療服務(wù)的最高標(biāo)準(zhǔn),該國(guó)的醫(yī)療保健系統(tǒng)存在成本過(guò)高及不平等訪(fǎng)問(wèn)等問(wèn)題。最近奧巴馬醫(yī)改失敗,導(dǎo)致美國(guó)聯(lián)邦政府的關(guān)閉證明了這一點(diǎn)。美國(guó)的衛(wèi)生保健系統(tǒng)是世界上最昂貴的(馬洛和沙利文,2007),目前一年達(dá)到 2 萬(wàn)億美元。對(duì)于美國(guó)患者個(gè)體的報(bào)道來(lái)自出國(guó)接受治療的文獻(xiàn)(特納,2007 年,約克,2007;格雷和皮羅,2008; 米爾斯坦和史密斯,2006;康奈爾,2006)。根據(jù)

41、納加爾(2011)的觀點(diǎn),美國(guó)人口的很大一部分,也就是 46 百萬(wàn)的人沒(méi)有醫(yī)療保險(xiǎn)或保額不足。因此,考慮到過(guò)度的醫(yī)療成本和保險(xiǎn)覆蓋面不足,美國(guó)病人正涌向世界其他地方尋找負(fù)擔(dān)得起的醫(yī)療服務(wù)。對(duì)于國(guó)家衛(wèi)生保健系統(tǒng)公開(kāi)資助的,如在英國(guó)或加拿大，病人尋求海外醫(yī)療服務(wù)的動(dòng)機(jī)是漫長(zhǎng)的手術(shù)等待(約翰斯頓,2010)。另一方面,欠發(fā)達(dá)國(guó)家的患者尋求健康治療的目的是為了國(guó)外更好的護(hù)理質(zhì)量。因此,越南和印尼等國(guó)家的病人紛紛涌向馬來(lái)西亞和新加坡等擁有更好醫(yī)療

42、保健系統(tǒng)的鄰國(guó)。 </p><p>　　雖然，成本、漫長(zhǎng)的等待和更高質(zhì)量保健可能是游客出國(guó)旅游的驅(qū)動(dòng)因素,我們還發(fā)現(xiàn)了其他驅(qū)動(dòng)因素?？唆斂怂?2010)發(fā)現(xiàn)，患者在本國(guó)治療過(guò)程中非法或不可用如干細(xì)胞或代孕,是其他驅(qū)動(dòng)因素。市場(chǎng)營(yíng)銷(xiāo)的影響,特別是網(wǎng)絡(luò)營(yíng)銷(xiāo)因素也會(huì)影響患者醫(yī)療旅游目的地的選擇。 </p><p>　　回顧相關(guān)文獻(xiàn)同時(shí)表明,醫(yī)療旅游在概念級(jí)別也是一個(gè)廣泛研究的主題 (阿雷利亞諾和

43、安妮特,2007;康奈爾,2006;古奇,2009,道格拉斯,2007;萊希,2008，約克,2008;卡瓦賈,2007)。醫(yī)療旅游是最近才出現(xiàn)的現(xiàn)象,所以對(duì)于該領(lǐng)域的研究還很貧乏,但也存在一些實(shí)證研究。例如,陳(2012)研究了潛在醫(yī)療游客從中國(guó)到臺(tái)灣尋求治療的意愿和障礙。馬丁 (2011),開(kāi)發(fā)了能測(cè)量游客醫(yī)療旅游意圖的工具。拉德(2010)探討了馬來(lái)西亞醫(yī)療游客的服務(wù)質(zhì)量和患者滿(mǎn)意度。波科克 (2011)還研究了醫(yī)療旅游的數(shù)據(jù)不足

44、和實(shí)證分析。這是可以理解的,因?yàn)閺尼t(yī)療游客中獲得關(guān)于調(diào)查問(wèn)卷的數(shù)據(jù)是一個(gè)艱巨的任務(wù)。作者進(jìn)行這項(xiàng)研究時(shí)，在數(shù)據(jù)收集 過(guò)程中面臨了重大挑戰(zhàn)。醫(yī)院關(guān)心病人隱私,另一方面, 患者除了關(guān)心健康不會(huì)對(duì)任何形式的調(diào)查感興趣。馬納夫(2012)提醒不愿意合作的病人,由于他們恐懼給服務(wù)提供者提供反饋，以及患病中的心理負(fù)擔(dān)?？紤]到得到病人反饋是一項(xiàng)艱巨的任務(wù),醫(yī)療旅游的經(jīng)驗(yàn)數(shù)據(jù)幾乎不存在是可以理解的。因此,進(jìn)行研究填補(bǔ)這一空白迫在眉睫。</p>