Journal articles on the topic 'Medical tourism – Singapore'

Indonesian citizens have spent the USD 11.5 × 109 for medical treatment services abroad. Singapore is one of the favorite countries in medical tourism for Indonesian people. This research aims at analyzing the attraction factors of medical tourism in Singapore. There are 100 respondents visited Singapore to do medical tourism. The retrieved data is processed using the CFA (confirmatory analysis factor) method. The result shows the five main factors that make Singapore attractive for medical tourism, and the factors are the atmosphere and medical accuracy, competency and price, facilities, customer satisfaction, and entertainment.

Transnational medical travel, widely quoted as medical combines health care with leisure travel. Asia-Pacific is the leading contributor to the global market revenue in medical tourism and the global turnover is expected cross over USD 31.21 billion by 2026. With protracted and expensive visa and medical services patients seek sophisticated but inexpensive healthcare unavailable in their country. These issues are capitalized by many developing and developed countries like Thailand, India, Malaysia and Singapore by the virtue of their marked cost differentials, economical airfare, advanced medical care, favourable health care infrastructures, destination competitiveness, service quality, travel and entertainment facilities, making them a popular medical destination.

Recently, medical tourism became one of the rapidly growing industries globally with 25% growth yearly with the value of over 200 billion euros. North America, Asia and Europe hold the most significant share of this value. According to The Medical Tourism Market – Global Industry Analysis Report, the forecast by 2027 will be a value of 272.70 billion US dollars. Croatia has strong potential for developing the medical tourism industry as an integral and essential part of the whole tourism industry in Croatia. But, lack of political will and public sector efforts decrease these opportunities. Fundamental healthcare reform is needed and improves outdated infrastructure with low service quality, including accommodation and accompanying catering and recreational facilities. Health care tourism is not competitive in this exceptionally demanding market. Singapore, India and Turkey can be excellent examples of doing thing rights, showing the path to success to the Croatian medical tourism industry. Where is Croatia right now, and what can be done to move forward is a big question. Several authors offer possible solutions that can lead to achieving objectives and goals stated in the National Strategy for Development of Healthcare and Action Plan until 2028. The future development of the medical tourism industry is an exciting area both in applicative and scientific fields, which can encourage further scientific efforts to explore more deeply the subject.

Medical tourism has become an investment focus for many Asian countries. For example, India, Singapore, Thailand, South Korea, and Malaysia have governmental projects to foster this emerging industry, and successfully attract millions of medical tourists each year. Medical tourism consists of diverse industries that can provide abundant opportunities of new businesses. Currently Taiwan is trying to catch up in this trend by making national development policies, setting up institutions, modifying laws and regulations, and encouraging investment of private sector. The purpose of this study is to analyze the status quo of international medical tourism in Taiwan, and identify several opportunities for small businesses to catch and to participate in forming a solid medical tourism industry for Taiwan.

The Asia-Pacific region is known as a favorite destination for global medical travelers due to its medical expertise, innovative technology, safety, attractive tourism destination and cost advantage in the recent decade. This study contributes to propose an approach which effectively assesses performance of medical tourism industry based on considering the economic impact factors as well as provides a conceptual framework for the industry analysis. Grey system theory is utilized as a major analyzing approach. According to that, factors impact on the sustainable development of medical tourism in Asia-Pacific region could be identified. The performance of each destination in this region was simultaneously revealed. The results presented an overall perspective of the medical tourism industry in the scope of the Asia-Pacific region, and in Taiwan particularly. Data was collected on six major destinations including Singapore, Thailand, India, South Korea, Malaysia and Taiwan. The results proved that tourism sources and healthcare medical infrastructures play a crucial role in promoting the healthcare travel industry, while cost advantage and marketing effectiveness were less considered. In addition, performance analyse indicated that Thailand has a good performance and stands in the top ranking, followed by Malaysia, India, Singapore, South Korea and Taiwan, respectively. The revenue of Taiwan has increased slowly in the last six years, with a market worth approximately NT$20.5 billion, and the number of medical travelers is expected to increase to 777,523 by 2025. The findings of this study are expected to provide useful information for the medical tourism industry and related key players in strategic planning.

The General Agreement on Tariffs and Trade (GATT), an outcome of Bretton Woods Conference, was a trade pact to pursue the objective of free trade in goods. The 8th Uruguay Round of GATT negotiations launched in Punta Del Este in 1986 went well beyond trade in goods and extended to trade in areas like intellectual property, investment and services, resulting in agreements such as TRIPS, TRIMS and GATS. GATS, The General Agreement on Trade in Services, internationalized trade in services and gave a momentum to international trade in services, including healthcare services. The Agreement specifies the four modes of supply of services, one of these being consumption abroad. In this mode a consumer who needs services moves to the country offering the service as in the case of a student going overseas for higher education or a person seeking medical treatment in a foreign country. The GATS gave a boost to medical tourism in some Asian countries such as Indonesia, Malaysia, Philippines, Singapore, Thailand and India.This Paper after distinguishing medical tourism from health/wellness tourism, traces the growth of medical tourism in Asian countries and points out the factors contributing to this growth. It then specifically highlights the reasons why India has become the preferred destination for medical tourism. What follows is a critical analysis of the opportunities and challenges posed by medical tourism for India. It concludes by opining that internationalization of healthcare services in India should not be at the cost of health injustice to the Indians, especially for those who need health justice the most!

Background:More and more developing nations are promoting cross-border medical tourism as a way to enhance economic growth. Major destinations for medical tourism in South and Southeast Asia include India, Thailand, Malaysia and wealthy Singapore. Much has been written on the pros and cons of the growth of medical tourism for both destination and source countries. This article uses a different approach.Methodology:Examples from India, Thailand and Malaysia are used to discuss the actual and potential impact of medical tourism on healthcare system efficiency and costs.Results and Conclusions:Based on the experience of these three countries, it is argued that the promotion of cross-border medical tourism to enhance economic growth is likely to be at the expense of national healthcare system efficiency as it goes directly against cost containment strategies and measures.

Medical tourism is a global phenomenon in many parts of the world. It features an activity where individuals travel from home country to the host country to seek or receive medical healthcare. Being the third largest sector, medical tourism has a significant contribution towards economic development in the Southeast Asia (SEA) region. However, the literature review depicts a scarcity of research on niche areas among the top player in this region. This study aims to explore the development of the medical tourism industry in the SEA region. An in-depth interview with stakeholders and private hospitals were conducted and analyzed using thematic analysis coupled with document analysis from various secondary data. Four SEA regions were chosen namely Malaysia, Indonesia, Thailand, and Singapore which offer specific niche markets to promote the medical tourism industry. Interestingly, these countries are complementing and not competing with each other in the same industry. This study is vital in enriching the literature in the field of medical tourism in showcasing the niche market of medical tourism in the SEA region. This study also contributes greatly to comparative analysis between these countries in the medical tourism sector.

Countries throughout Asia promote themselves as leading destinations for international travelers seeking inexpensive healthcare. India, Indonesia, Malaysia, Singapore, the Philippines, and Thailand are all trying to attract greater numbers of what their promotional campaigns call “medical tourists.” Government tourism initiatives, hospital associations, medical tourism companies, and individual hospitals advertise hip and knee replacements, spinal surgery, cosmetic surgery, and other medical procedures. In contrast to most nations marketing treatments to international patients, the Philippines differentiates itself by selling “all inclusive” kidney transplant packages. Patients from other countries travel to the Philippines and receive kidneys purchased from poor individuals.

Patients seeking medical care are traveling greater distances for treatment. The globalization of health care has given rise to a thriving global medical services industry. The ability to gain access to more advanced treatments and differences in cost and inflexible national health care systems encourage patients to seek treatment abroad. In the new information age, patients seek information about available treatment opportunities with less regard to national boundaries. International hospitals are seeking new marketing strategies for their services. Today, much of the marketing takes place on the Internet, which is accelerating the internationalization of the medical services industry. This article presents a comparative and interpretative study. We have interpreted the market orientation and degree of specialization of hospitals in Singapore and in Sweden, which in turn are compared to leading hospitals in the United States. In this research, we present evidence of different approaches to medical tourism based on different organizational frameworks for the marketing of medical services to international patients. The study indicates that market orientation results in greater emphasis on superior service quality of health care. This in turn leads to the delivery of improved services to patients.

The hospitality sector in India plays a vital role in terms of contributions to the economy of the country as an employment generator. The much wanted growth in the tourism sector of the country is in fact dependent on the growth and development of the hospitality sector. However, the ability of the hospitality sector to remain viable, profitable and competitive in the years to come will depend on its ability to foresee emerging trends and then capitalize on them. This is most essential, given that India, despite having high tourist potential, attracts far lesser foreign tourists as compared to smaller countries like Singapore, Thailand and Malaysia. This paper examines the key trends that are set to emerge in the hospitality sector in the country over the next decade. An exploratory methodology was used in this research including both theoretical and empirical methods. From the theoretical studies, it was found that these key trends include the growth of domestic tourism, the emergence of medical tourism as the key attraction in India, the development of tier 2 and tier 3 cities as important tourist hubs and the shift in tourist traffic away from luxury formats which have hitherto dominated the hotel industry and towards economically priced mid – level and budget hotels.

Today, medical tourism is one of the fastest growing sectors of the tourism industry around the world. Medical tourism can contribute to the sustainable development and economic dynamism of countries. Therefore, in this study, we prioritize the world’s leading countries in medical tourism for Iranians. First, five main criteria and 20 sub-criteria were selected, which are the reasons for choosing a country as a medical tourism destination. In this paper a combined fuzzy SWARA-PROMETHEE approach was used to prioritize tourism destinations. The acronym PROMETHEE stands for Preference Ranking Organization Method for Enrichment Evaluation method and represents an useful MCDA (Multi-Criteria Decision Analysis) tool. On the other hand, SWARA acronym means Step-wise Weight Assessment Ratio Analysis. The criteria were weighted using the fuzzy SWARA approach. In the following, using the PROMETHEE approach, we prioritized eight countries as tourism destinations, then we identified criteria related to sustainability of medical tourism destinations and prioritized medical tourism destinations using these criteria as the contributions of this paper. The weights obtained for criteria “Abilities of skilled staff,” “Applied medical equipment,” “Marketing capability,” “Type of service provided,” and “Application of information and communications technology” were 0.176, 0.232, 0.108, 0.395, and 0.089, respectively. The results show that medical tourism destination priorities for Iranians are India (Phi = 0.1396), Malaysia (Phi = 0.1128), Panama (Phi = 0.0976), Mexico (Phi = 0.0790), Singapore (Phi = 0.0096), Taiwan (Phi = −0.0442), Brazil (Phi = −0.1747), and Costa Rica (Phi = −0.2196), respectively. Negative Phi values indicate below average performance of those countries and positive Phi values indicate above average performance of those criteria. The results indicate that countries with negative Phi values should be strengthened relative to the improvement of some criteria.

Generally, people living in one country, if travel to another country or another region of the same country, for the purpose of getting medical care including surgery, which is not available in their own country or region otherwise, is termed as Medical Tourism or Health Tourism. For this purpose generally people travel from under developed countries to highly developed countries in absence of the facilities in their own country or when getting cheaper and better options in alternative countries. Its popularity is growing fast across the globe, focusing primarily and predominantly on biomedical reasons, combined witourism, if possible. Most of the medical tourists belong to Asian countries, annterestingly these tourists are visiting also to asian countries, whose number increasing very fast every year. In this field mainly four asian countries India, Singapore, Thailand and Malaysia are leading and these are promoting anopularizing medical tourism aggressively. India has great Prospects in the field of Medical Tourism by virtue of its corompetence developed in cardiovascular surgery and organ transplant/surgertc, along with low cost option and great reputation. Apart from generatinmployment opportunities, it will also increase our foreign exchange and causocio-economic development, strengthening our country’s economy. Aparrom the treatment by allopathic system, other Indian systems of medicines, i.e. Ayurveda, Yoga, Panchakarma, Rejuvenation Therapy and Naturopathtc. also have gained great popularity in recent past. The Govt also has takeeveral initiatives through Ministry of Tourism to promote India as a Medicand Health Tourism Destination. Special provisions have been made for thoreign visitors coming to India for their treatment, issuing them a neategory of visa "Medical Visa" for the purpose. Apart from the Government initiatives, most of the private hospitals are alsnvesting heavily, giving a facelift to their medical facilities, realizing thotential for Medical Tourism in India, in order to make them visible to nonly to local elite but also to overseas clients. This paper reviews some kessues, prospects, opportunities, challenges and some other relevant aspects of Medical Tourism with respect to India.

Generally, people living in one country, if travel to another country or another region of the same country, for the purpose of getting medical care including surgery, which is not available in their own country or region otherwise, is termed as Medical Tourism or Health Tourism. For this purpose generally people travel from under developed countries to highly developed countries in absence of the facilities in their own country or when getting cheaper and better options in alternative countries. Its popularity is growing fast across the globe, focusing primarily and predominantly on biomedical reasons, combined with tourism, if possible. Most of the medical tourists belong to Asian countries, and interestingly these tourists are visiting also to asian countries, whose number is increasing very fast every year. In this field mainly four asian countries India, Singapore, Thailand and Malaysia are leading and these are promoting and popularizing medical tourism aggressively. India has great Prospects in the field of Medical Tourism by virtue of its core competence developed in cardiovascular surgery and organ transplant/surgery etc, along with low cost option and great reputation. Apart from generating employment opportunities, it will also increase our foreign exchange and cause socio-economic development, strengthening our country’s economy. Apart from the treatment by allopathic system, other Indian systems of medicines, i.e. Ayurveda, Yoga, Panchakarma, Rejuvenation Therapy and Naturopathy etc. also have gained great popularity in recent past. The Govt also has taken several initiatives through Ministry of Tourism to promote India as a Medical and Health Tourism Destination. Special provisions have been made for the foreign visitors coming to India for their treatment, issuing them a new category of visa "Medical Visa" for the purpose. Apart from the Government initiatives, most of the private hospitals are also investing heavily, giving a facelift to their medical facilities, realizing the potential for Medical Tourism in India, in order to make them visible to not only to local elite but also to overseas clients. This paper reviews some key issues, prospects, opportunities, challenges and some other relevant aspects of Medical Tourism with respect to India.

Abstract This article examines the experiences of Bangladeshi patients and their families as they travel transnationally within Asia for medical care. I explain how failures of biomedicine in Bangladesh feed into idealized expectations of care abroad. This medical imaginary is fueled by the hope that more expensive treatment in wealthier countries will result in better care, and it is sustained by the way the medical tourism industry operates and the way Bangladeshi patients and their families make choices and engage in the doing of care abroad. A detailed case study of a Bangladeshi cancer patient’s prolonged care in Singapore illustrates the tensions and ambivalences in the quest for the best treatment. These tensions are exacerbated by the linguistic, monetary, and emotional challenges faced in traveling back and forth between countries. While patients feel at times betrayed by experiences of care that do not meet their expectations, they also feel compelled to carry on. I capture this dynamic in the term rhythms of care, understanding these as the way the medical imaginary shapes care practices that become a scaffolding for hope to be maintained and further travel to be undertaken. I also reflect on how I become part of these rhythms by acting as the family’s interpreter as they navigate health care in Singapore.

Medical tourism has become a booming industry in the recent past. People from all around the world cross the borders for better medical treatment. The leading destinations with markets for medical tourism include Malaysia, Thailand, India, Singapore, Turkey, and United States. Latest medical technology, high-quality services, insurance are a few of the criteria medical tourists seek for. As public-funded well-being insurance is unable to keep pace with the increasing demands of a growing aging population, patients from the United Kingdom and Canada travel to India to beat the huge waiting period for the routine procedures. The unprecedented COVID-19 outbreak has forced the market to observe diminishing growth. The pandemic is predicted to have a negative impact on this growing industry. The organizations, involved in the development of the medical tourism, stare at a dark future. It is, therefore, necessary to streamline the industry in view of this dismal scenario. However, with the growing technological development, one such platform that can bridge the distance in the health sector is telemedicine. This paper is an attempt to study the growing importance of telemedicine in a developing country like India. The research is based on both primary and secondary data along with a thorough literature review. Post lockdown telemedicine is likely to grow, and telemedicine is probably the future of the healthcare industry.

Health services are now advertised in a global marketplace. Hip and knee replacements, ophthalmologic procedures, cosmetic surgery, cardiac care, organ transplants, and stem cell injections are all available for purchase in the global health services marketplace. “Medical tourism” companies market “sun and surgery” packages and arrange care at international hospitals in Costa Rica, India, Mexico, Singapore, Thailand, and other destination nations. Just as automobile manufacturing and textile production moved outside the United States, American patients are “offshoring” themselves to facilities that use low labor costs to gain competitive advantage in the marketplace. Proponents of medical tourism argue that a global market in health services will promote consumer choice, foster competition among hospitals, and enable customers to purchase high-quality care at medical facilities around the world. Skeptics raise concerns about quality of care and patient safety, information disclosure to patients, legal redress when patients are harmed while receiving care at international hospitals, and harms to public health care systems in destination nations. The emergence of a global market in health services will have profound consequences for health insurance, delivery of health services, patient-physician relationships, publicly funded health care, and the spread of medical consumerism.

Mitochondrial replacement techniques (MRTs, also referred to as mitochondrial replacement therapies) have given hope to many women who wish to have genetically related children but have mitochondrial DNA mutations in their eggs. MRTs have also spurred deep ethical disagreements and led to different regulatory approaches worldwide. In this review, we discuss the current regulation of MRTs across several countries. After discussing the basics of the science, we describe the current law and policy directions in seven countries: the United Kingdom, the United States, Canada, Australia, Germany, Israel, and Singapore. We also discuss the emerging phenomenon of medical tourism (also called medical travel) for MRTs to places like Greece, Spain, Mexico, and Ukraine. We then pull out some key findings regarding similarities and differences in regulatory approaches around the world.

Governments are increasingly using cloud computing to reduce cost, increase access, improve quality, and create innovations in healthcare. Existing literature is primarily based on successful examples from developed western countries, and there is a lack of similar evidence from Asia. With a population close to 4.5 billion people, Asia faces healthcare challenges that pose an immense burden on economic growth and policymaking. Cloud computing in healthcare can potentially help increase the quality of healthcare delivery and reduce the economic burden, enabling governments to address healthcare challenges effectively and within a short timeframe. Advanced Asian countries such as Japan, South Korea, and Singapore provide successful examples of how cloud computing can be used to develop nationwide databases of electronic health records; real-time health monitoring for the elderly population; genetic database to support advanced research and cancer treatment; telemedicine; and health cities that drive the economy through medical industry, tourism, and research. This article examines these countries and identifies the drivers and barriers of cloud adoption in healthcare and makes policy recommendations to enable successful public health innovations through cloud adoption.

The background of this research was decreased by Indonesian citizens tend to choose medical tourism in neighboring countries such as Malaysia and Singapore, where hospitality is one of eksternal factor that causes it. Hospitality is a services provider to customer that which creates the impression by hosting and hospitableness. Hospitality in the health industries is divided into three such as public hospitality, personal hospitality, and therapeutic hospitality. The aims of this research is to describe the patient Inpatient unit perceptions with public hospitality, personal hospitality and therapeutic hospitality in Hasanuddin University Hospital. The method of this research is descriptive with devide class treatment using proportional stratified random sampling. Respondents of this research is 100 patients where patients undergoing treatment more than three days in Hasanuddin University Hospital.The result of this research showed that patient perception with public hospitality 56% good and 44% deficient, personal hospitality 66% good and 34% deficient, therapeutic hospitality 65% good and 35% deficient. Most respondents were undergoing treatment in Hasanuddin University Hospital has a good perception of the three hospitality although there are some complaints. Suggested for the hospital must improve the three hospitality in hospital, especially personal hospitality for patient.

Tanah Liek Citra batik is one of the batik craft businesses on the Duo Sitiung River, Dharmasraya Regency, West Sumatra. Became the first Tanah Liek batik business in Dharmasraya Regency since 1996 which raised various decorative batik motifs from the natural wealth of Dharmasraya Regency. The research was conducted with the aim of describing the decorative motifs of Tanah Liek Citra batik. The method used in this research is a qualitative method with a descriptive approach. The data sources chosen were primary data (written notes, picture recordings) and also used secondary data (library studies). The technique of collecting research data uses techniques, observations, interviews, and documentation. Furthermore, the technical analysis of the data will be reviewed and will be analyzed, namely reduction of data, presentation of research data and finally conclusions can be drawn from the data that has been collected. The results of the study describe the Tanah Liek Citra batik motifs, including those inspired by naturalist forms (flora such as: palm flower motifs, rubber tree motifs, bamboo motifs, lauik plant motifs, kaluak nails motifs, kiambang batauik motifs, fauna such as: hong bird motifs, motifs tapak kudo) decorative forms such as: rangkiang motif, rumah gadang motif.Keywords: batik motif, tanah liek.AbstrakBatik Tanah Liek citra adalah salah satu usaha kerajinan batik di Sungai Duo Sitiung, Kabupaten Dharmasraya, Sumatera Barat. Menjadi usaha batik Tanah Liek pertama di Kabupaten Dharmasraya sejak tahun 1996 yang mengangkat ragam hias motif batik dari kekayaan alam Kabupaten Dharmasraya. Penelitian dilakukan dengan tujuan untuk mendeskripsikan ragam hias motif dari batik Tanah Liek citra. Metode yang dipergunakan dalam penelitian ini yaitu metode kualitatif dengan pendekatan deskriptif. Sumber data yang dipilih yaitu berupa data primer (catatan tertulis, rekaman gambar) dan juga menggunakan data sekunder (studi kepustakaan). Teknik dari pengumpulan data penelitian menggunakan teknik, observasi, wawancara, serta dokumentasi. Selanjutnya teknis analisis data akan dikaji dan akan di analisis yaitu reduksi dari data, penyajian dari data hasil penelitian dan yang terakhir baru dapat ditarik kesimpulan dari data-data yang telah terkumpul. Hasil dari penelitian mendeskripsikan motif batik Tanah Liek citra diantaranya yaitu terispirasi dari bentuk naturalis (flora seperti : motif bunga sawit, motif pohon karet, motif bambu, motif tumbuhan lauik, motif kaluak paku, motif kiambang batauik, fauna seperti : motif burung hong, motif tapak kudo) bentuk dekoratif seperti: motif rangkiang, motif rumah gadang. Kata Kunci: motif batik, tanah liek.Authors:Resfi Norma Kuwala : Universitas Negeri PadangSri Zulfia Novrita : Universitas Negeri Padang References:Budiyono, D. (2008). Kriya Tekstil Untuk SMK Jilid 1. Jakarta: Direktorat Pembinaan Sekolah Menengah Kejuruan.Elliot, Inger McCabe. (2004). Batik: Fabled Cloth of Java. Singapura: Perinpus.Ernawati, I., & Nelmira, W. (2008). Tata Busana Jilid 2. Jakarta: Direktorat Pembinaan Sekolah Menengah Kejuruan, Direktorat Jendral Manajemen, Pendidikan Dasar dan Menengah, Departemen Pendidikan Nasional.Moleong, Lexy. (2005). Penelitian Metodologi Kualitatif. Bandung: PT Remaja Rosdakarya.Hadaf, A., Adriani, A., & Novrita, S. Z. (2016). Motif dan Pewarnaan Batik Tulis di Dusun Giriloyo Desa Wukirsari Kecamatan Imogiri Kabupaten Bantul Provinsi Daerah Istimewa YOGYAKARTA (Studi Kasus di Industri Batik Sri Kuncoro). Journal of Home Economics and Tourism, 11(1). http://ejournal.unp.ac.id/index.php/jhet/article/viewFile/5781/4511Hakim, L. M. (2018). Batik Sebagai Warisan Budaya Bangsa dan Nation Brand Indonesia. Nation State: Journal of International Studies, 1(1), 61-90. https://jurnal.amikom.ac.id/index.php/nsjis/article/view/90/42Kamala, N., & Adriani, A. (2019). Studi Tentang Motif dan Pewarnaan Batik Cap dengan Zat Pewarnaan Alam di Rumah Batik Dewi Busana Kecamatan Lunang Kabupaten Pesisir Selatan. Gorga: Jurnal Seni Rupa, 8(2), 303-307. https://jurnal.unimed.ac.id/2012/index.php/gorga/article/download/14703/12015Kusrianto, A. (2013). Batik, Filosofi, Motif & Kegunaan. Yogyakarta: Andi Offset.Oktora, N., & Adriani, A. (2019). STUDI BATIK TANAH LIEK KOTA PADANG (Studi Kasus di Usaha Citra Monalisa). Gorga: Jurnal Seni Rupa, 8(1), 129-136. https://jurnal.unimed.ac.id/2012/index.php/gorga/article/view/12879Suryani, A., & Nelmira, W. (2019). STUDI TENTANG ATIK DI DHARMASRAYA. Gorga : Jurnal Seni Rupa, 8(1), 255-259. https://jurnal.unimed.ac.id/2012/index.php/gorga/article/viewFile/13624/11475Susanto, M . ( 2002 ) . Diksi Rupa, Kumpulan Istilah Seni Rupa. Yogyakarta: Kanisius.Wulandari, Ari. 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Introduction Many destinations promote culinary encounters. Foods and beverages, and especially how these will taste in situ, are being marketed as niche travel motivators and used in destination brand building across the globe. While initial usage of the term culinary tourism focused on experiencing exotic cultures of foreign destinations by sampling unfamiliar food and drinks, the term has expanded to embrace a range of leisure travel experiences where the aim is to locate and taste local specialities as part of a pleasurable, and hopefully notable, culinary encounter (Wolf). Long’s foundational work was central in developing the idea of culinary tourism as an active endeavor, suggesting that via consumption, individuals construct unique experiences. Ignatov and Smith’s literature review-inspired definition confirms the nature of activity as participatory, and adds consuming food production skills—from observing agriculture and local processors to visiting food markets and attending cooking schools—to culinary purchases. Despite importing almost all of its foodstuffs and beverages, including some of its water, Singapore is an acknowledged global leader in culinary tourism. Horng and Tsai note that culinary tourism conceptually implies that a transferal of “local or special knowledge and information that represent local culture and identities” (41) occurs via these experiences. This article adds the act of reading to these participatory activities and suggests that, because food writing forms an important component of Singapore’s suite of culinary tourism offerings, taste contributes to the cultural experience offered to both visitors and locals. While Singapore foodways have attracted significant scholarship (see, for instance, work by Bishop; Duruz; Huat & Rajah; Tarulevicz, Eating), Singapore food writing, like many artefacts of popular culture, has attracted less notice. Yet, this writing is an increasingly visible component of cultural production of, and about, Singapore, and performs a range of functions for locals, tourists and visitors before they arrive. Although many languages are spoken in Singapore, English is the national language (Alsagoff) and this study focuses on food writing in English. Background Tourism comprises a major part of Singapore’s economy, with recent figures detailing that food and beverage sales contribute over 10 per cent of this revenue, with spend on culinary tours and cookery classes, home wares such as tea-sets and cookbooks, food magazines and food memoirs additional to this (Singapore Government). This may be related to the fact that Singapore not only promotes food as a tourist attraction, but also actively promotes itself as an exceptional culinary destination. The Singapore Tourism Board (STB) includes food in its general information brochures and websites, and its print, television and cinema commercials (Huat and Rajah). It also mounts information-rich campaigns both abroad and inside Singapore. The 2007 ‘Singapore Seasons’ campaign, for instance, promoted Singaporean cuisine alongside films, design, books and other cultural products in London, New York and Beijing. Touring cities identified as key tourist markets in 2011, the ‘Singapore Takeout’ pop-up restaurant brought the taste of Singaporean foods into closer focus. Singaporean chefs worked with high profile locals in its kitchen in a custom-fabricated shipping container to create and demonstrate Singaporean dishes, attracting public and media interest. In country, the STB similarly actively promotes the tastes of Singaporean foods, hosting the annual World Gourmet Summit (Chaney and Ryan) and Pacific Food Expo, both attracting international culinary professionals to work alongside local leaders. The Singapore Food Festival each July is marketed to both locals and visitors. In these ways, the STB, as well as providing events for visitors, is actively urging Singaporeans to proud of their food culture and heritage, so that each Singaporean becomes a proactive ambassador of their cuisine. Singapore Food Writing Popular print guidebooks and online guides to Singapore pay significantly more attention to Singaporean food than they do for many other destinations. Sections on food in such publications discuss at relative length the taste of Singaporean food (always delicious) as well as how varied, authentic, hygienic and suited-to-all-budgets it is. These texts also recommend hawker stalls and food courts alongside cafés and restaurants (Henderson et al.), and a range of other culinary experiences such as city and farm food tours and cookery classes. This writing describes not only what can be seen or learned during these experiences, but also what foods can be sampled, and how these might taste. This focus on taste is reflected in the printed materials that greet the in-bound tourist at the airport. On a visit in October 2013, arrival banners featuring mouth-watering images of local specialities such as chicken rice and chilli crab marked the route from arrival to immigration and baggage collection. Even advertising for a bank was illustrated with photographs of luscious-looking fruits. The free maps and guidebooks available featured food-focused tours and restaurant locations, and there were also substantial free booklets dedicated solely to discussing local delicacies and their flavours, plus recommended locations to sample them. A website and free mobile app were available that contain practical information about dishes, ingredients, cookery methods, and places to eat, as well as historical and cultural information. These resources are also freely distributed to many hotels and popular tourist destinations. Alongside organising food walks, bus tours and cookery classes, the STB also recommends the work of a number of Singaporean food writers—principally prominent Singapore food bloggers, reviewers and a number of memoirists—as authentic guides to what are described as unique Singaporean flavours. The strategies at the heart of this promotion are linking advertising to useful information. At a number of food centres, for instance, STB information panels provide details about both specific dishes and Singapore’s food culture more generally (Henderson et al.). This focus is apparent at many tourist destinations, many of which are also popular local attractions. In historic Fort Canning Park, for instance, there is a recreation of Raffles’ experimental garden, established in 1822, where he grew the nutmeg, clove and other plants that were intended to form the foundation for spice plantations but were largely unsuccessful (Reisz). Today, information panels not only indicate the food plants’ names and how to grow them, but also their culinary and medicinal uses, recipes featuring them and the related food memories of famous Singaporeans. The Singapore Botanic Gardens similarly houses the Ginger Garden displaying several hundred species of ginger and information, and an Eco(-nomic/logical) Garden featuring many food plants and their stories. In Chinatown, panels mounted outside prominent heritage brands (often still quite small shops) add content to the shopping experience. A number of museums profile Singapore’s food culture in more depth. The National Museum of Singapore has a permanent Living History gallery that focuses on Singapore’s street food from the 1950s to 1970s. This display includes food-related artefacts, interactive aromatic displays of spices, films of dishes being made and eaten, and oral histories about food vendors, all supported by text panels and booklets. Here food is used to convey messages about the value of Singapore’s ethnic diversity and cross-cultural exchanges. Versions of some of these dishes can then be sampled in the museum café (Time Out Singapore). The Peranakan Museum—which profiles the unique hybrid culture of the descendants of the Chinese and South Indian traders who married local Malay women—shares this focus, with reconstructed kitchens and dining rooms, exhibits of cooking and eating utensils and displays on food’s ceremonial role in weddings and funerals all supported with significant textual information. The Chinatown Heritage Centre not only recreates food preparation areas as a vivid indicator of poor Chinese immigrants’ living conditions, but also houses The National Restaurant of Singapore, which translates this research directly into meals that recreate the heritage kopi tiam (traditional coffee shop) cuisine of Singapore in the 1930s, purposefully bringing taste into the service of education, as its descriptive menu states, “educationally delighting the palate” (Chinatown Heritage Centre). These museums recognise that shopping is a core tourist activity in Singapore (Chang; Yeung et al.). Their gift- and bookshops cater to the culinary tourist by featuring quality culinary products for sale (including, for instance, teapots and cups, teas, spices and traditional sweets, and other foods) many of which are accompanied by informative tags or brochures. At the centre of these curated, purchasable collections are a range written materials: culinary magazines, cookbooks, food histories and memoirs, as well as postcards and stationery printed with recipes. Food Magazines Locally produced food magazines cater to a range of readerships and serve to extend the culinary experience both in, and outside, Singapore. These include high-end gourmet, luxury lifestyle publications like venerable monthly Wine & Dine: The Art of Good Living, which, in in print for almost thirty years, targets an affluent readership (Wine & Dine). The magazine runs features on local dining, gourmet products and trends, as well as international epicurean locations and products. Beautifully illustrated recipes also feature, as the magazine declares, “we’ve recognised that sharing more recipes should be in the DNA of Wine & Dine’s editorial” (Wine & Dine). Appetite magazine, launched in 2006, targets the “new and emerging generation of gourmets—foodies with a discerning and cosmopolitan outlook, broad horizons and a insatiable appetite” (Edipresse Asia) and is reminiscent in much of its styling of New Zealand’s award-winning Cuisine magazine. Its focus is to present a fresh approach to both cooking at home and dining out, as readers are invited to “Whip up the perfect soufflé or feast with us at the finest restaurants in Singapore and around the region” (Edipresse Asia). Chefs from leading local restaurants are interviewed, and the voices of “fellow foodies and industry watchers” offer an “insider track” on food-related news: “what’s good and what’s new” (Edipresse Asia). In between these publications sits Epicure: Life’s Refinements, which features local dishes, chefs, and restaurants as well as an overseas travel section and a food memories column by a featured author. Locally available ingredients are also highlighted, such as abalone (Cheng) and an interesting range of mushrooms (Epicure). While there is a focus on an epicurean experience, this is presented slightly more casually than in Wine & Dine. Food & Travel focuses more on home cookery, but each issue also includes reviews of Singapore restaurants. The bimonthly bilingual (Chinese and English) Gourmet Living features recipes alongside a notable focus on food culture—with food history columns, restaurant reviews and profiles of celebrated chefs. An extensive range of imported international food magazines are also available, with those from nearby Malaysia and Indonesia regularly including articles on Singapore. Cookbooks These magazines all include reviews of cookery books including Singaporean examples – and some feature other food writing such as food histories, memoirs and blogs. These reviews draw attention to how many Singaporean cookbooks include a focus on food history alongside recipes. Cookery teacher Yee Soo Leong’s 1976 Singaporean Cooking was an early example of cookbook as heritage preservation. This 1976 book takes an unusual view of ‘Singaporean’ flavours. Beginning with sweet foods—Nonya/Singaporean and western cakes, biscuits, pies, pastries, bread, desserts and icings—it also focuses on both Singaporean and Western dishes. This text is also unusual as there are only 6 lines of direct authorial address in the author’s acknowledgements section. Expatriate food writer Wendy Hutton’s Singapore Food, first published in 1979, reprinted many times after and revised in 2007, has long been recognised as one of the most authoritative titles on Singapore’s food heritage. Providing an socio-historical map of Singapore’s culinary traditions, some one third of the first edition was devoted to information about Singaporean multi-cultural food history, including detailed profiles of a number of home cooks alongside its recipes. Published in 1980, Kenneth Mitchell’s A Taste of Singapore is clearly aimed at a foreign readership, noting the variety of foods available due to the racial origins of its inhabitants. The more modest, but equally educational in intent, Hawkers Flavour: A Guide to Hawkers Gourmet in Malaysia and Singapore (in its fourth printing in 1998) contains a detailed introductory essay outlining local food culture, favourite foods and drinks and times these might be served, festivals and festive foods, Indian, Indian Muslim, Chinese, Nyonya (Chinese-Malay), Malay and Halal foods and customs, followed with a selection of recipes from each. More contemporary examples of such information-rich cookbooks, such as those published in the frequently reprinted Periplus Mini Cookbook series, are sold at tourist attractions. Each of these modestly priced, 64-page, mouthwateringly illustrated booklets offer framing information, such as about a specific food culture as in the Nonya kitchen in Nonya Favourites (Boi), and explanatory glossaries of ingredients, as in Homestyle Malay Cooking (Jelani). Most recipes include a boxed paragraph detailing cookery or ingredient information that adds cultural nuance, as well as trying to describe tastes that the (obviously foreign) intended reader may not have encountered. Malaysian-born Violet Oon, who has been called the Julia Child of Singapore (Bergman), writes for both local and visiting readers. The FOOD Paper, published monthly for a decade from January 1987 was, she has stated, then “Singapore’s only monthly publication dedicated to the CSF—Certified Singapore Foodie” (Oon, Violet Oon Cooks 7). Under its auspices, Oon promoted her version of Singaporean cuisine to both locals and visitors, as well as running cookery classes and culinary events, hosting her own television cooking series on the Singapore Broadcasting Corporation, and touring internationally for the STB as a ‘Singapore Food Ambassador’ (Ahmad; Kraal). Taking this representation of flavor further, Oon has also produced a branded range of curry powders, spices, and biscuits, and set up a number of food outlets. Her first cookbook, World Peranakan Cookbook, was published in 1978. Her Singapore: 101 Meals of 1986 was commissioned by the STB, then known as the Singapore Tourist Promotion Board. Violet Oon Cooks, a compilation of recipes from The FOOD Paper, published in 1992, attracted a range of major international as well as Singaporean food sponsors, and her Timeless Recipes, published in 1997, similarly aimed to show how manufactured products could be incorporated into classic Singaporean dishes cooked at home. In 1998, Oon produced A Singapore Family Cookbook featuring 100 dishes. Many were from Nonya cuisine and her following books continued to focus on preserving heritage Singaporean recipes, as do a number of other nationally-cuisine focused collections such as Joyceline Tully and Christopher Tan’s Heritage Feasts: A Collection of Singapore Family Recipes. Sylvia Tan’s Singapore Heritage Food: Yesterday’s Recipes for Today’s Cooks, published in 2004, provides “a tentative account of Singapore’s food history” (5). It does this by mapping the various taste profiles of six thematically-arranged chronologically-overlapping sections, from the heritage of British colonialism, to the uptake of American and Russia foods in the Snackbar era of the 1960s and the use of convenience flavoring ingredients such as curry pastes, sauces, dried and frozen supermarket products from the 1970s. Other Volumes Other food-themed volumes focus on specific historical periods. Cecilia Leong-Salobir’s Food Culture in Colonial Asia: A Taste of Empire discusses the “unique hybrid” (1) cuisine of British expatriates in Singapore from 1858 to 1963. In 2009, the National Museum of Singapore produced the moving Wong Hong Suen’s Wartime Kitchen: Food and Eating in Singapore 1942–1950. This details the resilience and adaptability of both diners and cooks during the Japanese Occupation and in post-war Singapore, when shortages stimulated creativity. There is a centenary history of the Cold Storage company which shipped frozen foods all over south east Asia (Boon) and location-based studies such as Annette Tan’s Savour Chinatown: Stories Memories & Recipes. Tan interviewed hawkers, chefs and restaurant owners, working from this information to write both the book’s recipes and reflect on Chinatown’s culinary history. Food culture also features in (although it is not the main focus) more general book-length studies such as educational texts such as Chew Yen Fook’s The Magic of Singapore and Melanie Guile’s Culture in Singapore (2000). Works that navigate both spaces (of Singaporean culture more generally and its foodways) such Lily Kong’s Singapore Hawker Centres: People, Places, Food, provide an consistent narrative of food in Singapore, stressing its multicultural flavours that can be enjoyed from eateries ranging from hawker stalls to high-end restaurants that, interestingly, that agrees with that promulgated in the food writing discussed above. Food Memoirs and Blogs Many of these narratives include personal material, drawing on the author’s own food experiences and taste memories. This approach is fully developed in the food memoir, a growing sub-genre of Singapore food writing. While memoirs by expatriate Singaporeans such as Cheryl Lu-Lien Tan’s A Tiger in the Kitchen: A Memoir of Food and Family, produced by major publisher Hyperion in New York, has attracted considerable international attention, it presents a story of Singapore cuisine that agrees with such locally produced texts as television chef and food writer Terry Tan’s Stir-fried and Not Shaken: A Nostalgic Trip Down Singapore’s Memory Lane and the food memoir of the Singaporean chef credited with introducing fine Malay dining to Singapore, Aziza Ali’s Sambal Days, Kampong Cuisine, published in Singapore in 2013 with the support of the National Heritage Board. All these memoirs are currently available in Singapore in both bookshops and a number of museums and other attractions. While underscoring the historical and cultural value of these foods, all describe the unique flavours of Singaporean cuisine and its deliciousness. A number of prominent Singapore food bloggers are featured in general guidebooks and promoted by the STB as useful resources to dining out in Singapore. One of the most prominent of these is Leslie Tay, a medical doctor and “passionate foodie” (Knipp) whose awardwinning ieatŸishootŸipost is currently attracting some 90,000 unique visitors every month and has had over 20,000 million hits since its launch in 2006. An online diary of Tay’s visits to hundreds of Singaporean hawker stalls, it includes descriptions and photographs of meals consumed, creating accumulative oral culinary histories of these dishes and those who prepared them. These narratives have been reorganised and reshaped in Tay’s first book The End of Char Kway Teow and Other Hawker Mysteries, where each chapter tells the story of one particular dish, including recommended hawker stalls where it can be enjoyed. Ladyironchef.com is a popular food and travel site that began as a blog in 2007. An edited collection of reviews of eateries and travel information, many by the editor himself, the site features lists of, for example, the best cafes (LadyIronChef “Best Cafes”), eateries at the airport (LadyIronChef “Guide to Dining”), and hawker stalls (Lim). While attesting to the cultural value of these foods, many articles also discuss flavour, as in Lim’s musings on: ‘how good can chicken on rice taste? … The glistening grains of rice perfumed by fresh chicken stock and a whiff of ginger is so good you can even eat it on its own’. Conclusion Recent Singapore food publishing reflects this focus on taste. Tay’s publisher, Epigram, growing Singaporean food list includes the recently released Heritage Cookbooks Series. This highlights specialist Singaporean recipes and cookery techniques, with the stated aim of preserving tastes and foodways that continue to influence Singaporean food culture today. Volumes published to date on Peranakan, South Indian, Cantonese, Eurasian, and Teochew (from the Chaoshan region in the east of China’s Guangdong province) cuisines offer both cultural and practical guides to the quintessential dishes and flavours of each cuisine, featuring simple family dishes alongside more elaborate special occasion meals. In common with the food writing discussed above, the books in this series, although dealing with very different styles of cookery, contribute to an overall impression of the taste of Singapore food that is highly consistent and extremely persuasive. This food writing narrates that Singapore has a delicious as well as distinctive and interesting food culture that plays a significant role in Singaporean life both currently and historically. It also posits that this food culture is, at the same time, easily accessible and also worthy of detailed consideration and discussion. In this way, this food writing makes a contribution to both local and visitors’ appreciation of Singaporean food culture. References Ahmad, Nureza. “Violet Oon.” Singapore Infopedia: An Electronic Encyclopedia on Singapore’s History, Culture, People and Events (2004). 22 Nov. 2013 ‹http://infopedia.nl.sg/articles/SIP_459_2005-01-14.html?s=Violet%20Oon›.Ali, Aziza. Sambal Days, Kampong Cuisine. Singapore: Ate Ideas, 2013. Alsagoff, Lubna. “English in Singapore: Culture, capital and identity in linguistic variation”. World Englishes 29.3 (2010): 336–48.Bergman, Justin. “Restaurant Report: Violet Oon’s Kitchen in Singapore.” New York Times (13 March 2013). 21 Nov. 2013 ‹http://www.nytimes.com/2013/03/17/travel/violet-oons-kitchen-singapore-restaurant-report.html?_r=0›. Bishop, Peter. “Eating in the Contact Zone: Singapore Foodscape and Cosmopolitan Timespace.” Continuum: Journal of Media & Cultural Studies 25.5 (2011): 637–652. Boi, Lee Geok. Nonya Favourites. 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Ryan Bishop, John Phillips, and Yeo Wei Wei. New York: Routledge, 2003: 123–48. Singapore Government. Singapore Annual Report on Tourism Statistics. Singapore: Singapore Government, 2012. Suen, Wong Hong. Wartime Kitchen: Food and Eating in Singapore 1942-1950. Singapore: Editions Didier Millet & National Museum of Singapore, 2009. Tan, Annette. Savour Chinatown: Stories, Memories & Recipes. Singapore: Ate Ideas, 2012. Tan, Cheryl Lu-Lien. A Tiger in the Kitchen: A Memoir of Food and Family. New York: Hyperion, 2011. Tan, Sylvia. Singapore Heritage Food: Yesterday’s Recipes for Today’s Cooks. Singapore: Landmark Books, 2004. Tan, Terry. Stir-Fried and Not Shaken: A Nostalgic Trip Down Singapore’s Memory Lane. Singapore: Monsoon, 2009. Tarulevicz, Nicole. Eating Her Curries and Kway: A Cultural History of Food in Singapore. Champaign, IL: U of Illinois P, 2013. Tay, Leslie. ieat·ishoot·ipost [blog] (2013) 21 Nov. 2013 ‹http://www.ieatishootipost.sg›. ---. The End of Char Kway Teow and Other Hawker Mysteries. Singapore: Epigram Books, 2010. Time Out Singapore. “Food for Thought (National Museum).” Time Out Singapore 8 July (2013). 11 Nov. 2013 ‹http://www.timeoutsingapore.com/restaurants/asian/food-for-thought-national-museum›. Tully, Joyceline, and Tan, Christopher. Heritage Feasts: A Collection of Singapore Family Recipes. Singapore: Miele/Ate Media, 2010. Wine & Dine: The Art of Good Living (Nov. 2013). 19 Nov. 2013 ‹http://www.wineanddine.com.sg›. Wine & Dine. “About Us: The Living Legacy.” Wine & Dine (Nov. 2013). 19 Nov. 2013 ‹http://www.wineanddine.com.sg/about-us› Wolf, E. “Culinary Tourism: A Tasty Economic Proposition.” (2002) 23 Nov. 2011 ‹http://www.culinary tourism.org›.Yeong, Yee Soo. Singapore Cooking. Singapore: Eastern Universities P, c.1976. Yeung, Sylvester, James Wong, and Edmond Ko. “Preferred Shopping Destination: Hong Kong Versus Singapore.” International Journal of Tourism Research 6.2 (2004): 85–96. Acknowledgements Research to complete this article was supported by Central Queensland University, Australia, under its Outside Studies Program (OSPRO) and Learning and Teaching Education Research Centre (LTERC). An earlier version of part of this article was presented at the 2nd Australasian Regional Food Networks and Cultures Conference, in the Barossa Valley in South Australia, Australia, 11–14 November 2012. The delegates of that conference and expert reviewers of this article offered some excellent suggestions regarding strengthening this article and their advice was much appreciated. All errors are, of course, my own.

The shocking worldwide transmission of COVID-19 has encouraged many governments to interfere to avoid the spread of the infection. Medical tourism is a growing phenomenon with policy implications for health systems, particularly of destination countries. Medical tourism, a rapidly growing market, has been recognized by many countries as a potential sector for economic diversification. Although Singapore stands out as one of the top destinations of medical tourism, investigation regarding its competitiveness has been limited and narrow in scope. This case study takes a quantitative approach to identify and analyze the factors that position Singapore as a competitive medical tourism destination. Based on a holistic approach, this study has shown that integrating diverse strategies for medical tourismdevelopment with sound government policies and proactive management practices have led to significant positive outcomes towards mutual success of tourism and healthcare sectors of Singapore. Additionally, the study provides strategic insights to drive lasting improvements in medical tourism, exchange rare and service sectors through efficient management and intelligent utilization of resources in tourism sector.

In the recent era medical tourism has certain significance place in the tourism industry, In India now famous for low cost medical service with high quality medical treatment. The countries where medical tourism is being actively promoted include Greece, South Africa, Jordan, India, Malaysia, Philippines and Singapore. Recently, Indian healthcare sector shows huge advancements in fields such as technology, infrastructure, and manpower, catapulting India as one of the preferred medical destinations in the world and invariably paving path to an entirely new sector, the medical tourism industry. The medical tourism in India will touch the $8 billion mark by the end of 2020, the influx of the population that experiences a saving of close to 50 to 70 percent on medical tourism industry. Cost effectiveness is a major factor in India, because a patient can undergo any type of treatment at an extremely affordable cost without compromising the quality and other reason is of course the availability of medical visa without any hassle. The Indian government predicts that, India $17-billion-a-year healthcare industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which industry watchers say is growing at 30 per cent annually. This study has been focused by the fully by secondary data, which are collected from the Indian tourism department, and also it analyze the growth percentage in Past years, it will be more helpful to medical service providers. Mainly this study’s objective was examining the foreign exchange earning option through medical tourism and analysis of annual growth of foreign tourist in India. It proves that the annual growth an efficiency of handling capacity of Indian medical the medical industry

Why in the World Do Patients Travel for Medical Care? Is Medical Tourism For You? …a Look into the System of Healthcare Abroad Asia Medical Tourism: First-Rate Healthcare for Sale Medical Tourism and Clinical Trials: The New Silk Road Aesthetic Medicine in 2007: Trends and Updates Clinical Assisted Reproduction in Singapore — Challenges Posed by Medical Tourism and Future Prospects for Growth Busting the Fear for Breast cancer

Background: Today, medical tourism is a growing phenomenon in the healthcare industry, especially among developing countries. Objectives: The purpose of this study was to compare the Iranian medical tourism industry with selected countries. Methods: This comparative study was conducted in 2020. Data were gathered from databases, including PubMed, Web of Knowledge, Scopus, Magiran, SID, and websites of the World Tourism Association, the Ministry of Tourism, and the Ministry of Health of the selected countries from 2000 to 2020. A researcher-made checklist was used to collect data. Selected countries were compared in terms of the status of tourism and travel competitiveness, governance and policy-making status, the status of the medical tourism industry, and medical tourism infrastructure Results: The main difference between the selected countries and Iran lies in the organizational structure of the main stakeholders of the tourism industry. In other countries, this industry is organized and supervised by specific coordination bodies. In terms of tourism and travel competitiveness, Singapore, with a global rank of 17, was better than other countries. Based on the status of the medical tourism industry, Costa Rica ranked 7th in the world, and Singapore, the UAE (Dubai), Turkey, UAE (Abu Dhabi), Jordan, and Iran ranked 15, 22, 27, 31 35, and 41, respectively. In Iran, all indicators of medical tourism infrastructure were lower than those of other countries except for competitive prices. Conclusions: Considering a low rank of Iran in all the studied components, the organizational integration structure of the medical tourism industry and increasing competitiveness can help the development of this industry in Iran.

As tourism industry is always increasing, nowadays, it does not only touch the leisure sector, it expands into health industry. Medical tourism is a combination of both health care and leisure activity. It is projected to grow US$38 until US$55 billion per year. In Asia, it successfully attracts visitors which increase by 20% every year because affordable price, yet high quality. Malaysia, Thailand, India and Singapore take this opportunity. These countries take control at least 80% of Asia market share. Unfortunately, Indonesia plays only a small part. Moreover, the data reveals a surprising truth that 57% of Malaysian patients are Indonesian. This raises a paradox, whether it is an irony or opportunity. Thus, this comparative study is conducted based on literature review in qualitative and analyzed through SWOT.Bali is very potential. It already has three international hospitals, popular for its wellness tourism, rich for its unique culture, sophisticated medical equipments, professional medics and paramedics, and good image for the hospitality.The next important step is the synergy of every stakeholders which consists of government, academic, media, private sector and community. Those stakeholders have to be eager in seriously creating better regulation, offering an interesting medical tour package, and participating actively.

AUSTRALIA – New Therapy could Restore Mobility in Stroke Victims. AUSTRALIA – Sugar as Bad as Fat. AUSTRALIA – Scientists Uncover Cancer-fighting "Death" Protein. AUSTRALIA – Shrinking Brain in Dementia Prompts Overeating. AUSTRALIA – New Monitoring System for Mosquito-Borne Disease. AUSTRALIA – Australian Researcher Finds Radical Technique to Save MAS Babies. AUSTRALIA – Austrian Scientists Discover Enzyme Function in Cancer. CHINA – Domestic Dengue Fever Cases Breaks 1,000. CHINA – China Experts Design Gel to Protect Women from HIV. INDIA – India, South Africa to Team up on HIV Vaccine Research. MALAYSIA – Malaysia to use Lab Mosquitoes to Fight Dengue NEW ZEALAND – Plant Derived Foods can Keep us Feeling Full. SINGAPORE – Singapore Hosts First "Decade of the Mind" Conference in Asia and Expands Efforts in Brain & Cognition Research. SINGAPORE – Drugs May Replace Chemo in Leukemia Therapy. SINGAPORE – Singapore Scientists First to Perform Genome-Wide study of Human Stem Cells. SINGAPORE – Singapore Babies in Waste-disease Trial. SINGAPORE – New Technology a Shot in the Arm for Biofuels. SINGAPORE – S$3.7 Billion for Singapore Biomedical Sciences R&D. TAIWAN – Medical Tourism Booms in Taiwan. OTHER REGIONS — EUROPE – Gene that Triggers Human Cancer Identified. OTHER REGIONS — EUROPE – Painfully Potent Pepper. OTHER REGIONS — NORTH AMERICA – 2 Dads and No Mum make 10 Mice.

Purpose The study aims to facilitate the medical tourists visiting emerging countries for various kinds of ailments by ranking the possible destinations to avail medical treatments. Design/methodology/approach A Fuzzy Analytical Hierarchical Process (FAHP) with a mixed-method approach is applied to analyze data collected from patients and substantiate it with medical tour operators in India to gain managerial insights on the choice-making patterns of the patients. Findings India is a preferred emerging market location due to the low cost and high medical staff quality. India offers value for money, whereas Singapore and Thailand are preferred destinations for quality and technology. Research limitations/implications The study will facilitate the emerging markets' governments, hospitals and medical tourists to understand the importance of various determinants responsible for availing medical treatment outside their country. Practical implications The study recommends that cost and quality care are the patients' prime focus; government policies must provide clear guidelines on what the hospitals and country environment can offer and accordingly align the marketing strategies. Originality/value This study is the first attempt to rank various factors affecting medical tourism using the FAHP approach.

AUSTRALIA — Lung Cancer Cases on the Rise. AUSTRALIA — Cantox Announces the Launch of Ashuren Health Sciences Pharmaceutical Division. CHINA — Biotech Crops Exhibit Impressive Double-digit Growth. CHINA — World Genomes Project to Promote Research on Human Diseases. HONG KONG — New Anti-Hepatitis Drug Found. INDIA — Pneumonia Kills More Than 1000 Children Daily in India. INDIA — PepsiCo to Open Carrageenan Biopolymer Plant in India. INDIA — Medical Tourism Insurance Covers Will Soon be Available in the West. JAPAN — Green Tea May Reduce Prostate Cancer Risk. SINGAPORE — QIAGEN to Supply Avian Flu Surveillance Solutions to Singapore. TAIWAN — NTU Discovery May Help Cardiovascular and Cancer Experiments. VIETNAM — Bird Flu Hits Poultry Farm in Northern Vietnam.

AUSTRALIA – Australia: Top 20 Cancer Drug Sales to Hit US$1B by 2018. AUSTRALIA – Effective Prostate Cancer Treatment Discovery. AUSTRALIA – Australia Developing World First Treatment for Leukemia. AUSTRALIA – African DNA Breakthrough. AUSTRALIA – Genetic Link Between Mammographic Density and Breast Cancer. AUSTRALIA – Arthritis Genes Discovered By University Of Queensland Scientists, Australia. AUSTRALIA – Australian First for Melbourne Stem Cell Scientists. BANGLADESH – Bangladesh Slaughters 117,000 Birds on Flu Fears. CHINA – Quintiles Launches New Tissue Testing Services In China To Help In Fight Against Cancer. CHINA – Tainted Milk Scandal Resurfaces in China. INDIA – Hyderabad - Hot Destination for Medical Tourism. INDIA – New Genetic Control Tools to Combat Dengue and Chikungunya. JAPAN – Japan Commits $2 Million to Boost Immunization In Haiti, Bringing Post-Quake Total For UNICEF To $8.5 Million. SINGAPORE – Taxes on Life Sciences Firms Likely to Rise: PwC. SINGAPORE – New National Centre for Treatment of Cancer Opens at NUH. SINGAPORE – Singapore Buys 1m Bird Flu Vaccine Doses. SINGAPORE – IME Develops All-in-One Diagnostic Test for Point-of-Care Deployment. SINGAPORE – A*STAR Science and Technology Festival 2010 Showcases Latest Products and Technologies from Life Science Vendor Companies in Singapore. SINGAPORE – US Tech Firm FormFactor Opens $30m Facility in Singapore. THAILAND – Thai Researchers Produce Omega 3 from Microbes. OTHER REGIONS — NORTH AMERICA – Looking Younger is in the Genes. OTHER REGIONS — NORTH AMERICA – Study Links Sugary Soft Drinks to Pancreas Cancer.

AUSTRALIA – Second-Generation Diagnostic Achieves 98% Accuracy in Detecting Early Stage Ovarian Cancers AUSTRALIA – New Center Brings Australian and Chinese Researchers Together to Fight Infectious Diseases AUSTRALIA – Co-developing New Treatment Guidelines for Melanoma AUSTRALIA – Australia Leads World's First Global Effort to Improve Genetic Disorders Diagnosis CHINA – China Bans Illegal Food Additives to Reinforce Food Safety Control CHINA – China Steps Up Tighter Inspection in Food Safety CHINA – WHO and China to Do More for Chinese with Hearing Impairment CHINA – First TCM Drug for Arrhythmia CHINA – First Human-Human Transmission of Tick-Borne Disease Reported in China CHINA – Bird Flu Found in Chickens in Eastern China CHINA – First Bird Flu Death Reported for 2009, No Bird-flu Outbreak HONG KONG – Hong Kong Alerts New Bird Flu Outbreak INDIA – India Also Confirmed Bird Flu Incidence INDIA – India Plans 20 More Biotech Parks for Life Sciences Research KOREA – An Economic Share in Medical Tourism Market JAPAN – Brain Tissues Made from Stem Cells NEW ZEALAND – Newly Merged Research Institute Leverage Greater Synergy NEW ZEALAND – Kiwi's Green Plastic Well-Acclaimed in International Awards NEW ZEALAND – Sea Sponge Indigenous to NZ Could Reduce Chemo Side Effects PHILIPPINES – Ebola-Reston Virus Jumped Species SINGAPORE – Human Sewage, the Potential Source of Clean Energy SINGAPORE – No More Heart-stopping Incidents for Heart Patients SINGAPORE – China Milk Products Get All-Clear from Singapore SINGAPORE – Discovery of New Properties in Imidazolium Salts Yield Multi Applications SINGAPORE – S'pore Ranked World's Most Prolific for Eye Research Per Capita SINGAPORE – Outdoor Sun Reduces Incidence of Myopia in Children TAIWAN – University Hospital in Taiwan Collaborates with Neuralstem VIETNAM – Return of Bird Flu, Vietnam Runs High Risk of Human Infection VIETNAM – Conjoined Twins Successfully Separated VIETNAM – Rise in Off-Season Dengue Fever Cases NORTH AMERICA – Epilepsy Drugs Prescription to Carry Suicide Risk Warning NORTH AMERICA – U.S. Doctors Succeeded Near-total Face Transplant NORTH AMERICA – Vaccinating Pacific Girls against Cervical Cancer NORTH AMERICA – Manipulating Love and Emotions by Spray EUROPE – Cambridge Pips Oxford in Research EUROPE – Adapting Car Manufacturing Technology to Produce Synthetic Bone Implants EUROPE – Dioxin-tainted Irish Pork Products Recalled

AUSTRALIA – Mosquito Parasite Could Control Dengue CHINA – China has Twice the Global Average of Drug-Resistant Tuberculosis CHINA – 80 000 Antibiotics Abuse-related Deaths Annually CHINA – Bird Flu Found in Chicken from China CHINA – China on Alert following Bird Flu Death CHINA – Chinese Dairies to Compensate Tainted Milk Victims' Families CHINA – New Insulin Resistance Tricks Found CHINA – World's First Plant Chromosome Atlas CHINA – Project Launched to Study Structure of Proteins CHINA – Fake Diabetes Drug Linked to Two Deaths CHINA – Birth Defects Rising in Polluted China INDIA – India Culls Poultry in Darjeeling After Bird Flu INDIA – India Introduces Second-Line Anti-retroviral Treatment in Eight States INDIA – Indian Medical Tourism to Reach US$1.9 billion by 2015 INDIA – Canadian and Indian Ministers Sign Pact on Agriculture Cooperation INDIA – 6000 year-old Rice Species Discovered in Meghalaya INDIA – Genetics to Help Conserve Rare Bird Species JAPAN – Coating the Protein Enhances Disease-fighting Capability JAPAN – Scientists Isolate Genes that Made 1918 Flu Lethal JAPAN – Researchers in Japan Develop All-round Flu Vaccine PHILIPPINES – Ebola Reston Virus Found in Filipino Farm Worker SINGAPORE – New Method to Create iPS Cells SINGAPORE – Ray of Hope for Liver Cancer Sufferers SINGAPORE – Bacteria Improve Energy and Cost Efficiency in Water Treatment TAIWAN – Secrets of “Speciation” Gene Unravelled TAIWAN – Initial Breakthrough in Poultry Vaccine Development TAIWAN – Taiwan Gains Direct Access to WHO VIETNAM – Doctors Report First Drug Hypersensitivity Syndrome VIETNAM – Public Advised Serious Caution Against Bird Flu NORTH AMERICA – Kids of Pregnant Drinking Mums will Like Booze NORTH AMERICA – High Functional Diversity in Mycobacterium Tuberculosis Driven By Genetic Drift And Human Demography NORTH AMERICA – Newly Discovered Tuberculosis Protein May Help Explain Bacterium's Resilience NORTH AMERICA – U.S. Patent For Diagnostic Technology Awarded To URMC, Lighthouse Biosciences EUROPE – Structure Mediating Spread of Antibiotic Resistance Discovered EUROPE – New EU Pesticide Regulations Could Undermine Battle against Malaria EUROPE – iPill – The Smart Drug Delivery that can “Call” the Doctor EUROPE – What Drives Locusts to Swarm

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IntroductionCroquembouche, blast chillers, and plating up—these terms have become normal to ordinary Australians despite Adriano Zumbo’s croquembouche recipe taking more than two hours to complete and blast chillers costing thousands of dollars. Network Ten’s reality talent quest MasterChef Australia (MCA) has brought fine dining and “foodie” culture to a mass audience who have responded enthusiastically. Vicariously “tasting” this once niche lifestyle is empowering viewers to integrate aspects of “foodie” culture into their everyday lives. It helps them become “everyday foodies.” “Everyday foodies” are individuals who embrace and incorporate an appreciation of gourmet food culture into their existing lifestyles, but feel limited by time, money, health, or confidence. So while a croquembouche and blast chiller may be beyond a MCA viewer’s reach, these aspects of “foodie” culture can still be enjoyed via the program. The rise of the “everyday foodie” challenges criticisms of vicarious consumption and negative discourses about reality and lifestyle television. Examining the very different and specific ways in which three MCA-viewing households vicariously experience gourmet food in their adoption of the “everyday foodie” lifestyle will demonstrate the positive value of vicarious consumption through reality and lifestyle programming. A brief background on the MCA phenomenon will be provided before a review of existing literature regarding vicarious consumption and tensions in the reality and lifestyle television field. Three case studies of MCA-viewing households who use vicarious consumption to satisfy “foodie” cravings and broaden their cultural tastes will be presented. Adapted from the United Kingdom’s MasterChef, which has aired since 1990, MCA has proven to be a catalyst for the “cheffing up” of the nation’s food culture. Twenty-odd amateur cooks compete in a series of challenges, guided, and critiqued by judges George Calombaris, Gary Mehigan, and Matt Preston. Contestants are eliminated as they move through a series of challenges, until one cook remains and is crowned the Master Chef of that series. Network Ten’s launch of MCA in 2009 capitalised on the popularity of reality talent quests that grew throughout the 2000s with programs such as Popstars (2000–2002), Australian Idol (2003–2009), X Factor (2005, 2010–) and Australia’s Got Talent (2007–). MCA also captures Australian viewers’ penchant for lifestyle shows including Better Homes and Gardens (1995–), Burke’s Backyard (1987-2004), The Living Room (2012–) and The Block (2003–2004, 2010–). The popularity of these shows, however, does not match the heights of MCA, which has transformed the normal cooking show audience of 200,000 into millions (Greenwood). MCA’s 2010 finale is Australia’s highest rating non-sporting program since OzTAM ratings were introduced in 2001 (Vickery). Anticipating this episode’s popularity, the 2010 Federal Election debate was moved to 6.30pm from its traditional Sunday 7.30pm timeslot (Coorey; Malkin). As well as attracting extensive press coverage and attention in opinion pieces and blogs, the level of academic attention MCA has already received underscores the show’s significance. So far, Lewis (Labours) and Seale have critiqued the involvement of ordinary people as contestants on the show while Phillipov (Communicating, Mastering) explores tensions within the show from a public health angle. While de Solier (TV Dinners, Making the Self, Foodie Makeovers) and Rousseau’s research does not focus on MCA itself, their investigation of Australian foodies and the impact of food media respectively provide relevant discussion about audience relationships with food media and food culture. This article focuses on how audiences use MCA and related programs. Vicarious consumption is presented as a negative practice where the leisure class benefit from another’s productivity (Veblen). Belk presents the simple example that “if our friend lives in an extravagant house or drives an extravagant car, we feel just a bit more extravagant ourselves” (157). Therefore, consuming through another is viewed as a passive activity. In the context of vicariously consuming through MCA, it could be argued that audiences are gaining satisfaction from watching others develop culinary skills and produce gourmet meals. What this article will reveal is that while MCA viewers do gain this satisfaction, they use it in a productive way to discipline their own eating and spending habits, and to allow them to engage with “foodie” culture when it may not otherwise be possible. Rather than embrace the opportunity to understand a new culture or lifestyle, critics of reality and lifestyle television dismiss the empowering qualities of these programs for two reasons. The practice of “advertainment” (Deery 1)—fusing selling and entertainment—puts pressure on, or excludes, the aspirational classes who want, but lack the resources to adopt, the depicted lifestyle (Ouellette and Hay). Furthermore, such programs are criticised for forcing bourgeois consumption habits on its viewers (Lewis, Smart Living) Both arguments have been directed at British celebrity chef Jamie Oliver. Oliver’s latest cookbook Save with Jamie has been criticised as it promotes austerity cooking, but costs £26 (approx. 48AUD) and encourages readers to purchase staple ingredients and equipment that total more than £500 (approx. 919AUD) (Ellis-Petersen). Ellis-Petersen adds that the £500 cost uses the cheapest available options, not Oliver’s line of Tefal cooking equipment, “which come at a hefty premium” (7). In 2005, Oliver’s television series Jamie’s School Dinners, which follows his campaign for policy reform in the provision of food to students was met with resistance. 2008 reports claim students preferred to leave school to buy junk food rather than eat healthier fare at school (Rousseau). Parents supported this, providing money to their children rather than packing healthy lunches that would pass school inspections (Rousseau). Like the framing of vicarious consumption, these criticisms dismiss the potential benefits of engaging with different lifestyles and cultures. These arguments do not recognise audiences as active media consumers who use programs like MCA to enhance their lifestyles through the acquisition of cultural capital. Ouellette and Hay highlight that audiences take advantage of a multitude of viewing strategies. One such strategy is playing the role of “vicarious expert” (Ouellette and Hay 117) who judges participants and has their consumption practices reinforced through the show. While audiences are invited to learn, they can do this from a distance and are not obliged to feel as though they must be educated (Ouellette and Hay). Viewers are simply able to enjoy the fantasy and spectacle of food shows as escapes from everyday routines (Lewis, Smart Living). In cases like Emeril Live where the host and chef, Emeril Lagasse “favors [sic] showmanship over instruction” (Adema 115–116) the vicarious consumption of viewing a cooking show is more satisfying than cooking and eating. Another reason vicarious consumption provides pleasure for audiences is because “culinary television aestheticises food,” transforming it “into a delectable image, a form of ‘gastro-porn’ […] designed to be consumed with the eyes” (de Solier, TV Dinners 467). Audiences take advantage of these viewing strategies, using a balance of actual and vicarious consumption in order to integrate gourmet food culture into their pre-existing lifestyle, budget, and cooking ability. The following case studies emerged from research conducted to understand MCA’s impact on households. After shopping with, and interviewing, seven households, the integration of vicarious and actual food consumption habits was evident across three households. Enjoying food images onscreen or in cookbooks is a suitable substitute when actual consumption is unhealthy, too expensive, time consuming, or daunting. It is this balance between adopting consumption habits of a conventional “foodie” and using vicarious consumption in contexts where the viewer sees actual consumption as unreasonable or uncomfortable that makes the “everyday foodie.” Melanie—Health Melanie is 38 years old and works in the childcare industry. She enjoys the “gastro-porn” of MCA and other food media. Interestingly she says food media actually helps her resist eating sumptuous and rich foods: Yeah, like my house is just overrun by cookbooks, cooking magazines. I have Foxtel primarily for the Food Network […] But I know if I cooked it or baked it, I would eat it and I’ve worked too hard to get where I am physically to do that. So I just, I read about it and I watch it, I just don’t do it. This behaviour supports Boulos et al.’s finding that while the Food Network promotes irresponsible consumption habits, these programs are considered a “window into a wider social and cultural world” rather than food preparation guides (150). Using vicarious consumption in this way means Melanie feels she does not “cook as much as what a true foodie would cook,” but she will “have low fat and healthy [options] whenever I can so I can go out and try all the fancy stuff cooked by fancy people.” MCA and food media for Melanie serves a double purpose in that she uses it to restrict, but also aid in her consumption of gourmet food. In choosing a chef or restaurant for the occasions where Melanie wants to enjoy a “fancy” dining experience, she claims food media serves as an educational resource to influence her consumption of gourmet food: I looked up when I was in Sydney where Adriano Zumbo’s shop was to go and try macarons there […] It [MCA] makes me aware of chefs that I may not have been aware of and I may go and … seek that [their restaurants/establishments] out […] Would Adriano Zumbo be as big as he is without MasterChef? No. And I’m a sucker, I want to go and try, I want to know what everyone’s talking about. Melanie’s attitudes and behaviour with regards to food media and consumption illustrates audiences’ selective nature. MCA and other food media influence her to consume, but also control, her consumption. Curtis and Samantha—Broadening Horizons Time and money is a key concern for many “everyday foodies” including Curtis’ family. Along with his wife Samantha they are raising a one-year-old daughter, Amelia. Curtis expressed a fondness for food that he ate while on holiday in the United States: I guess in the last few weeks I’ve been craving the food that we had when we were in America, in particular stuff like pulled pork, ribs, stuff like that. So I’ve replicated or made our own because you can’t get it anywhere around Brisbane like from a restaurant. When talking about cooking shows more generally, Curtis speaks primarily about cooking shows he watches on Foxtel that have a food tourism angle. Curtis mentions programs including Cheese Slices, The Layover and Man v. Food. The latter of these shows follows Adam Richman around the United States attempting to conquer eating challenges set at famous local establishments. Curtis describes his reaction to the program: I say woah that looks good and then I just want to go back to America. But instead of paying thousands of dollars to go, it’s cheaper to look up a recipe and give it a go at home. Cookbooks and food television provide their viewers not only with a window through which they can escape their everyday routines but, as Curtis points out, inspiration or education to cook new dishes themselves. For money conscious “everyday foodies”, the cooking demonstration or mere introduction of a dish broadens viewers’ culinary knowledge. Curtis highlights the importance of this: Otherwise [without food media] you’d be stuck cooking the same things your mum and dad taught you, or your home economics teacher taught you in high school. You’d just be doing the same thing every day. Unless you went out to a restaurant and fell in love with something, but because you don’t go out to restaurants every day, you wouldn’t have that experience every day […] TV gives you the ability—we could flick over to the food channel right now and watch something completely amazing that we’ve never done before. His wife Samantha does not consider herself an adventurous eater. While she is interested in food, her passion lies in cakes and desserts and she jokes that ordering Nando’s with the medium basting is adventurous for her. Vicarious consumption through food media allows Samantha to experience a wider range of cuisines without consuming these foods herself: I would watch a lot more variety than I would actually try. There’s a lot of things that I would happily watch, but if it was put in front of me I probably wouldn’t eat it. Like with MasterChef, I’m quite interested in cooking and stuff, but the range of things [ingredients and cuisines] […] I wouldn’t go there. Rose and Andrew—Set in Their Ways Rose and her husband Andrew are a “basically retired” couple and the parents of Samantha. While they both enjoy MCA and feel it has given them a new insight on food, they find it easier to have a mediated engagement with gourmet food in some instances. Andrew believes MCA is: Taking food out of this sort of very conservative, meat, and three vegetables thing into […] something that is more exotic, for the want of a better word. And I guess that’s where we’ve—we follow it, I follow it. And saying, ‘Oh, geez it’d be nice to do that or to be able to do that,’ and enjoy a bit of creativity in that, but I think it’s just we’re probably pretty set in our ways probably and it’s a bit hard to put that into action sometimes. Andrew goes on to suggest that a generational gap makes their daughters, Samantha and Elle more likely to cook MCA-inspired meals than they are: See Samantha and Elle probably cook with that sort of thing [herbs] more and I always enjoy when they do it, but we probably don’t […] We don’t think about it when we go shopping. We probably shop and buy the basic things and don’t think about the nicer things. Andrew describes himself as “an extremely lazy reader” who finds following a recipe “boring.” Andrew says if he were tempted to cook an MCA-inspired dish, it is unlikely that the required ingredients would be on-hand and that he would not shop for one meal. Rose says she does buy the herbs, or “nicer things” as Andrew refers to them, but is hesitant to use them. She says the primary barrier is lacking confidence in her cooking ability, but also that she finds cooking tiring and is not used to cooking with the gas stove in her new home: Rose: I also think that I probably leave my run late and by night time I’m really tired and my feet are hurting and I tend to think ‘Oh I’ll just get something ready’ […] I know that probably sounds like a lame excuse, but yeah, it’s probably more the confidence thing I think. I often even buy the things [ingredients] to do it and then don’t make it. I’m not confident with my stovetop either. Researcher: Oh why—can you please explain more about that?Rose: Well it’s a gas stovetop and I used to have the electric. I felt like I could main—I could control the setting—the heat—better on it. Rose, in particular, does not let her lack of confidence and time stop her from engaging with gourmet food. Cookbooks and cooking shows like MCA are a valuable channel for her to appreciate “foodie” culture. Rose talks about her interest in MCA: Rose: I’m not a keen cook, but I do enjoy buying recipe books and looking at lovely food and watching—and I enjoyed watching how they did these beautiful dishes. As for the desserts, yes they probably were very fancy, but it was sort of nice to think if you had a really special occasion, you know […] and I would actually get on the computer afterwards and look for some of the recipes. I did subscribe to their magazine […] because I’m a bit of a magazine junkie.Researcher: What do you get out of the recipe books and magazines if you say you’re not a keen cook?Rose: I’d just dream about cooking them probably. That sounds terrible, doesn’t it? But, and also probably inspire my daughters […] I like to show them “oh, look at this and this” or, you know, and probably quite often they will try it or—and one day I think I will try it, but whether I ever do or not, I don’t know. Rose’s response also treats the generation gap as a perceived barrier to actual consumption. But while the couple feel unable to use the knowledge they have gained through MCA in their kitchen, they credit the show with broadening the range of cuisines they would eat when dining out: Andrew: You know, even when we’ve been to—I like Asian food in Australia, you know, Chinese, Thai, any of those sorts of foods.Rose: Indian. Andrew: Indian, yeah I like that in Australia.Rose: Which we have probably tried more of since the likes of MasterChef.Andrew: Yeah.Rose: You know, you—and even sushi, like you would never have ever […]Andrew: Gone to sushi previously. And I won’t eat sashimi, but the sushi bar is all right. Um […] but [I] did not enjoy Chinese food in places like Hong Kong or Singapore. As the couple does not seek educational information from the show in terms of cooking demonstration, they appear more invested in the progress of the contestants of the show and how they respond to challenges set by the judges. The involvement of amateur cooks makes the show relatable as they identify with contestants who they see as potential extensions of themselves. Rose identifies with season one winner, Julie Goodwin who entered the program as a 38-year-old mother of three and owner of an IT consulting business: Rose: Well Julie of course is a—I don’t like to use the word square, but she’s sort of like a bit of an old fashioned lady, but you know, more like basic grandma cooking. But […]Andrew: She did it well though.Rose: Yes, yeah. Andrew: And she, she probably—she progressed dramatically, you know, from the comments from when she first started […] to winning. In how she presented, how she did things. She must have learnt a lot in the process is the way I would look at it anyway. Rose: And I’ve seen her sort of on things since then and she is very good at like […] talking about and telling you what she’s doing and—for basic sort of cook—you know what I mean, not basic, but […] for a basic person like me. Although Rose and Andrew feel that their life stage prevents has them from changing long established consumption habits in relation to food, their choices while dining out coupled with a keen interest in food and food media still exemplifies the “everyday foodie” lifestyle. Programs like MCA, especially with its focus on the development of amateur cooks, have allowed Rose and Andrew to experience gourmet food more than they would have otherwise. Conclusion Each viewer is empowered to live their version of the “everyday foodie” lifestyle through adopting a balance of actual and vicarious consumption practices. Vicariously tasting “foodie” culture has broadened these viewers’ culinary knowledge and to some extent has broadened their actual tastes. This is evident in Melanie’s visit to Adriano Zumbo’s patisserie, and Rose and Andrew’s sampling of various Asian cuisines while dining out, for example. It also provides pleasure in lieu of actual consumption in instances like Melanie using food images as a disciplinary mechanism or Curtis watching Man v. Food instead of travelling overseas. The attitudes and behaviours of these MCA viewers illustrate that vicarious consumption through food media is a productive and empowering practice that aids audiences to adopt an “everyday foodie” lifestyle. References Adema, Pauline. “Vicarious Consumption: Food, Television and the Ambiguity of Modernity.” Journal of American and Comparative Cultures 23.3 (2000): 113–23. Belk, Russell. “Possessions and the Extended Self.” Journal of Consumer Research 15.2 (1988): 139–68. Boulous, Rebecca, Emily Kuross Vikre, Sophie Oppenheimer, Hannah Chang, and Robin B. Kanarek. “ObesiTV: How Television is influencing the Obesity Epidemic.” Physiology & Behavior 107.1 (2012): 146–53. Coorey, Phillip. “Chefs Win in Ratings Boilover.” Sydney Morning Herald 20 Jul. 2010: n. pag. Deery, June. “Reality TV as Advertainment.” Popular Communication: The International Journal of Media and Culture 2.1 (2005): 1–20. Ellis-Petersen, Hannah. “Jamie’s Idea of Cooking on a Budget—First Buy £500 of Kitchen Utensils and ‘Basics’ (And Yes Most Of Them DO Come From His Own Range).” Mail Online 31 Aug. 2013: n. pag. Greenwood, Helen. “From TV to Table.” Sydney Morning Herald 3 Jul. 2010: n. pag. Lewis, Tania. Smart Living: Lifestyle Media and Popular Expertise. New York: Peter Lang, 2008. -----. “You’ve Put Yourselves on a Plate: The Labours of Selfhood on MasterChef Australia.” Reality Television and Class. Eds. Helen Wood, and Beverly Skeggs. Basingstoke: Palgrave Macmillan, 2011. 104–6. Malkin, Bonnie. “Australian Election Debate Makes Way for MasterChef Final.” The Telegraph 20 Jul. 2010: n. pag. Ouellette, Laurie, and James Hay. Better Living through Reality TV. Malden: Blackwell, 2008. Phillipov, Michelle. “Communicating Health Risks via the Media: What can we learn from MasterChef Australia?” The Australasian Medical Journal 5.11 (2012): 593–7. -----. “Mastering Obesity: MasterChef Australia and the Resistance to Public Health Nutrition.” Media, Culture & Society 35.4 (2013): 506–15. Rousseau, Signe. Food Media: Celebrity Chefs and the Politics of Everyday Interference. London: Berg, 2012. Seale, Kirsten. “MasterChef’s Amateur Makeovers.” Media International Australia 143 (2012): 28–35. de Solier, Isabelle. “Foodie Makeovers: Public Service Television and Lifestyle Guidance.” Exposing Lifestyle Television: The Big Reveal. Ed. Gareth Palmer. Aldershot: Ashgate, 2008. 65–81. -----. “Making the Self in a Material World: Food and Moralities of Consumption.” Cultural Studies Review 19.1 (2013): 9–27. -----. “TV Dinners: Culinary Television, Education and Distinction.” Continuum: Journal of Media and Cultural Studies 19.4 (2005): 465–81. Vickery, Colin. “Adam Liaw Wins MasterChef as Ratings Soar for Channel 10.” Herald Sun 25 Jul. 2010: n. pag. Veblen, Thorstein. The Theory of the Leisure Class. Oxford: Oxford UP, 2007.

IntroductionTransformation, claims McCracken, is the expression of consumer agency and individual freedom in which consumers, as “co-creators of culture,” are empowered to creatively construct new improved selves (xvi). No longer an “extraordinary event for extraordinary creatures,” transformation today is routine and accessible (McCracken xxi). Contemporary consumer culture encourages individuals to enact these transformations by turning to the market to purchase the resources they require to achieve their desired identity (Ellis et al. 179). This market model of transformation embraces the concept of the marketplace exchange where the one party satisfies the needs of the other in a mutually beneficial exchange relationship. For consumers, the market enables transformation through the purchase and consumption of the desired products and services which support identity building.Critics, however, argue that markets have less positive effects. While it is too simplistic to claim that markets manipulate consumers, marketing exchanges constitute an enduring shaping force on individuals and society (Laczniak and Murphy). Markets shape consumer identities by homogenising them and suppressing their self-expressive capabilities (Kozinets 22). As producers become more powerful, “the market is transformed from a consumer-driven mechanism to a sphere where the producers assimilate consumers’ needs to their own through commercial activity” (Sassatelli 76) (my italics). Marketing and promotion have a persuasive influence and their role in the transformation process is a crucial element in understanding the consumer’s impetus to transform. Consumer identity is of course neither fully a “liberatory act” nor “wholly dictated by the market” (Ellis et al. 182), but there is a relationship between consumer autonomy and the dictates of the market which can be explored through focusing on the transformation of identity through the consumption of cosmetic surgery. Cosmetic surgery is an important site of enquiry as a social practice which “merges the attention given to the body by an individual person with the values and priorities of the consumer society” (Martinez Lirola and Chovanec 490). The body, as Kathy Davis highlighted, has long been seen as a commodity which can be endlessly transformed (Davis, Reshaping the Female Body), and the market for cosmetic surgery is at the forefront of this commodification process (Aizura 305). What is new, however, is the increasing marketisation and commercialisation of the cosmetic surgery industry combined with rising consumerism in which surgical transformation can be purchased simply as a “lifestyle choice alongside fashion, fitness and therapy” (Elliott 7). In the cosmetic surgery market, “patients” are consumers. Rather than choosing cosmetic surgery in order to feel whole or normal, contemporary consumers see surgery as a grooming practice which is part of a body maintenance routine (Jones).As the cosmetic surgery market becomes progressively more competitive, it relies more and more on marketing and promotion for its survival. The intense rivalry between providers drives them, in some cases, to aggressive and often unethical promotional practices. In the related field of pharmaceuticals for example, marketers have been charged with explicitly manipulating social understanding of disease in order to increase profits (Brennan, Eagle, and Rice 17). Unlike TV make-over shows whose primary purpose is to entertain, or celebrity culture which influences indirectly through example, cosmetic surgery promotion sets out with intent to persuade consumers to choose surgical transformation. Cosmetic surgery is presented to consumers “through the neoliberal prism of choice,” encouraging women (mostly) to choose surgery as a self-improvement practice in order to “feel good or pamper herself” (Gurrieri, Brace-Govan, and Previte 534). In a promotional culture which valorises external values and ‘the new’ (Fatah 1), the cost, risk, and pain of surgery are downplayed as an increasing array of self-transformative possibilities are presented as consumption choices. This scenario sees the impetus to transform as driven as much by marketing imperatives as by consumers’ free choice. Indeed in mobilising the rhetoric of choice, the “autonomous” consumer, it seems, plays into the hands of the cosmetic surgery industry.This paper explores consumer transformation through cosmetic surgery by focusing on the tension between the rhetoric of consumer autonomy, freedom, and choice and that of the industry’s marketing and promotional practices in the United Kingdom (UK). I argue that while the consumer is an active player, expressing their freedom and agency in choosing self-transformation through surgery, that autonomy is influenced and constrained by the marketing and promotional practices of the industry. I focus on the inherent paradox in the discourse of transformation in consumer culture which advocates individual consumer freedom and creativity yet limits these freedoms to “acceptable” bodily forms constructed as the norm by promotional images of the cosmetic surgery industry. To paraphrase Susan Bordo, those promotions which espouse consumer choice and self-determination simultaneously eradicate individual difference and circumscribe choice (Unbearable Weight 250). Here I explore how ideals of autonomy, freedom, and choice are utilised to support consumer surgical transformation. Drawing on market research, professional publications, blogs and industry webpages used by UK consumers as they search for information, I demonstrate how marketing and promotion adopt these ideals to provide a visual reference and a language for consumer transformation, which has the effect of shaping and limiting consumer freedom and creativity. Consumer Transformation as Expression of Freedom Contemporary consumers need not be content just to admire the appearance of celebrities and film stars, but can actively engage in the creative construction of new improved selves through surgical transformation (McCracken). This transformation is often expressed by consumers as a liberatory act, as is illustrated by the women surveyed for a UK Department of Health report. As one respondent explains, “I think it’s just the fact that they can . . . and I think over the years, women have a battle with their bodies, as they change, different ages, they do, they struggle with trying to accept it over different years and the fact that you can, it’s like ‘wow, so what, it’s a bit of money, let’s just change ourselves’” (UK Department of Health 32). Even young consumers see cosmetic surgery as an easily available transformative option, such as this 16-year-old female research respondent who describes surgery as “Things that you don’t really need but you just feel you want to have them” (UK Department of Health 33). As these women attest, cosmetic surgery is seen as an increasingly normal and everyday practice. By rhetorically constructing the possibility of transformation as an expression of individual consumer empowerment (“wow, so what, it’s a bit of money, let’s just change ourselves”), they distance the practice “from negative associations with vanity” and oppression (Tait 131). This postmodern consumer is no dupe or victim but a “conscious subject who modifies their body as a project of identity” (Gibson 51) and for whom cosmetic surgery transformation is “the route to happiness and personal empowerment” (Tait 119). Surgical transformation is not a way to strive narcissistically after “an elusive beauty ideal” (Heyes 93). Instead, it is expressed as something they choose to do just for themselves—which Bordo calls the “for me” argument (“Braveheart, Babe, and the Contemporary Body”). In an increasingly visual culture, the accessibility and affordability of cosmetic surgery enable consumers, who are already accustomed to digitally editing their photographical images, to “edit” their physical bodies. This is candidly expressed by Singaporean blogger Ang Chiew Ting who writes, "When I learnt how to use Photoshop, the things that I edited about myself, those have now all been done in real life through plastic surgery. Whatever I wanted to change about my face, I have done." Yet, as I illustrate later, the emphasis on transformation as empowerment through exercising choice (“Whatever I wanted to change about my face, I have done"), plays into the hands of the industry as it “reproduces the logic of surgical industries” (Tait 121). In the politics of consumption, driven by neo-liberal ideologies, consumer choice is sovereign (Sassatelli 184), and it is in the ability to exercise choice, choosing surgery and taking responsibility for that choice, that agency and empowerment are expressed (Leve, Rubin, and Pusic). Blogger Stella Lee explains her decision as “I don't want to say I encourage plastic surgery, this is just my personal choice. It is like saying if I dye my hair purple then I want everyone to have purple hair too. It is simply just for me only. If you wish to do so, go ahead. If you're satisfied with what you have, go ahead.” This consumer is a “discerning and knowledgeable consumer” who researches information about potential surgical procedures and practitioners (Gimlin, “Imagining” 58) and embraces the ideology of self-determinism (Heyes). Consumers considering surgery may visit recommended doctors, research doctors online, and peruse beauty magazines (Leve, Rubin, and Pusic). Tatler magazine, for example, publishes an annual Beauty and Cosmetic Surgery Guide which celebrates “the newest, niftiest ways to reclaim your face and your figure” (Tatler nd). In taking responsibility for themselves, the contemporary consumer reflects the neoliberal agenda “that promotes empowerment through consumer choice and responsibility for self-care” (Leve, Rubin, and Pusic 131). Yet, consumer information on the suitability of surgery and alternative providers is often partial. As one research respondent recalled, “I just typed it into Google and then worked through whatever came up; you're trying to go for the names of companies that are a bit more reputable” (UK Department of Health 28). Internet searches most frequently identify promotional information from the surgery providers themselves including customer stories and testimonials, which seem informative in nature but which have persuasive intent to influence choice. Therefore although seemingly exerting agency by undertaking a process of search in order to make an informed choice, that choice is made within a promotional context that the consumer may not be fully aware exists.Consumer Transformation as Marketing ImperativeThe aim of marketing and promotion, as medicine meets consumerism, is to secure clients for cosmetic surgery (Mirivel). As a consequence, the discourse of cosmetic surgery is highly persuasive and commercially motivated, promoting the need for surgery by mobilising the existing ideological link between identity and physical appearance for commercial ends (Martinez Lirola and Chovanec 489). Promotional strategies include drawing attention to possible deficiencies in appearance, creating opportunities for surgery by problematising normal bodily states, promising intangible benefits, and normalising surgery by positioning it within a consumerist vision of success. Consumer transformation can be driven by perceived lack, inadequacy, or deficit, where a part of the body or face does not stand up to scrutiny when compared to media images. Marketing and promotion draw attention to this lack and imply that any deficiency in appearance can be remedied by consumption practices such as the purchase of hair dye, make-up, or, more drastically, cosmetic surgery. As one research respondent considering surgery explains, “I think people want to look their best and media portrays ‘perfect’ looking people or they portray a certain image and then because it’s what you see all the time, it almost feels like if you don't look like that, then it’s wrong” (UK Department of Health 18). The influence of media on the impetus to transform is explored elsewhere (see Wegenstein), so is not addressed further here. However, the insecurity which results from such media images is further exploited by the marketing and promotional strategies adopted by cosmetic surgery providers in an increasingly competitive marketplace. This does not go unnoticed by consumers: as one research respondent noted, “They pick out your insecurities as a tactic for making you purchase stuff . . . it was supposed to be a free consultation but they definitely do pressure you into having stuff” (UK Department of Health 19). In this deficiency model of transformation, the cosmetic surgery consumer is insecure, lacking in power and volition, and convinced of her inadequacy. This is exacerbated by the promotional images of models featured on cosmetic surgery websites against which consumers evaluate their own looks in a process of social comparisons (Markey and Markey 210). This reflects Bernadette Wegenstein’s notion of the cosmetic gaze, a circular process whereby “the act of looking at our bodies and those of others is informed by the techniques, expectations, and strategies of bodily modification” (2). In comparing themselves with the transformed images on surgery websites, consumers are drawn into a process of comparison that tells them how they should look. At the same time as convincing consumers of their inadequacies, providers also tell consumers that they are in control and can act autonomously to transform themselves. For example, a TV advert for The Hospital Group which shows three smiling “transformed” customers claims “If you’re unhappy with your appearance you could change it. If it affects your confidence you could overcome it. If it makes you feel self-conscious, you could take control with cosmetic surgery or dentistry from The Hospital Group” (my italics). In this way marketers marshal the neo-liberal rhetoric of consumer empowerment to encourage the consumption of cosmetic surgery and normalise the practice through the emphasis on choice. Marketing and promotional messages contribute further to these perceived deficits by problematising “normal” bodily conditions resulting from “normal” life experiences such as ageing and pregnancy. Surgeon Ran Rubinstein, for example, draws attention in his blog to thinning lips as an opportunity for lip augmentation: “Lip augmentation might seem like a trend among the younger crowd, but it’s something that people of any age can benefit from getting. As you get older, some areas of your body thin out while some thicken. You might find that you’re gaining weight around your stomach, while your lips and face are getting thin.” Problematising frames a real or perceived physical state as “as a medical problem that requires a medical solution,” subtly implying that cosmetic surgery is “an unavoidable necessity” which is medically justified (Martinez Lirola and Chovanec 503). For example, Jules’s testimonial for facial fillers frames natural, and even positive, features such as smile lines as problematic: “I smile a lot and noticed some smile lines coming through.” Indeed as medicine has historically defined the female body as “deficient and in need of repair,” cosmetic surgery can be legitimately proposed as a solution for “women’s problems with their appearance” (Davis, “A Dubious Equality” 55). Promotional messages emphasise the intrinsic benefits of external transformation, encouraging consumers to opt for surgery in order to align their external appearance with how they feel inside. Much of this discourse calls on consumers’ perceptions of a disparity between how they feel inside and their external body image (Gibson 54). For example, a testimonial from “Carole Anne 69” claims that facial fillers “make me feel like I’m the best version of myself.” (Note that Carole Anne, like all the women providing testimonials for this website, including Carol 50, Jules 38, or Pamela 59, is defined by her looks and by her age.) Although Gimlin’s research suggests that the notions of the “body reflecting the ‘true’ self or re-creating one’s ‘genuine’ appearance” have become less important (“Too Good” 930), they continue to dominate in customer testimonials on surgery websites. For example, Transform breast enlargement client Rebecca exclaims, “I’m still me, but it has completely transformed how I feel about myself on the inside, how I hold and present myself on the outside.” A typical promotional strategy is to emphasise the intangible benefits of cosmetic surgery, such as happiness or confidence. This is encapsulated in a 2011 print advert for Transform Cosmetic Surgery Group which shows a smiling young girl in a bikini holding a placard which reads, “I’ve just had my breasts done, but the biggest change you’ll see is on my face.” In promising happiness or self-confidence, intangible effects which are impossible to measure, marketers avoid the reality of surgery—where a cut is made, what is added or removed, how many stitches are required. Consumers know the world through shopping (Elliott 43), and marketers draw on this behaviour to associate surgery with any other purchase in the life of a successful consumer. Consumers are encouraged to choose from a gallery of looks, to “Browse through our Before and After Gallery for inspiration,” and the purchase is rendered more accessible through the use of discounts, offers, and incentives, which consumers are accustomed to seeing in familiar shopping contexts. Sales intent can be blatant, such as this appeal to disposable income on Realself.com: “Now that your 2015 taxes are (hopefully) filed and behind you, were you fortunate enough to get a refund? If it just so happens that the government will be returning some of your hard-earned cash, what will you be using it for? Electronic gadgets, an island vacation, a shopping spree . . . or plastic surgery?” Providers reduce perceived risk by implying that interventions such as facial fillers are considered normal practice for others, claiming that “Millions of women choose facial fillers, so that they can age exactly the way they want to” and by providing online interactive tools which consumers can use to manipulate facial features to see the potential effect of surgery (This-is-me.com).ConclusionThe aim of this article was to explore the tension between two different views of transformation, one which emphasised consumer autonomy, freedom, and market choice and the other which claims a more restrictive and manipulative influence of the market and its promotional practices. I argue that McCracken’s explanation of transformation as “the expression of consumer agency and individual freedom” (xvi) offers an overly optimistic view of consumer transformation. In the cosmetic surgery market, the expression of consumer autonomy and freedom rests on the discourse of choice. This same discourse is adopted by surgery providers in their persuasive strategies to secure new clients so that the market’s promotional language (e.g. a whole new you) becomes part of the consumer’s understanding of and articulation of cosmetic surgery transformation. I argue that marketing and promotion work to progress consumers along the path to surgery, by giving them reasons to do so. This is achieved by reflecting existing consumer anxieties as deficiencies, by creating new reasons for surgery by problematising normal conditions, by promising intangible benefits, and by normalising the purchase. 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