When Indonesian Rismayanti Maulana?s husband was diagnosed with liver cancer, she had no hesitation in bringing him to Singapore for an operation despite the city-state?s higher medical costs. Syahrul, a 36-year-old former civil servant, still travels to Singapore for chemotherapy after being hospitalized for three weeks following an operation. ?Many Indonesians go to Singapore for treatment because of its medical sophistication. The doctors are well-trained and, in my husband?s case, there?s no liver surgeon in Indonesia,? said Maulana.

Maulana?s words are music to the ears of the Singapore government, which is on a mission to re-establish the island as the region?s medical hub as it fights growing competition from lower-cost countries Thailand and Malaysia. In 2003, Singapore had about 230,000 medical visitors despite the SARS outbreak, a nearly 9 percent increase over the 2002 level of 211,600 visitors receiving medical treatment, according to the Singapore Tourism Board.

Now Singapore aims to draw 1 million foreign patients to its shores by 2012 and a government study showed the target could potentially generate $1.5 billion in expenditures, adding about 1 percent to Singapore?s gross domestic product. ?Our top markets are Indonesia and Malaysia which account for more than 75 percent of total. We are also seeing signs of good growth, albeit starting from a small base, from the rest of ASEAN and new markets such as the Middle East,? said Dr Chan Tat Hon, assistant chief executive at the Singapore Tourism Board.

The fight for the rich Asian patient covers a range of services from simple health screening to plastic surgery, knee or hip replacement and heart bypass surgery. The push goes hand-in-hand with a goal to develop the biomedical sciences sector into a second engine of growth for the trade-dependant economy. But since the 1997 Asian financial crisis, other countries in the region have also been aggressively promoting themselves as destinations for health tourism, with Thailand?s Bumrungrad Hospital leading the drive.

In a typical health tourism package, hospital staff arrange airport transfers, book relatives into nearby hotels and even organize local tours. More luxurious packages can include a massage at a spa as well as dinner at an elegant restaurant. In the face of the growing competition, Singapore?s Parkway Holdings Ltd, Southeast Asia?s largest listed private hospital company, has decided to focus on the high-end of the market involving complex cases.

Raffles Hospital, a privately owned Singapore hospital which has earned an international reputation in the area of separating conjoined twins, cut its fees for some common surgical procedures in September to make them more competitive against Thailand.

Its fixed-price package of S $15,700 (US $ 9,235) for a heart bypass operation is 25 percent lower now, and includes multiple-arterial grafts, doctors? fees and eight days stay in the hospital.

Bangkok?s Bumrungrad advertises for the same treatment at 299,900 baht (US $ 7,315) but this offers only one arterial graft. The cost is estimated to increase by another 25,000 baht for an additional graft. Despite its higher prices, Singapore?s greatest challenge is to attract the Asian elite who still prefer to go to the United States for treatment.

A government study said the wealthy island should style itself on the United States? Mayo Clinic, whose enduring brand name for cutting-edge medicine allows it to command a price premium. Parkway charges $156,000 for liver transplant that would cover the costs for the recipient and the living donor, whereas an American hospital offers this procedure at $ 300,000, Parkway?s Tan said.