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Published on July 16, 2007

It is rather ironic and not uncommon nowadays to find a McDonald's restaurant right above the reception area of a private international hospital - and the fact that the eatery is never short of visitors can be baffling to the health-conscious. But such is the reality of the healthcare industry's globalised nature, which is driving the growth of medical tourism in Thailand.

Last year, 30 private hospitals in Thailand accommodated 1.4 million international patients - non-Thais of all descriptions - and generated from them a total turnover of Bt36.4 billion.

Medical tourism began as a kind of accident. It was born out of the 1997financial crisis, which caught many businesses - hospitals, as well - completely unguarded. Among them was Bumrungrad International Hospital, now the country's foremost purveyor of medical tourism.

Marketing director Kenneth Mays remembers how the plummeting baht left the hospital straddled with twice its level of debt in 1997, since most of its loans were in US dollars. There was also the problem of finding some means of earning revenues from a newly completed US$110-million building in the face of a large-scale exodus of Thai patients to state hospitals. The hospital's future was hanging in limbo, but management did not balk, instead rechannelling its energy into the development of the nascent medical-tourism industry.

Necessity is the mother of invention, says Mays, adding, "We practically tore up the old business plan."

But for a country perceived in many a one-dimensional foreigner's view to be a tropical paradise for golf and sex (remember the controversial Newsweek cover story in 1999?), Thailand had a credibility hurdle to overcome - at least in terms of medical standards.

That it has surmounted that hurdle is borne out in the testimony of the many who have experienced the services of Bangkok's larger private hospitals over the past few years. They can attest to the quality of these hospitals and their capacity to compete internationally.

Samitivej Hospital managing director and CEO Raymond Chong believes Thai healthcare practitioners are as capable as their main regional competitors in Singapore and have in fact stolen quite a few surgical patients from the island-state. But what they sorely need is independent, international recognition.

Last month, Samitivej Hospital in Sukhumvit Soi 49 joined Bumrungrad as Thailand's second hospital to be accredited by the US-based Joint Commission International (JCI). The JCI emblem reassures prospective patients of the standards of treatment they will receive, especially if a prospective client's only point of contact is a brochure or hospital website.

Chong says the JCI accreditation will no doubt attract more corporate clients and insurers, and with the number of medical tourists conservatively estimated to grow to 2 million this year, business opportunities are abundant.

Foreigners flock to Thailand's private hospitals for a variety of reasons, among them accessibility, cost and quality.

With their welfare systems in limbo or at least in trouble, be they tax-based or a mixture of contributions from individuals, employers and governments, Westerners are feeling the pinch.

Edwina Johns, 91, from Fishguard, Wales, was recently told by her National Health Service doctor to wait two years for her arthritis jab. However, she could jump the queue if she paid £600 (Bt40,600).

Across the Atlantic, Joe Lindsay, 56, flew half the globe from West Fork, Arkansas, to Bangkok, for arthritis surgery. It cost him $16,200 (Bt540,000) for the airfare and minor surgical work. His insurance at home excluded arthritis treatment, so he would have had to pay anything from $100,000 to $150,000 there.

While European welfare systems are becoming more Americanised - "The state to provide help, the citizens to use that help to help themselves," suggested former UK prime minister Tony Blair recently in The Economist - Thailand stands a good chance of attracting many medical pilgrims as a consequence.

Besides the Occident, customers are also coming from the Middle East in large numbers, more or less as a result of the September 11, 2001, attacks. Tightening immigration measures and mainstream Islamophibia in the West have turned these heavy spenders away to Asia.

But Chalermkul Apibunyopas, CEO of Thonburi Hospital, whose company is trying to break into the medical-tourism market, doubts Thailand will be able to sustain its Middle East edge for long.

"I'm afraid we're losing out to Singapore in terms of human-resources quality, because they have a large population of foreign-national doctors," Chalerm says.

The Singaporean government, in response to competition from Thailand and India, plans to invest $974 million in medical research and has hired McKinsey and Co to consult on its Singapore Medicine project, in a bid to attract 1 million foreign patients by 2012.

Singaporean Health Minister Khaw Boon Wan even announced in parliament recently that the city-state would give priority to hospitals when it came to buying land on the tiny island.

Such government-led initiatives - unheard of in Thailand - lead to investor confidence. The Far East Organisation, a major Singaporean developer and owner of the Fullerton Hotel, has already built a medical complex costing 257 million Singaporean dollars (Bt5.65 billion) right next to Tan Tock Seng Hospital, a major international facility. The conducive climate has also led Parkway Holdings, Southeast Asia's biggest healthcare group by market value, to launch a S$765-million real-estate investment trust.

The Thai government's "support role" - promotion through various international trade fairs, for instance - has been limited, admits Chamnan Muangtim, director of service promotion at the Tourism Authority of Thailand (TAT). The private sector has always led the industry, he says.

With the TAT lumping medical tourism into the same category as spas, private hospitals are left to their own devices. The fortunate ones like Bumrungrad successfully woo corporate clients and insurance companies. It recently signed a deal with a South Carolina medical centre giving it access to 1.3 million potential US medical tourists.

There is one thing that all practitioners of medical tourism agree upon: what Thailand lacks is made up for in its hospitality and affordability. In terms of surgical expertise, Thailand is moving towards more advanced areas like orthopaedics, Chong says, and the Kingdom's expertise is no longer solely in cosmetic surgery.

Despite intensifying competition, not only from Singapore and India, but also possibly from South Korea and Taiwan in the future, many operators believe demand will outstrip supply, especially as the global population ages.

Consider this: in Japan alone - forgetting ageing Scandinavians for a second - three in every five people will be aged 65 or over by 2055. And then together there are billions of Chinese and Indians. At least, quantity-wise, it must be good news for those in medical tourism for the long haul.

Ki Nan Tsui

The Nation