MEDICAL TOURISM IN THAILAND

MEDICAL TOURISM IN THAILAND

Thailand is a leader in medical tourism. “Medical tourists” are visitors that come to Thailand and other countries for various medical procedures and tests and combine the medical care that with some rest and relaxation, for a price that is often considerably less than what they pay back home. People come to Thailand from all over the world for ultrasound tests, Lasik surgery, barium stomach X-rays and sex change operations. M.R.I.s are only $190. Complete physicals are $250. Many medical tourists come for cosmetic surgery.

In 2011, 500,000 of the 19 million visitors that came to Thailand traveled specifically for medical treatment, whereas of the 10.2 million tourists that visit Singapore each year, only 200,000 go to receive medical care. About 1.4 million international patients received medical treatment in 2012 and the number is increasing annually. According to the BBC: “Medical tourism in Thailand is growing at a yearly rate of 16 percent, while in financial terms the foreign medical services sector is expected to make a whopping 100 billion baht by 2015. Currently, medical tourism makes up 0.4 percent of the GDP. [Source: BBC]

Some hospitals advertise aggressively to get foreign customers: 1) running ads on cable televisions and setting up flashy websites with attractive Caucasian models; 2) making deals with nearby five-star hotels to provide patients with escorts, comfortable rooms and fancy food; and 3) giving travel agencies commissions to steer business their way. One hospital, with medical and fitness facilities. billed itself as a “breakthrough integrated medical rejuvenation providing spa, medical and fitness facilities” and has established a VitalLife Wellness Center that offers “body-fluid assays” and checks for “antioxidants and free radicals.”

According to Tourism Authority of Thailand (TOT): “No matter where you go in Thailand, medical tourism offers a wide array of procedures. The country has earned a reputation for dependable and affordable treatments and services, including massage centers, spas and wellness clinics and retreats, as well as surgical procedures such as laser, cosmetic, and cardiovascular. Thailand’s high standards and healthcare expertise make it a world leader in medical tourism, while the options for a post-medical treatment holiday are the best in the world. [Source: TAT]

Caroline Eden of the BBC wrote: Given Thailand’s reputation for graceful and attentive service, it is not hard to see why Bangkok has quickly become the medical tourism hub of Asia. Suvarnabhumi Airport is serviced by airlines from around the world, reasonably-priced hotel rooms abound, there is reliable public transportation and 30-day visas for many nationalities are easy to get upon arrival, all of which help to make a stay -- in a hotel or hospital -- easy. The Tourism Authority of Thailand (TAT), which began promoting medical tourism in 2004, has a detailed medical tourism website that highlights many of the most popular treatments available, including dental work, dermatology and cosmetic surgery, as well as listing reputed hospitals, making it easy for potential visitors to decide on a procedure. Forward thinking in many of its approaches, that has also recently partnered with state-owned Krungthai Bank, the national bank of Thailand, to offer tourists a debit card called the Miracle Thailand Card, which offers some medical and life insurance coverage in case of an accident. [Source: Caroline Eden, BBC, September 4, 2012]

Medical Tourism Trend and Tips for Those Who Seek It

Asia’s medical tourism industry generated around $4.5 billion by 2012. As it stands now Thailand and India are the major providers. Rough number of medical tourists based on data from 2010 and 2011: 1) Thailand, 1.2 million; 2) Singapore, 600,000; 3) the United States, 400,000; 4) India, 390,000; 5) Malaysia , 380,000; 6) Hungary, 360,000; 7) Japan, 80,000. [Source: Japan Tourism Agency]

Caroline Eden of the BBC wrote: “Widespread air travel, mounting healthcare costs in developed countries, long waiting lists and an ageing world population have all contributed to a global explosion of medical tourism in the past decade -- and Asia is leagues ahead in terms of world market share. More than 89 percent of medical tourists travelled to Thailand, India or Singapore in 2010, with Bangkok and Singapore leading the pack. But the cost of hotel rooms and treatment are both far more expensive in Singapore than in the Thai capital, making Bangkok the most popular place for medical tourism in the world. [Source: Caroline Eden, BBC, September 4, 2012 **]

There are risks associated with medical tourism and there have been many horror stories. Some of the concerns and question that have been raised include: 1) what about the follow up care?; 2) if something goes wrong it can be very expensive fixing the problem; 3) the high volume procedures might mean some of them are rush jobs; 4) how do you sue or seek claims if something goes wrong. On top of all this it can sometimes be difficultt to get data on a doctor’s credentials such as how many operations he or has performed and mortality rates at a hospital. It is good to deal with a facility accredited by Joint Commission International (JCI).

Caroline Eden of the BBC wrote: Western accreditation is also a vital component for confidence in undergoing foreign medical treatments and Bangkok’s Bumrungrad and Samitivej hospitals were among Southeast Asia’s first recipients of the United States’ prestigious Joint Commission International (JCI) certification, which is seen as the gold standard for healthcare service providers around the world. Now Bangkok has no less than eight JCI-accredited hospitals for medical tourists to book with. Singapore, on the other hand, has 13 JCI-accredited hospitals. **

Bumrungrad Other Hospitals in Bangkok That Specialize in Medical Tourism

Bumrungrad Hospital in Bangkok is a major center of medical tourism. Accredited by the reputable U.S.-based Joint Commission International, it seems more like a fancy hotel than a modern hospital. In addition to a Starbucks and McDonalds, it also has valet parking, a visa extension service, hotel-like rooms and suits, cable television in every room, and a team of interpreters and translators. Test results delivered to the hotel room with three days after they are done. Many meical tourist go there because they relax in Thailand while they are recuperating. Some foreigners like the service so much they come every year for physicals.

The staff Bumrungrad Hospital told Travel & Leisue magazine they treated two kinds of patients: 1) leisure tourists who get out-patient procedures such as dental work, Lasix and some cosmetic procedures; and 2) patients who come fore serious cardiovascular, orthopedic procedures or more intensive plastic surgeries but also want to catch a few sights. The head of marketing at the hopital told the magaizne: “The prevailing wisdom is ‘If I’ve traveled his far , then I should at least take a few days to do some sightseeing. In 2005, the hospital treated 58,000 Americans, an increase of 25 percent from 2004. In 2006 the hospital received 400 e-mail enquiries a day and was working with Diethlem Travel to set up special tours for medical travelers.

Caroline Eden of the BBC wrote: “Hospitals in Thailand are also very popular with those who travel from neighbouring Asian countries to seek treatment. Bangkok Hospital, which specifically caters to medical tourists, has an entire Japanese wing, while Phyathai Hospitals Group has translators for 22 languages, including Swedish, Khmer and Flemish, as well as a team of English-speaking staff. It is also well known that when Prime Minister Girija Prasad Koirala of Nepal needed medical care in 2006, he chose to travel to Bangkok ‘s Bumrungrad Hospital for treatment. [Source: Caroline Eden, BBC, September 4, 2012]

“The hospitals in Bangkok are some of the highest quality in the world, meeting or exceeding US standards,” said Steven Lash, CEO of Satori World Medical, a US-based medical travel company that sends patients to Bangkok as well as to seven other countries, including Turkey and Mexico. “All of the patients we have sent to these hospitals have given us excellent feedback on their procedures and their experiences at the facilities.”

Medical Tourism Procedures Available in Thailand

According to Healthy Travel Media the average cost in Thailand of: 1) heart-valve replacement with bypass surgery is $25,000 compared to $75,000 in the U.S., $22,000 in Singapore and $9,500 in India; 2) hip replacement surgery is $12,700 compared to $33,000 in the U.S., $12,000 in Singapore and $10,200 in India; and 3) knee replacement surgery is $11,500 compared to $30,000 in the U.S., $9,600 in Singapore and $10,200 in India. The costs include hospital and doctor fees but not travel and lodging. [Source: New York Times, March 21, 2009]

In Thailand: 1) coronary artery bypass surgery costs $22,000 compared to $75,000 to $133,000 in the United States; 2) prostrate surgery (TURP procedure) costs $4,400 compared to $10,000 to $16,000 in the United States; 3) gastric bypass surgery costs $13,000 compared to $35,000 to $52,000 in the United States; and 4) a face lift costs $5,000 compared to $10,500 to $16,000 in the United States. [Source: Patients Beyond Border,U.S. News and World Report, May 12, 2008]

Some American have traveled to Bangkok for experimental therapies such as “adult stem cell therapy” heart treatment not available in the United States. A firm called Thera-Vitae that offers the servive charges $35,000 and has a slick website advertisement that reads “Adult Stem Cell Therapy, New Hope, New Life.” In the procedure patients with a weak or diseased heart have stems cells taken from their blood and injected into the heart, the reasoning goes to make it stronger. Studies in the U.S. have shown only “modest benefit” from the treatment but since there are few risks some doctors have told their patients “why not?” because otherwise they have few options left. [Source: U.S. News and World Report, May 12, 2008]

Cosmetic Surgery for Foreigners in Thailand

Cosmetic surgery is big business in Thailand. There are even package tours that include an examination, surgery and recovery time on the beach. Among the pioneers in the industry were doctors who performed sex change operations for transsexuals and breast enlargements for bar girls. In the 1980s and early 90s the business boomed among Thais and Asians. After the baht collapsed during the Asian economic crisis in 1997, foreigners began coming to Thailand in large numbers for the reasonable quality surgery at low prices. [Source: Margeret Talbot, New York Times Magazine, May 6, 2001]

Bumrungrad Hospital in Bangkok specializes in cosmetic surgery packages for foreigners. One official there told the New York Times, “You can come here, get a face lift and spend five days vacationing on the beach, and it’s still going to cost you 40 percent less than it would if you had the same procedure in LA.”

A face lift at Bangkok’s Yan Hee Hospital, the largest volume cosmetic surgery facility in Thailand, in the early 2000s went for around $2,300, a nose job for $1,150— prices that were a quarter or less of than the prices for the same procedures in the United States. Other services offered by the hospital included body contouring, buttocks lifts, brow shaves, tumescent liposuction and laser face resurfacing. Liposuction packages including “under the chin only” and “thighs and love handles.”

Needless doctors in the United States and Europe frown on the practice. They say they have seen many victims of botched overseas cosmetic surgery—in many cases caused by the clinics that offer the lowest prices—and they have been brought in to fix the mess, At one sun and surgery clinic in Pattaya a number of patients developed severe infections after undergoing breast enlargement surgery that cost only $256. It turned out the “doctor” didn’t even have a medical degree and was later jailed for three years on fraud.

Advantages of Medical Tourism in Thailand

“Six Reasons to Make Thailand Your Medical Tourism Destination” by the Tourism Authority of Thailand: 1) Hospitals. Hospitals and other medical facilities in Thailand pride themselves on their high standards, and many have subjected their premises and systems to the most rigorous inspections by applying for accreditation and certification, whereby a qualified standards organization - distinct from the healthcare organization under review - assesses the hospital or facility to determine if it meets a set of standards and requirements designed to improve the quality of patient care. Thailand was the first country in Asia to achieve JCI accreditation in 2002, and 15 hospitals are now accredited. [Source: Tourism Authority of Thailand <>]

2) Doctors: The physicians, surgeons and nurses have been trained to the highest levels, while many specialists have been conducting research and gaining experience at the world’s best medical institutes with some even leading the field in which they specialise. Many Thai doctors and surgeons practicing today have won awards for their work, and more than 500 doctors practicing in Thai hospitals are American Board Certified. These medical professionals are skilled at providing the highest quality medical treatment.<>

3) Cost saving. The cost of medical treatments in Thailand is significantly lower compared to identical treatments in the West and other developed parts of the world. Some comparisons include: the US $130,000 cost of a heart bypass in the United States, which can be performed by skilled and qualified doctors at a Thai hospital for only US $11,000. Even most cosmetic treatments are around 50 percent less expensive in Thailand than in the US, where breast enlargements costs around $3,500-4,000 as opposed to $2,600-$3,200 in Thailand. <>

4) No waiting lists. Thai hospitals have numerous operating theaters and enough qualified surgeons that there is little, if any, waiting for scheduling even the most complex and invasive procedures. <>

5) Thailand’s medical technology is state-of-the-art. All of Thailand’s leading hospitals feature state-of-the-art technology that helps them provide the highest degree of medical treatment and service, such as,Siemens Biograph 64 PET/CT, Image Guided Radiotherapy (IGRT), and Blood Marrow Stem Cell Transplant. <>

6) Thailand offers excellent service. Thais are proud that their national character has won them a well-deserved reputation for their compassion and warm hospitality, and that’s why the country is nicknamed “The Land of Smiles”. Patients become so at ease that they feel almost like a guest on holiday from the moment they arrive at the hospital. <>

Arab Medical Tourists to Thailand

AFP reported: Thailand's top private hospital,Bumrungrad International Hospital, says it has seen "exponential growth" in the number of Middle Eastern patients since the September 11 attacks. In 2000, Bumrungrad saw only 5,000 patients from the Middle East, but the number surged to 70,000 in 2005, says Ruben Toral, group marketing director at the hospital. [Source: AFP, September 10, 2006 **]

“Middle Easterners, mainly from the United Arab Emirates, Oman and Qatar, now make up nearly 20 percent of the hospital's foreign patients, according to Toral. "They used to enjoy holidays and medical care in the United States and Europe. But September 11 changed both the travel patterns and the health care patterns of patients from the Middle East," Toral says."Just the sheer number is really quite amazing." **

“To meet the needs of Middle Eastern patients, Bumrungrad has created prayer rooms, beamed in Arabic TV channels and now cooks halal meals in accordance with Islamic dietary laws. The hospital, which did not have any Arabic translators before September 11, now has 25 to accommodate Middle Easterners seek services ranging from check-ups to cancer operations to spinal surgery, Toral says. **

Matar from the United Arab Emirates says he is getting a check-up at Bumrungrad during his one-week stay in Thailand. "I'm very happy with the service. Thai people are very nice," says Matar, clad in a white Arab robe, at the hospital in central Bangkok. **

A 63-year-old Qatari patient at Bumrungrad says he is also having a check-up while travelling in Thailand for two weeks. "The hospital is very good. I used to go to the United States to see doctors, but no, I don't want to go there anymore," says the owner of a construction company, who declined to be named. "I feel very welcome in Thailand. People are very nice," says the Qatari, adding his wife, their two children and his sister are getting check-ups at Bumrungrad as well. **

Japanese Seeking Ova in Thailand

In 2012, the Yomiuri Shimbun reported: “The number of Japanese who received ova donations as part of fertility treatments in Thailand has increased more than 10-fold in recent years, a recent investigation has found. According to the research, the number of Japanese who traveled to Thailand for such treatment had been about 20 a year from 2007 to 2009, but surged to 133 in 2010 and to 231 in 2011. [Source: Yomiuri Shimbun, May, 3, 2012]

Apparent reasons include lower costs than in the United States, Thailand's relative proximity to Japan and toughened regulations on the procedure in South Korea.The investigation also found that at least 62 Japanese women in 2011 went to Thailand to donate ova. The findings shed light on the fact that there is an ova-brokering industry mediating between Japanese donors and recipients in Thailand.

The cost of a one-time treatment ranges from about 1 million yen to 3 million yen in Thailand, compared with between 2.5 million yen and 6 million yen in the United States. Somboon Kunathikom, president of the Royal Thai College of Obstetricians and Gynecologists, said the standard of medical treatment in Thailand is on a par with that in the United States because many of the doctors have studied at U.S. universities.

For reasons of low cost and geographical convenience, South Korea had been the major destination for such Japanese until recent years. But as South Korea has toughened regulations on the de facto trading of ova in the guise of payment for expenses, brokerage firms shifted to Thailand.

Ova donors are not only Thai women but also Japanese women recruited by brokerage firms via the Internet and other means. Three brokerage firms alone that provided information to The Yomiuri Shimbun said that 15 Japanese women traveled to Thailand to donate ova in 2010, followed by 62 in 2011. The brokerage firms said they have tried to avoid future problems by not giving donors' names to the recipient women or allowing them to meet.

Thailand does not have any laws to restrict ova donations. Thai medical associations, however, now prohibit donations of ova in exchange for monetary rewards. But even that prohibition has no penalty clauses. Sources said Japanese donors receive 600,000 yen to 700,000 yen on average. In Japan, there is no official system for third-party ova donations, and only a limited number of medical institutions conduct the treatment. As a result, many Japanese who wish to have children through the method traveled abroad to receive ova donations.

Western Nations Sending Alzheimer’s Patients to Thailand for Care

Developing world countries such as Thailand are offering cheaper---and in the minds of some— better care for people with dementia and long-term memory loss. Reporting from Chiang Mai,Denis D. Gray of Associated Press wrote: “Residents of this facility for people with Alzheimer’s disease toss around a yellow ball and laugh under a cascade of water with their caregivers, in a swimming pool ringed by palm trees and wind chimes. Susanna Kuratli, once a painter of delicate oils, swims a lap and smiles. Watching is her husband, Ulrich, who has a heart-rending decision: to leave his wife of 41 years in this facility 9,000 kilometres from home, or to bring her back to Switzerland. Their homeland treats the elderly as well as any nation on earth, but Ulrich Kuratli says the care here in northern Thailand is not only less expensive but more personal. In Switzerland, “You have a cold, old lady who gives you pills and tells you to go to bed,” he says. [Source: Denis D. Gray Associated Press, December 31, 2013 ^^^]

“Kuratli and his three grown children have given themselves six months to decide while the retired software developer lives alongside his 65-year-old wife in Baan Kamlangchay, a facility in Chiang Mai that caters to Alzheimer’s sufferers. Kuratli is not yet sure how he will care for Susanna. But he’s leaning toward keeping her in Thailand, possibly for the rest of her life. “Sometimes I am jealous. My wife won’t take my hand but when her Thai carer takes it, she is calm. She seems to be happy,” he says. “When she sees me she starts to cry. Maybe she remembers how we were and understands, but can no longer find the words.” ^^^

“Spouses and relatives in Western nations are increasingly confronting Kuratli’s dilemma as the number of Alzheimer’s patients and costs rise, and the supply of qualified nurses and facilities struggles to keep up. Faraway countries are offering cheaper, and to some minds better, care for those suffering from the irreversible loss of memory. The nascent trend is unnerving to some experts who say uprooting people with Alzheimer’s will add to their sense of displacement and anxiety, though others say quality of care is more important than location. There’s also some general uneasiness over the idea of sending ailing elderly people abroad: The German press has branded it “gerontological colonialism.” ^^^

“A number of European countries have generous national health insurance, but these generally do not cover treatment abroad. Kuratli says the Swiss government would cover two-thirds of the bill for his wife’s care if she stays in Switzerland, but since high-end private clinics there can cost $15,000 or more per month, he could still end up paying more there than he would in Thailand. ^^^

Baan Kamlangchay: a Thai Alzheimer’s Care Facility for Westerners in Chiang Mai

At Baan Kamlangchay — “Home for Care from the Heart— in Chiang Mai patients live in individual houses within a Thai community, are taken to local markets, temples and restaurants, each with three caretakers working in rotation to provide personal around-the-clock care. The monthly $3,800 cost is a third of what basic institutional care would come to in Switzerland. [Source: Denis D. Gray Associated Press, December 31, 2013 ^^^]

Denis D. Gray of Associated Press wrote: “In Chiang Mai, a pleasant city ringed by mountains, Baan Kamlangchay will be followed by a $10-million, holidaylike home scheduled to open before mid-2014. Also on the way is a small Alzheimer’s unit within a retirement community set on the grounds of a former four-star resort. With Thailand seeking to strengthen its already leading position as a medical tourism and retirement destination, similar projects are likely. ^^^

“The pioneering Baan Kamlangchay was established by Martin Woodtli, a Swiss who spent four years in Thailand with the aid group Doctors Without Borders before returning home to care for his mother who had been diagnosed with Alzheimer’s. Wanting to return to Thailand and knowing that Thais traditionally regard the elderly with great respect, he brought his mother to Chiang Mai, where she became the home’s first “guest.” Woodtli never uses the word “patient.” ^^^

“Over the next 10 years, the 52-year-old psychologist and social worker purchased or rented eight two-storey houses where 13 Swiss and German patients now reside. Two people normally share the modest but well-kept, fully furnished houses, each sleeping in a separate bedroom along with their caretaker. Breakfast and lunch are eaten together at another residence where Woodtli, his wife and son live. On most afternoons, the group gathers at a private, walled park to swim, snack and relax on deck chairs. Regular outside activities are organized because he believes these stimuli may help delay degeneration. ^^^

“Movement is important. Tensions are also relieved if they have freedom to move. Our carers allow our guests a lot of space as long as it does not pose a danger to them,” he says. “In Switzerland we don’t have opportunity for such care.” He says his guests “cannot explain it, but I think they feel part of a family, a community, and that is very important.” ^^^

“Those who end up staying at a facility being built in the outlying Chiang Mai district of Doi Saket will have amenities that would be tough for its European counterparts to match, including a clubhouse with a massage room and beauty parlour, a restaurant, Swiss bakery and pavilions with soaring ceilings and skylights. “The idea is that this is a resort, not a hospital,” says Marc H. Dumur, a veteran hotelier who will manage the Swiss-owned, 3.5-hectare facility built amid orchards and groves of teak. Going up are 72 patient rooms in six spacious pavilions, plus villas for visiting family members. Around-the-clock care will be provided by a staff of 150, including a Swiss head nurse and at least one licensed Thai nurse for each pavilion. ^^^

“These patient-to-carer ratios reflect the costs in a developing country like Thailand and the West. A licensed Thai nurse earns less than $700 a month, compared to about $7,000 for one in Switzerland, where care centres will have one nurse responsible for 10 patients. Care at the Doi Saket home will cost $6,000 a month, roughly what a mid-level employee in Switzerland would receive as a pension, Dumur says. ^^^

“At the swimming pool, Madeleine Buchmeier snaps photos and laughs as she watches a caregiver take her smiling husband’s hands to twirl around together in a dance out of childhood. He used to sink when entering water. In the three weeks since they arrived, her husband has calmed down and can swim again, all while his medicine is being sharply reduced. Geri used to bang his head against the walls of a care facility in Switzerland, says Madeleine, “as if he wanted to do something, get somewhere.” Like Kuratli, Buchmeier is deciding whether her 64-year-old husband should stay or go back to Switzerland. Once a Ford Motor Co. employee who spoke four languages, he now mutters largely disjointed sentences but appears to recognize his wife. “It’s a miracle,” she says. ^^^

Criticism of Western Nations Sending Alzheimer’s Patients to Thailand for Care

Denis D. Gray of Associated Press wrote: “Woodtli says he has received criticism about “the Swiss starting to export their social problems.” The German press has recently described shifting the aged and ailing abroad as “grandmother export.” [Source: Denis D. Gray Associated Press, December 31, 2013 ^^^]

“Sabine Jansen, head of Germany’s Alzheimer Society, says that while some with Alzheimer’s may adjust to an alien place, most find it difficult because they live in a world of earlier memories. “People with dementia should stay in their familiar environment as long as possible. They are better oriented in their own living places and communities,” she says. “Friends, family members, neighbours can visit them. Also because of language and cultural reasons, it is best for most to stay in their home country.” ^^^

“Angela Lunde of the U.S.-based Mayo Clinic says that generally the afflicted do better in a familiar environment, but over time, even those with advanced stages of the disease can adjust well. “I think a positive transition has less to do with the move itself and more with the way in which the staff and new environment accommodates the person living with dementia,” she says. ^^^

“Woodtli agrees that moving to country like Thailand is not the answer for everyone with Alzheimer’s, but those who have travelled widely and are accustomed to change can probably adapt. “One of our guests sometimes wakes up in the morning and says, ‘Where am I?’ But she would do the same if she was in a care centre in Switzerland,” he says. “And they take their past with them. One guest thinks she is in a schoolhouse at Lake Lucerne.” Woodtli agrees that it is crucial “for the patients to be together with their carers, to know and trust.” He says Thai caregivers like those at Baan Kamlangchay are generally more emotionally and physically engaged with their charges. ^^^

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Tourist Authority of Thailand, Thailand Foreign Office, The Government Public Relations Department, CIA World Factbook, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Global Viewpoint (Christian Science Monitor), Foreign Policy, Wikipedia, BBC, CNN, NBC News, Fox News and various books and other publications.

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© 2008 Jeffrey Hays

Last updated May 2014

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