Thailand leads world healthcare

Dwi Atmanta, The Jakarta Post, Bangkok

A quick around the Bumrungrad Hospital here in Bangkok may catch a first-time visitor by surprise.

On the floor just above the lobby, people enjoy their meals in a McDonald's fast food outlet, sip their favorite Starbuck's cappuccino, have their muscles relieved in a spa or just take a stroll along an arcade of shops.

There is not much difference between the hospital and a hotel, except for the nurses who walk about with or without patients. Even the smell of medicine can only be detected around the hospital's pharmacies.

Located deep inside a crowded area off the Sukhumvit thoroughfare, the 12-story Bumrungrad Hospital is just one of dozens of healthcare providers in the capital of Thailand offering the luxury of staying in a top-rated hotel while undergoing a medical treatment.

They boast of the high standard of their service, with the full support of state-of-the-art technology.

The Thai government has contributed a lot to the robust healthcare industry, which, like other sectors across the Southeast Asian region, was hard hit by the economic crisis in 1997. Since Thaksin Shinawatra assumed power in 2001, the Tourism Authority and the Ministry of Trade and Commerce of Thailand have been actively promoting "medical tourism" to attract international customers.

"There are three categories of international customers: expatriates and citizens of neighboring countries, foreigners who look for low-price healthcare and tourists who are sick," said Surapong Ambhanwong, the president of the advisory and foreign affairs board of the Thailand Private Hospital Association.

Indeed, international customers make up a huge market, with around 11 million tourists spending their time and money in Thailand annually, plus hundreds of thousands of expatriates.

To capture the international market, hospitals in Thailand offer non-healthcare services to foreign patients, including arranging their flights, visas and accommodation while undergoing treatment in the country, according to Surapong. Big players like Bumrungrad, the Bangkok Hospital chain, Praram 9 Hospital, Pyha Thai Hospital, and even specialist clinics, provide these extra services. Each of them also provides a special section for international patients, which include medical staff who speak the customers' languages.

Surapong said pricing was the biggest advantage Thai hospitals had. With state-of-the-art treatment on offer at a half the price charged by private hospitals in Singapore, Europe or the United States, Thai hospitals have become a major destination for healthcare seekers worldwide.

"Around 500,000 foreigners have sought various healthcare services in Thailand, mostly in hospitals in Bangkok, ranging from one-day medical check-ups to surgery. There are also some foreigners who have sought sex-change operations here, which are quite popular overseas but remain controversial here," he said.

A heart by-pass operation costs a patient US$10,000 in Thailand, said noted heart surgery Kitipan Visatharom of Bangkok Hospital, less than one fourth the price in the United States.

The government taxation policy is behind the cut-price campaign, Surapong said. Under the policy, import duty is not charged on medical equipment brought into Thailand and new hospitals or clinics are exempted for the first five years of their operation.

Surapong said the low prices helped Thai hospitals keep their international market intact despite the Sept. 11, 2001, terrorist attack on the United States, the war in Iraq and the Severe Acute Respiratory Syndrome (SARS) outbreak earlier this year.

"More patients from the Middle East turned to Thailand following the Sept. 11 attack, which has made it difficult for them to travel to the West for healthcare," he said.

Revenue from foreign patients accounts for almost 40 percent of patient revenue in the American-run Bumrungrad Hospital, which posted Baht 300 million ($15 million) in net income for the first half of 2003, already 32 percent above the level achieved in the first half of 2002. It accepts an average 270,000 people from 154 different countries a year.

The Bangkok Hospital, the largest hospital chain in the region with eight hospitals and approximately 4,000 in-patient beds throughout Thailand, said international patients accounted for 30 percent of its customers. It recorded Baht 3.2 billion ($160 million) in total revenues in 2001.

Another major player, Praram 9, accepts over 20,000 international patients or 12 percent of total patients. Japanese comprise the majority of the foreign patients. The number of foreigners seeking medical attention fell slightly after the Sept. 11, 2001 terrorist attacks in the U.S., but jumped back to above 22,000 the following year.

The hospital's managing director, Satian Proopaseert, said kidney transplants and blastocyst cultures were the most popular services the 11-year-old healthcare provider offered to foreigners.

In Phuket, some 700 kilometers south of Bangkok, the booming tourist industry inspired the launch of the Phuket Health and Travel Co. (PHT), a specialist in health-related tour packages for both domestic and foreign tourists. It provides a wide range of health-related programs, including simple medical check-ups, plastic surgery and more complicated treatments like knee or hip replacements, and bypass heart surgery. For medical services, PHT cooperates with the Bangkok Phuket Hospital, the Bangkok Hospital Group member on the southernmost island of Thailand.

Non-medical services offered by PHT include hotel accommodation, transportation, city tours, off-island visits and other holiday programs, which allow people to dive to the depths of the blue sea or tee off on international standard golf courses after their medical treatment is over.

Thailand is one of the foreign countries Indonesia can learn from regarding the hospital business, admits Moeki Reksoprodjo, the former secretary-general of the Association of Indonesian Hospitals (ARSI), which groups around 800 hospitals and clinics across the country.

"Two or three decades ago, we were leading the way in medical treatment in the region, but now it has changed 180 degrees," Moeki said. He recently visited Thailand along with the top executives of several private hospitals in Jakarta.

Moeki, also a director of the Metropolitan Medical Center (MMC) in Jakarta's golden triangle area of Kuningan, said it was the government that was the cause of the lack of growth in the healthcare business in Indonesia compared to Thailand.

Let alone wooing foreign patients, Indonesian private hospitals, he said, had been struggling to survive since the crisis and had to think twice before investing in new medical equipment. The main reason is that the government treats medical equipment in the same way as luxury goods, like cars, which are subject to 5 percent luxury goods tax and 10 percent value added tax.

"It's a bit unfair then if the government requires all hospitals to provide 10 percent of their beds for lower income people, while they receive no incentive in return," he said.

The taxation policy hampered the access of people from the lower income brackets to health services, which was a violation of their basic rights, he added.

"The burden has to be shouldered by patients, regardless of their economic status, because hospitals must survive in an era where the provision of medical services is an industry," he said.

ARSI, he said, had long been demanding changes in the taxation policy through the Ministry of Health, but to no avail. The finance ministry had been reluctant to heed the demand, saying other sectors would only follow suit.

The Indonesian Consumers' Foundation (YLKI) has supported the exempting of medical equipment from tax, but pointed to the need for tight controls so that the poor would benefit.

YLKI chairwoman Indah Suksmaningsih said some would try to take advantage of such a tax exemption to increase their profits if both government control and law enforcement remained weak. She highlighted the current difficulties in ensuring the mandatory allocation of beds to low income people.

Health ministry data for 2001 recorded 1,179 registered hospitals, 598 of which were private. While this was an increase in the number of hospital beds compared to previously, the level of public access to healthcare in hospitals had declined from one bed for 1,500 people to one bed for 1,600.