Thailand leads world healthcare

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.