With a highly competitive international healthcare system that is the envy of many western countries, Bangkok has developed a reputation as a medical tourism destination. Mark Bibby Jackson discovers what the city offers for both expat and international patients. Photos by Nick McGrath.
David Towers walked into a hospital in Cambodia for what he assumed was a routine medical check up. That was where the drama started.
“They carried out a series of standard tests and told me I’d suffered a heart attack,” Towers explains. While detained for further tests, his wife Chansinoun was summoned to the hospital and then asked to pay for a three night stay. “She asked them why three nights, why not one, why not four?”
“The level of care required seemed very dependent on what my insurance company would pay in the first 24 hours,” Towers says. “I lay in bed feeling like a hypochondriac for three days. Nurses kept telling me I looked fine, but the doctor insisted I was near death’s door.”
Eventually, the fortysomething Scottish expat was evacuated to Thailand where an ambulance was waiting at the airport to take him at high speed to Bangkok Hospital. On arrival, he was wired up to machines by a team of heart experts in the Accident and Emergency Unit. Within minutes they diagnosed that there was nothing wrong and he had not suffered a heart attack after all, much to his relief.
“I’d carried some heavy bags shortly before my check-up,” he says. “I think the strain of that had something to do with it.”
Fortunately Towers’ hospital bill, which amounted to around $18,000, was covered by his medical insurance, but neither he nor Chansinoun received any compensation for the stress and anguish caused by the initial misdiagnosis.
His story is one of many that stem from Cambodia. Shortly after I arrived in the country, some seven years ago, a friend of mine broke his leg while jumping from a motorbike that had collided with another vehicle. He was rushed to a hospital – not the one Towers visited for his check up – where they ‘set’ his leg.
Armed with his x-rays, he flew to Bangkok for a check up on the work the Cambodian hospital had done. Two operations and $11,000 later – unlike Towers he had no medical insurance – his leg was broken again and then reset before being held together with pins. The doctors said his decision to go to Bangkok had prevented from him walking with a permanent limp for the rest of his life and had possibly even saved his leg.
The Hospital of Choice Both stories explain why expats across the region choose Thailand for both routine and emergency procedures.
“It’s not uncommon for a patient to come here from one of those countries [Vietnam, Myanmar and Cambodia] and get a different diagnosis or treatment,” says Kenneth Mays, senior director of hospital marketing and business development at Bumrungrad International Hospital. “It runs both ways. You can get a patient who has back pain and is told it’s no big problem and he comes here and we say we have to do some surgery. Equally, we have patients who come to us saying their surgeon back in Vietnam or Cambodia wanted to do spine surgery and our surgeon says we can handle it with injections of pain killers.”
The key is to get the right diagnosis for the problem you have, and this is often more likely to be the case in Thailand than in some neighbouring countries. This is not to advocate patients jump on a plane for basic medical care.
“You should have a doctor you can see about your routine aches and pains close to home,” says Mays. “If you run into more serious problems, patients should consider coming to a hospital like ours.”
As an American, he maintains Bumrungrad compares favourably with hospitals back home, a view his patients seem to endorse. “Most of the American patients say it’s much better than going back to America for medical care.”
According to Ruben Toral, Bumrungrad is by no means alone in the standard of medical care it provides its patients. “The top international hospitals in Thailand are competitive with those you would find in Europe, the US and Australia,” he says. Toral, who has established web portal Medeguide, travels around the world working with hospitals and doctors from Brazil to Turkey.
One thing that makes Bangkok stand out from the crowd is the level of service provided at the leading hospitals.
“Those of us who live in Bangkok are probably a little jaded, but for medical tourists and first time users there is a tangible difference in service standards found here versus hospitals in Europe or the US,” says Toral. “The top international hospitals employ an army of support staff, including interpreters, concierge services and even valet parking.”
Another advantage is the lack of time needed to see a specialist. In Bangkok you can walk in and see an expert in his or her field, something that Toral claims is “unheard of in other parts of the world.”
Although all clinical doctors are Thai, as they have to pass medical examinations in the Thai language, many are trained overseas and accustomed to the needs of international patients. Some hospitals also have medical coordinators that are foreign doctors. Others — including Bumrungrad, Bangkok Hospital, BNH Hospital and Samitivej — have attained accreditation from the Joint Commission International (JCI), the US-based agency widely regarded as the gold standard for healthcare providers worldwide.
It is not surprising therefore that Bangkok has developed a reputation for medical tourism. Whether it is for a routine check up, emergency operations or specialist surgery, many regional expats choose Thai hospitals. Last year, more than 480,000 international patients chose to go to Bumrungrad, a further 200,000 went to Bangkok Hospital and 100,000 to Samitivej, to name just three of the many hospital groups in Bangkok.
Many are natives of other Southeast Asian countries who realise that the healthcare provision in Bangkok is of a higher standard than that provided in their own country.
“Cambodia and Myanmar are the two biggest outbound markets,” says Toral. “Vietnam less so, as their medical infrastructure is more advanced and they tend to prefer Singapore over Thailand for overseas medical care.”
According to Toral, Cambodians and Burmese come predominantly for diagnostics and specialty medical services, like cancer treatment, cardiac surgery and neurological disorders. Vietnamese are much more selective, and tend to travel for cancer treatment, neurosurgery and specialty medicine.
“We get thousands of patients coming here from Cambodia and Vietnam each year,” says Mays, equating the situation with that of small town Australia where people travel to a larger city for major surgery. “That’s the same way that people in Vietnam and Cambodia are using hospitals. They come because they feel that the medical facilities here are more advanced than what they get back home.”
The Complete Package
In additional to the quality of service, cost is a key factor in drawing medical travellers from not just across the region but around the world.
“Our medical costs are typically far less than what might be found in Europe or America,” says Dieter Burckhardt, assistant marketing communications and branding manager of Bangkok Hospital. He cites a coronary artery bypass which costs between B450,000 and B600,000 and total knee replacement at B450,000 as two examples of surgery that would cost much more if taken privately in the west.
Reduced waiting time is another key factor.
“We also have many patients coming to us from countries that have universal healthcare systems that, albeit free, have associated waiting times that drive the patient to seek a private alternative,” says Burckhardt. “An example of this would be a patient from Australia or the Netherlands, who could be faced with an 18-month waiting list for a total knee replacement.”
This is what Burckhardt describes as the “complete package” – the combination of medical expertise, technological innovation and world renowned service standards that makes Thailand’s international hospitals rival more developed countries.
Spoilt for Choice
The quantity of international standard hospitals and the range of treatments and services that they provide has created a very competitive environment. According to Mays, this is intensified by canny Thais who shop around in order to ensure they attain best value for money. The benefit of this in turn trickles down to both expat and overseas customers.
“The international patients get the same prices as locals and they benefit from that competition,” he says. “They are getting great value for money. They are getting the same quality of care as in San Francisco or Singapore but at a fraction of the price.”
Toral believes that the playing field is not quite as level as Mays maintains. He says that hospitals prefer expats and medical tourists because they tend to pay more.
“While there are rules and regulations against dual pricing, any expat who lives in Thailand will tell you what’s on paper and what’s done in practice are two very different things,” he says. “Hospitals are not immune to this practice, and even if the hospital’s prices are fixed, doctors’ fees are not.”
Also with so many hospitals marketing themselves as “international” and offering an array of services at competitive prices it can be difficult to sort the wheat from the chaff.
“It’s a buyer’s market and from a consumer perspective that’s a good thing, but from a healthcare consumer perspective too much choice can be a confusing thing,” says Toral.
That is why he decided to establish Medeguide initially in response to hearing “thousands” of patients asking for the same thing – the name of a good doctor.
“Users can search doctors by country, specialty, hospital, procedure or condition,” he explains. “Most hospitals only allow you to search by specialty. The key benefit for consumers is that Medeguide is an easier way to search for and connect with doctors instead of bouncing from hospital site to hospital site.”
David Towers, for one, is not complaining about Bangkok’s competitive medical scene. One year on from his heart scare, he’s back in Bangkok, this time for a check-up at Bumrungrad. Passing without any mishap, he can spend a more relaxed time in the City of Angels together with Chansinoun. And, with his heart no longer on the endangered species list, he is even able to explore the city’s restaurants and shopping malls without running the risk of meeting his maker each time he sees the bill.
International Hospitals in Bangkok
Bangkok’s hospital scene is very competitive and can be confusing. Here are some basic details about five of Bangkok’s top hospitals.
Bangkok Hospital is the flagship of the largest network of private hospitals in Southeast Asia. The 500-bed tertiary hospital has 64 specialised centres and clinics with three primary hospitals: Bangkok Heart Hospital, Wattanosoth Cancer Hospital and the original Bangkok Hospital building where the vast majority of medical services are offered. Its 900 full-time and consulting physicians represent specialists in every major field of medicine. Last year it treated over 200,000 international patients.
BNH provides specialty care for women including breast health, infertility, complex spine surgeries, beauty and plastic surgery. The Breast Health Centre specialises in holistic breast conservation treatment, the hospital also works closely with Queen Sirikit Centre for Breast Cancer Foundation in terms of clinical research and breast cancer support. The BNH Spine clinic was the first to introduce total artificial disc replacements to Thailand. The majority or patients from overseas are from China and Australia, mostly seeking elective treatment, such as IVF, Plastic Surgery and check-ups.
With 554 beds and over 30 specialist centres Bumrungrad is the largest private hospital in southeast Asia, treating over 480,000 international patients in 2012. A one-stop medical centre with top doctors in over 50 sub-specialties including brain surgery, liver transplants, cancer treatment and spine surgery, it also provides for routine check-ups. It has the world’s largest private sector outpatient clinic, including 150 translators.
Rutnin Eye Hospital
Rutnin Eye Hospital was Thailand’s first hospital specialising exclusively in ophthalmology. The hospital combines excellence in medical and surgical procedures, investment in the latest technology, and the highest standards of safety to care for your eyes. The full-support facilities include an outpatient clinic, day surgery unit, three operating theatres and an in-patient unit.
Samitivej Srinakarin, with over 400 beds is Thailand’s first dedicated children’s hospital, with highly specialised services such as down syndrome treatment and adolescent psychiatry. Since inception, the Children Hospital has developed a reputation for its Bone Marrow Transplant and Neonatal intensive care services in its Bangkok Orthopedic Clinic.