Health holidays - sun, sand...surgery

As health care prices continue to soar in the west, increasing numbers of patients are outsourcing their ailments. With state-of-the-art facilities, internationally-trained staff and low labor costs, Asian hospitals are becoming the choice for a booming industry called Health Tourism.

CHARLES BROOKS "FELT A MILLION DOLLARS better” within days after arriving in Thailand. But not for the usual reasons noted by holiday makers: sun, sand and smiles.

  Brooks came for prostate surgery. “I feel like I haven’t since I was a teen,” he enthused.

  An advertising executive in stress-filled New York City, Brooks, 58, could have had the operation at home. Cost wasn’t a consideration, since he was fully insured.

  However, the procedure he sought was new, not yet widely adopted in America.

  In Bangkok, Bumrungrad International Hospital had a doctor experienced in over 200 of the laser procedures, which Brooks said had less risk of infection and sexual dysfunction.

  So, the New Yorker flew to Bangkok, had tests, surgery and could detail his recovery – all within a week.

  David Shaw had the same treatment at Bumrungrad, but almost as an afterthought. The anesthesiologist from Indiana suffered from longtime back pain.

  Despite a lifelong medical career, he had no health insurance, and balked at the cost of surgery in America, which he estimated would have totaled $30,000.

  Intsead, Shaw opted for back surgery at Bumrungrad. Afterwards, he was so impressed, he immediately booked tests then prostate surgery – but only after a relaxing beach holiday on the island of Ko Samui.

  The cost for everything – operations, plane tickets, hospital and hotel rooms – was $10,000, a third of the original quote. And he raved about his treatment. “I work in medical centers. Nowhere have I seen the quality of care I got in Thailand.”

  Brooks was equally positive. “In America, care is largely left to orderlies on minimum-wage,” he said from his Bumrungrad hospital bed. “Here, health care is still a good job, and people are clearly happy to have it. The care is a world of difference.”

  The two aren’t isolated in their experience, or assessment. Bumrungrad treats a million patients a year. A third are foreigners, making this hospital the world leader in a trade often called health tourism; it’s booming across Asia and, to a lessor extent, East Europe, South Africa and Latin America.

  You needn’t be a brain surgeon to see the appeal. Heart procedures can cost $200,000 in the US, versus $7,000 in India.

  Most foreigners come for minor elective surgery and cosmetic treatments, which typically cost a third to a tenth of what they would expect to pay in the West.

  Not that the cut-price care means reduced quality. Bumrungrad cemented its market-leading role by obtaining the same certification of most American hospitals.

  Designed to be friendly rather than frightening, televisions at the modern hospital in central Bangkok show football matches in waiting rooms, while children’s areas are filled cartoon characters and other fun diversions.

  Yet, the 12 floors are also packed with spotless, state-of-the art equipment. Many physicians have worked in America or Europe, and five dozen translators handle a range of languages from English, German, French and Japanese to Arabic, Bengali and Khmer.

  “This is the future of medicine, you’re looking at it right here,” insisted Ruben Toral, Bumrungrad’s director of marketing, as he guided me around a facility that looked more like five-star hotel than hospital.

  Hospitable young ladies welcomed visitors as they stepped into the bright lobby. Families sat on stools in surrounding cafes. At the patient intake center, you could book tours, send faxes or rent a laptop from the concierge.

  “What we are seeing, is a fundamental shift in how health care is going to be delivered. Five years from now,” Toral predicted, “everyone will be buying health care electronically. You’ll go to the web for consultation, book your flights and arrange your treatment just like you do now with hotels and air tickets.”

  Actually, that future has already arrived. Numerous web sites now offer medical services and diagnosis. Prospective patients can browse menus of surgical procedures and prices at distant facilities, then detail ills by email for an online consultation – much like the high-tech approach to software complains and computer ailments.

  “This is just the next logical step in outsourcing,” noted Toral. As work continues its logical migration from rich western countries to developing nations with lower labor, he noted, why should health care be different than call centers?

  Hence, it’s no surprise to find India, already the computer industry’s outsource center of choice, seeking to fill the same role as health care goes global.

  Leading the way is Apollo Hospitals Group. From a single hospital in Chennai in 1983, it has grown into what it claims is Asia’s largest integrated healthcare company, treating seven million patients annually at three dozen hospitals around the country.

  Apollo’s web site details services that start with online consultation and include airport pickup, help with accommodation and visas, and translation in numerous languages.

  Apollo plans to increase capacity by 30 percent per year, and much of the expansion will be financed by foreign patients.

  Just a few years ago, they constituted 5 percent of Apollo’s patient load, said Anil K. Maini, president of corporate development. “Now, it’s over 15 percent,” and he expects the figure to double in a few years.

  Maini has every reason to be bullish. A study by consultancy McKinsey estimated that “medical tourism” could bring India an additional $1.1 to $2.2 billion within six years.

  Such potential has spurred a building boom among Asian hospitals, many of which are constructing facilities dedicated to foreign business, linking up with international health companies or, like Bumrungrad, bringing in teams of western managers.

  Credit a health-care crunch in rich western nations, where costs are spiraling upwards, and quality is, by all accounts, in a drastic decline. Patients are generally motivated by two main factors: cost savings, or expediency and convenience.

  The later come from countries like the United Kingdom, where health care is largely free, just frustratingly beyond reach.

  The British can wait a painful year for a hip replacement, or have it done in days in India.

  Dental hospitals across the former communist states of East Europe are doing a booming business providing fast and inexpensive root canals and caps to all the decaying teeth of western Europe.

  Cost is the key attraction to Americans, whose health system has become a national disgrace. The US spends 1.4 trillion on health care, yet insurance premiums continue rising so fast that over 40 million people in the world’s richest country have no coverage.

  “About 18,000 Americans die each year from treatable conditions because they cannot afford health care," noted a World Bank study in July 2005.

  That report, “Does Health Insurance Impede Trade in Health Care Services,” looked at 15 basic procedures and found that $1.4 billion could be saved annually if only a tenth of the patients needing these treatments obtained them abroad.

  Health tourism might be a new buzz term, but this business has actually been around for a long time, if not quite so apparent.

  Americans have long slipped south of the border (or, in smaller numbers, north into Canada) for treatments, controversial cures and medicines, although mainly for pharmaceuticals and procedures that weren’t available in the US.

  As its economy crashed, Cuba began milking the benefits of its excellent medical system, providing health services to visitors from around Latin America. In 2002, an estimated 5,000 people visited the island specifically for medical treatment, bringing in much of the $250 million earned by Cuba’s medical sector.

  The Crossroads Center in nearby Antigua was cited by the World Bank as an excellent example of the potential of outsourcing health care. Founded in 1998, it treats addiction with a month-long program modeled on those in the US, which is also the source of most patients. Treatment costs a third of facilities like the famed Betty Ford clinic.

  Dental and eye clinics in Hungary and the former Czechoslovakia have, for decades, been the destination of rich neighbors from Germany, Switzerland and other parts of western Europe. Clearly more would go if barriers to trade across borders were relaxed.

  A survey in eight European nations by Stockholm Network, one of Europe’s top think-tanks, found people uniformly felt their health systems were insufficient, under-funded and would decline further in coming years.

  The study, “Impatient for Change; European Attitudes to Healthcare Reform,” noted that nearly two-thirds of those surveyed would travel to another country for treatment, if the cost was covered by their health system.

  Increasingly, they will pack their swimsuits and tanning lotion, as the destination for much of this business is Asia. By all indications, that should increase.

  Across the region, institutions are targeting medical outsourcing, and the leaders of the pack offer the same lure that pulled call centers to the East: lower wages and good English skills.

  Singapore is trading on its reputation for stability and safety amid numerous regional health scares, with a target of 300,000 foreigners for treatment.

  Malaysia checked in nearly 100,000 medical tourists last year, mostly from Indonesia and other parts of Asia.

  Already some Indian hospitals are applying outsourcing experience to such tasks as collating hospital records and reading X-rays for western institutions.

  But, Thailand is by far the leader, and only plans to push its business.

  Bumrungrad is in the midst of an expansion that, by the end of 2006, will more than double capacity, currently 300 beds. This is all the more remarkable when you consider that the 25-year-old hospital nearly went bankrupt in the Asian Financial Crisis of 1997.

  Now, the hospital is taking stakes in, operating or managing hospitals from Manila and Myanmar to the Middle East.

  Toral boast that Bumrungrad has even higher hopes, to become the Mayo Clinic of Asia. And competitors aren’t far behind as other Thai hospitals pursue the same healthy business.

  Dusit Medical Services operates nine hospitals across Thailand. Flagship Bangkok Hospital boasts interpreters in over two dozen languages. Like Bumrungrad, it offers upscale facilities, private rooms and a host of meal options.

  There are, of course, numerous downsides. Upon sight of India’s dirty cities, many visitors naturally worry about cleanliness and the risk of infection.

  Despite spiffy facilities for foreigners, Thailand’s own health care has been widely criticized at home. Thai Day newspaper reported that the doctor to patient relationship in Thailand is lower than in Tonga, as “1,000 professionals a year leave the government sector for private practice.”

  Of course, medical migration is neither new nor limited to Thailand. The number of international medical graduates working in the US now constitutes a quarter of the US physician workforce, according to the American Medical Association. The vast number of them come from developing nations, with India providing over 20 percent.

  Hence, the terrain may change, but the physician’s face can be comfortably familiar, noted Pamela McKain, a grandmother in Alabama, who recently traveled to Thailand for hip-replacement surgery.

  “It has been our experience that the specialist here in the states were either Asian or Indian so I just went to them directly,” she said.

  Representative of the health tourist Thailand is keen to attract, McKain had never traveled abroad. Lacking health insurance, she figured her procedure would have cost $50,000-$70,000.

  In Thailand, she paid $7,500 for the treatment, and spent another $6,500 of the savings for touring and shopping with two children and a friend.

  “I have nothing but wonderful things to say about the people, culture and treatment during our entire trip.” Needless to say, she plans a repeat trip, bringing more friends.

  Others, like Jonathan Edelheit see Bumrungrad as a “magic bullet” for health care. Vice president of American insurer United Group Programs, he said the globalization of care is inevitable.

  “We will be the first to breach these waters,” he said. “We will be shortly offering to all our groups the option of having surgeries performed overseas.”

  Three years from now, Edelheit predicted, such treatment would be as commonplace as the cold. And, he added, we’ll all be healthier for it.

Ron Gluckman is an American reporter, currently based in Bangkok (and Cambodia), who has been roaming around Asia for 16 years for a variety of publications including Scanorama (the Scandanavian Airline magazine) which ran this story in early 2006.

All pictures by Ron Gluckman

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