“We needed a visa to go to India, but not to come here. So, we came to Thailand for medical treatment.”
So said a couple from Dubai, with whom I shared a table while we were on a cruise boat down the Chao Phraya River to Bangkok from the historic ruins of Ayutthaya.
After completing the medical procedures, the young husband and wife from Dubai had been vacationing in and around Bangkok for a week, which is when I met them. They represent very well the rapidly growing medical tourism market, into which India has jumped as well.
The previous day, I spent almost three hours in Bumrungrad Hospital, which is in one of the busiest areas of Bangkok — not as a patient, but as an observer curious about the globalized health care market.
The multistoried building is impressive even from the outside. Even the healthy options in the food court reflected the multinational customer base, with visitors and patients’ families invited to choose among varieties ranging from Lebanese to American foods.
And, yes, there is a Starbucks, too!
Bumrungrad is a hospital that offers as much as, or sometimes even more than, what some of the best hospitals in the United States have to offer, but for much lower fees. Its certification from the Joint Commission International speaks for the quality of medical professionals, technology and care.
In fact, it was the first hospital in Asia to have met the American standards for hospital accreditation.
The success of Bumrungrad, and the potential for an ever-expanding international health care market, has catalyzed the growth of a similar industry in India. According to one estimate, India treated about 450,000 foreign patients in 2007 alone. However, reliable data on precise numbers of medical tourists are hard to obtain for a number of reasons; for one, it is quite likely that a foreigner might not want to explicitly state that medical treatment is the reason for a visit, because of worries that the visa application will be denied.
Wockhardt Hospital and Apollo Hospitals, both with highly qualified staff and some of the latest technologies, are examples in India. Wockhardt has partnered with Harvard Medical International, while Apollo operates hospitals not only in India but even in Africa.
With six of its 43 hospitals having been accredited by Joint Commission, Apollo has the largest number of accredited facilities outside the United States. The male half of the Dubai couple remarked that his father prefers going to India because of better service and, interestingly enough, for the tastier foods.
An important aspect of medical tourism is not discussed much in America — the United States was the true pioneer for medical tourism. It used to attract patients from all over the world because of its dominance with the latest and sophisticated health care. But now, patients from Asia and Africa can choose from facilities such as Bumrungrad or Apollo, which compete to provide American-quality health care at lower prices — sometimes as low as one-third of American prices.
As with many other products and services, the rest of the world is racing to catch up with America. I am, therefore, less worried about a potential outflow of American patients to Thailand or India, but more concerned that America might have lost her groove.
Finally, medical tourism highlights a profound contradiction — quality health care is available for those who are able to afford it, irrespective of where they live, even as many millions lack access to basic health care. India’s Planning Commission notes that public expenditures are a very small fraction of the nation’s total health care expenditures.
In other words, health care is a highly privatized economic activity in India, where the number of poor exceeds the entire population of the United States. This highly privatized nature immediately implies that the poor, who cannot afford to spare a rupee, have practically no health care at all.
I suppose to a large extent, the health care problems in Thailand or India are no different from what we are struggling with in the United States — how to guarantee a minimum level of health coverage to citizens, while making sure that any such framework does not take away the incentives for further progress in the research, development, and provision of advanced health care. I hope that we in the United States can set a successful example for the rest of the world.
Appeared in print: Monday, Jul 6, 2009
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