Clean, Not Sterile: Patients come to Bumrungrad and Bangkok Hospital for the surgery -- but stay for the espresso. | photograph by Steve Bronstein
Not a Hotel: The main lobby at Bumrungrad offers up a global cross section of humanity. Your recovery suite awaits. | photogragh by Tony Law
"This doesn't look like a hospital," says Ruben Toral, showing me around. "It feels more like a hotel or an upscale mall." After studying the gleaming lobby of Bumrungrad International for a minute or two, I'm inclined to agree. Americans in shorts recline across from Arab couples in flowing white dishdashas and black abayas, the latter accessorized with designer handbags and sunglasses. We're in Bangkok in August, when even the asphalt is overripe and malodorous, but the only scent inside is a faint whiff of espresso from the Starbucks in the corner.
Toral is responsible for luring that cosmopolitan clientele here, thousands of miles from home, for a knee replacement or a triple bypass or even just a checkup. Before he arrived in 2001 as Bumrungrad's marketing director, "we were a Thai hospital serving a Thai community," he says. "Now we're an international hospital that just happens to be in Thailand."
Toral himself just happens to be a dead ringer for George Clooney, and he tells his story in similarly seductive tones. He's still amazed, seven years later, that folks who have never set foot on a plane, let alone owned a passport, will log a 24-hour flight -- in coach! -- to put themselves in the care of a hospital whose name they can't even pronounce. Overseas patients have more than doubled on his watch, to 430,000 in 2006, generating the majority of the privately owned hospital's revenue. "It's the high-school-cafeteria person," Toral says. "The independent businessman, the doctor, the lawyer. They tell me, 'We did the math. We can't afford to pay $1,200 for insurance every month.' "
The phrase "medical tourism" was once used to describe early retirees jetting in to Bangkok or Bangalore to have a little work done before recuperating on the beach. That image doesn't jibe with the numbers today. As many as half a million Americans streamed abroad last year in search of affordable alternatives for hip replacements or prostate surgery. And they went not for the postsurgical tanning but for the savings: up to 90% off the going rates in the United States. They went because 47 million Americans lack insurance and can't pay for surgery to fix a bad back or clogged arteries. Or because they have insurance but can't begin to pay the soaring deductibles a major surgery entails. They're fleeing a system that is by far the most expensive in the world and growing more so by the hour, with diminishing returns in quality of care.
"Your options are paying $50,000 to $60,000 in the States or coming here and paying $8,000," says Toral, an American raised in North Carolina. "That's the difference between putting it on your credit card or going into bankruptcy."
A journey to Bumrungrad is hardly a descent into some third-world medical hell. It was arguably a world-class hospital even before it became a world-famous one (thanks in large part to a 60 Minutes segment in 2005 orchestrated by Toral). Administrators have spent the past 15 years acquiring state-of-the-art technology, adding beds, and wooing Thai doctors abroad to come home. Bumrungrad replaced its paper records seven years ago with a homegrown, all-digital system, an upgrade U.S. hospitals have struggled with for years, despite the assistance of giants like Cerner, Siemens, and General Electric. (Replacing prescription pads with tablet PCs is harder than you'd think, which might explain why last year Microsoft bought the company that designed Bumrungrad's software. Toral now works for Bumrungrad in an advisory role; he has struck out on his own with MedNet Asia, a software startup helping insurers handle paperwork.)
The hospital's outpatient clinic is more stylish than the bar at my five-star hotel. Instead of waitresses, some two dozen nurses tend to a polyglot mix of patients. Arrivals from Asia or the Middle East have separate floors to make them feel at home. There's an in-house travel agency offering visa extensions in case they suddenly need to stay. Modernizing late offered Bumrungrad a chance to leapfrog the competition and build the world's first truly global hospital.
But the Arabs sprawled across its lobby aren't oil sheikhs awaiting VIP treatment. They're humble civil servants, shipped in bulk from Riyadh and Dubai because Toral cut a deal with their governments to outsource their care to Bumrungrad. Medical tourism, Toral explains, is only the beginning. The next step is globalized medicine, in which millions of fully insured patients here in the United States are connected to hospitals in Bangkok, Singapore, and India. The patients will belong to Blue Cross Blue Shield, UnitedHealth Group, and maybe even your insurer. If Toral has his way, Bumrungrad's next heart- or knee- or brain-surgery patient will be you.
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Recent Comments | 30 Total
April 18, 2008 at 12:13am by Healthbase Medical Tourism
Medical tourism is a rapidly growing industry and is here to stay until our domestic health care system is fixed and for as long as there is affordable care avaialble overseas which beats the US in quality. For more information about the process of medical tourism and to meet medical tourists, check out http://www.healthbase.com.
April 18, 2008 at 10:26am by Dirk Nuehouse
I used a company called PlanetHospital to help our 48 employees get affordable care and for the first time we did not see increased premiums in our healthcare costs. I am surprised they were not mentioned in this article.
April 19, 2008 at 12:14pm by Jeff Schult
I'm going to have to ask Ruben about the comparison to George Clooney -- he may never live that down! ;-)
Jeff Schult
Author, Beauty from Afar, the medical tourism book ...
April 25, 2008 at 3:25pm by Gabriel Biller
I am a graduate design student who worked last year on a project about this very topic:
http://www.gabrielbiller.com/pdfs/SPW_Expedia_Report_final.pdf.
As the son of a physician, I am certainly concerned about the idea of medical care being treated like any other manufactured product or service, but the reality is that we live in a flatter world than ever before, and our American system is screwed up. Administrative costs are out of control, and healthy competition is good for the end-users: the patients. We do have to face the facts that other people in the world can do things as well as or better than we can. And that medical care needs to be viewed as a larger system/experience of providing care and assistance to patients (not only in the hospital).
I would have liked to have seen some more details about WHY our costs are so high, which I understand to be the administrative costs (stupid insurance companies and hospitals and way too much paperwork and manpower devoted to pencil-pushing in order to avoid covering expenses) as well as a highly-litigious environment where doctors and hospitals have to protect themselves from lawsuits. I'm not saying that doctors don't ever make mistakes, but the reality is that nothing in life is guaranteed, so when people abuse their bodies and expect a doctor to make a quick fix but it doesn't work, something needs to be done about this mindset of Americans that they are entitled to 100% satisfied outcomes.
Does the author have anything to add about the legal rights of patients of globalized health care? Isn't it the case that those rights are much more limited than within the U.S.? Also, physicians make less money overseas, in general, than in the U.S. Does this mean a different quality of life for practitioners of this profession? Less respect?
April 29, 2008 at 1:03pm by jonathan edelheit
Anyone researching medical tourism should start with the Medical Tourism Association, which is the international non-profit association for the medical tourism industry. They also have an annual convention in San Francisco, September 9-12th of each year. www.medicaltravelauthority.com
May 4, 2008 at 1:48am by Carlos Perez
My sister needed dental work that would have cost her about $3000 (after insurance)in the U.S. She had visited several dentists in the U.S. and none could treat her problem (she needed extensive root canal, cap, etc) She contacted "New Medical Horizons" in NYC and they arranged her treatment in India which only cost $250. She said she didnt see any difference between her dental care in the U.S. and India (same knowledgeable dentist, same medical requipments, same dental procedures, etc).
In fact, she said that the dentist she visited in India was more concerned about about fixing her problem whereas in the states, the dentist(s) were more focused on immediate patch up treatments (maybe because they were trying to stay within the insurance budgets) that eventually left her in continued pain. Anyway, she is back and now pain free. Her dental work went smoothly and the dentist still personally emails her to make sure she is fine.
May 4, 2008 at 1:50am by Carlos Perez
My sister needed dental work that would have cost her about $3000 (after insurance)in the U.S. She had visited several dentists in the U.S. and none could treat her problem (she needed extensive root canal, cap, etc) She contacted "New Medical Horizons" in NYC and they arranged her treatment in India which only cost $250. She said she didnt see any difference between her dental care in the U.S. and India (same knowledgeable dentist, same medical requipments, same dental procedures, etc).
In fact, she said that the dentist she visited in India was more concerned about about fixing her problem whereas in the states, the dentist(s) were more focused on immediate patch up treatments (maybe because they were trying to stay within the insurance budgets) that eventually left her in continued pain. Anyway, she is back and now pain free. Her dental work went smoothly and the dentist still personally emails her to make sure she is fine.
May 6, 2008 at 11:56am by Robbie Neely
Two other reasons this trend is growing is 1) to avoid waiting lists, especially in Canada; and 2) to get access to procedures not commonly practiced in at home. Take the case of Kevin Stewart. He had a live liver transplant in India last August, facilitated by www.WorldMedAssist.com. He not only would have had to pay $350,000 in the U.S. but worse, he was in a waiting line for a liver from a deceased person that was longer than his life expectancy without a transplant. His sister donated a lobe of her liver to save Kevin Stewart's life. Listen to his story: http://www.worldmedassist.com/liver-transplant-India-video.htm.
An example of a procedure done more commonly overseas than in the US is hip resurfacing, a less radical alternative to hip replacement. This procedure was approved in the US only in 2006, so the track record of US doctors is nowhere near what it is in places like Belgium and India.
May 16, 2008 at 2:47am by John Hughes
In a globalized world, shopping for health care is an inevitability, and if travelling abroad for treatment should prove the best option, it becomes a natural consequence. As the article points out, perceptions on hospital care differ in different parts of the world and face value can sometimes prevail over medical standards. It’s important to do thorough research and a number of sites exist that can help:
www.discoverythailand.com/medical
www.travelfish.org/feature/63
www.tourismthailand.org/activities/general_information
www.medical-tourism-in-thailand.com/
www.en.wikipedia.org/wiki/Medical_tourism
May 26, 2008 at 12:58pm by Carter Newton
Terrific article and good comments. I am a cardiologist totally grossed out by the cost of medical services and pharmaceuticals and yet aware of how reduction of financial incentives leads to disinterested providers who will do poor work. So I don't support universal healthcare. But, here we have something of a free market in healthcare services. The idea of affordable fee for service, I had given up on the concept. But the more I think about it I would even think of working in an outsourced system: where the hospital and is a friend and not a foe and where a malpractice a ttourney is not lurking behind every bush.
May 27, 2008 at 9:47am by Scott Mills
I would like to have seen a sidebar on international legal remedies for medical procedures that do not go well for these medical tourists. If any of these people had an unfortunate result do they have the same legal avenues of restitution/retribution that are available in America?
It seems that we often hear the success stories of international medicine - what about the failures that require some legal remedy? And what is the legal exposure of employers who register employees for medical care that includes offshore major medical procedures offshore?
Americans need to understand that every medical procedure in America carries an inherent premium for potential legal involvement. Without this built-in premium our health care would cost noticeably less money. As we debate health care reform it is imperative that everyone recognize that healthcare reform also means tort reform.
June 5, 2008 at 1:38pm by Tim Tymchyshyn
it is strange on how our medical systems can't do anything without costing a fortune. maybe we are pricing ourselves out of the game instead of playing the game
August 28, 2008 at 6:02pm by Michelle Smith
Medical tourism has a bright future. with 45 million Americans uninsured, there does not see any other solution. www.MedicalTourismCo.com is one company that is addressing this growing oversear medical travel demand.
April 20, 2009 at 4:43pm by Michael Dunage
As more individuals become unemployed, the cost of Healthcare has remained very much the same. We speak to people everyday that tell us how they have been referred or told about the option of medical travel abroad to save a chunk of money. We facilitate the medical travel to and from the U.S. Canada as well as the UK. For more information about medical travel abroad for specific health concerns, please visit us at http://www.medpathgroup.com
July 13, 2009 at 3:41pm by Ken Fyre
Countries like Malaysia, South Africa, India and others are taking the lead in medical tourism, equipped with 5-star hotel treatment for recovery rooms, not to add that medical procedures could be a third of the cost of similar procedures in the U.S.
Health Classifieds | Local Doctor Reviews and Ratings
August 11, 2009 at 4:29am by Quincy Q
John Hughes, one of Hollywood's most successful directors and screen writers, whose movies during the 1980s helped to define that era and became cultural touchstones, has died at age 59. Hughes, who directed the "The Breakfast Club;" "Ferris Bueller's Day Off;" "Sixteen Candles", and "Planes, Trains and Automobiles," died of a heart attack during a walk while he visited family in Manhattan, according to reports.
September 4, 2009 at 12:27am by FMT Taiwan
At Formosa Medical Travel, we offer Americans the opportunity to receive a knee or hip replacement in Taiwan at a fraction of the price in the United States. While Thailand and Bumrungrad hospital have blazed a trail in the medical travel industry over the last few years, Taiwan is ready to enter the market as a viable option for medical tourists.
More medical tourism links:
Knee replacement cost | Knee replacement alternatives | Knee replacement India
September 16, 2009 at 7:37am by FMT Taiwan
It's unfortunate that medical tourism has been left out of the US Healthcare Reform debate. There are a number of intelligent people out there that believe little is being done to reduce the inherent costs in our system that make overseas care so attractive.
September 28, 2009 at 1:26am by Medical Tourism Companies
There are now a number of medical tourism companies that offer healthcare packages to many destinations around the world. Many of these companies don't charge any additional fees to the patient - instead, they take a commission percentage from the hospital. For patients looking to pursue medical travel, it is worth researching these "facilitation" companies.
September 30, 2009 at 10:16am by Pat Jewett
That fact that this is taking off speaks volumes. How can we not recognize that there is a problem with the US Health Care system if people are flocking overseas for treatment. As Medical insurance coverage gets debated in Washington, we need to let Congress know how we feel.