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
And if all this sounds a bit outlandish, brace yourself: The big insurers are already looking into it. "Once they understand the ramifications of this, you'll see the larger players start crafting policies that allow people to receive treatment overseas," Ori Karev, CEO of UnitedHealth International, the global arm of the UnitedHealth insurance conglomerate, told me. "I think you'll find most of us exploring this. We are a business at the end of the day."
Toral is an outsider twice over. Not only is he a foreigner in a Thai hospital, but he's neither doctor, operator, nor administrator. That may explain his near-total lack of empathy for the panic or anger those professionals would feel upon hearing his chilling vision of their future.
He only came to medicine after a stint consulting with Duke University's Center for Living, arriving in Thailand 15 years ago to set up "health and wellness" retirement villages for Westerners. That may explain his idea of health as a lifestyle choice, as opposed to a total war against death and disease. Health care, in his mind, is not necessarily a social compact or a universal right, but a quality product to be packaged and sold at a sensible price; he assumes patients are much savvier consumers than their doctors give them credit for.
Annual health-care spending in the United States has topped $2 trillion -- about half from private sources, half from public coffers -- to comprise a staggering 15% of GDP. That's almost double the average of other developed countries (9%) and more than half of global spending overall. That figure will only keep climbing, perhaps exponentially, as 80 million baby boomers, the so-called silver tsunami, begin to reach old age over the next 25 years. Their needs alone could keep every doctor from Boston to Bangalore gainfully employed for half a century, and a shocking percentage lacks insurance (or any real guarantee that Medicare will still be around when they reach qualifying age). As Toral puts it, a little indelicately: "God forbid you have a family of four, earning $50,000 a year. You are fucked."
Some economists have hailed our extreme health-care spending as the central pillar of a postglobalization economy built around services. In their view, hospitals and their support systems of doctors, administrators, and insurers have been, and will continue to be, the greatest creators of domestic jobs this century -- nearly 2 million so far -- especially in the Rust Belt and other areas hit hard by manufacturing's migrations. Yet when McKinsey consultants dug into health-care costs last year, a research team concluded there were no real incentives for either hospitals or consumers to think hard about the ultimate price of treatment. Even adjusting for our higher per capita incomes, we're still overpaying by $477 billion a year, McKinsey concluded. At the same time, the United States ranks just 37th in the World Health Organization's list of the world's best health systems -- behind such medical hubs as Singapore and Costa Rica, and only 10 spots ahead of Thailand.
For someone such as Toral, the hypertrophied medical-industrial complex is just begging for a dose of disruptive innovation. He calls his vision the "Toyota-ization of health care," a metaphor so vast that it contains multiple readings, some fit for industry conferences and others he'll cop to only in confidence. In Toral's view, medical tourism as we know it is already giving way to "globalized health care." Hospital chains at home will buy, partner with, or even sell out to foreign rivals like Bumrungrad, creating worldwide networks of patients who will hopscotch across continents chasing the best care and costs. Insurers will leap at the chance to lower their own bills and offer members more options. And employers, dying to do the same, will induce employees to play ball by kicking back a share of the savings.
We'll learn to love surgery overseas, Toral insists, just as we came to prefer Toyota Camrys to Chevys. Nevermind that globalization of the auto industry gutted Detroit; it gave us cheaper, safer cars and helped lift Japan and South Korea into the ranks of first-world nations. Toral believes globalization will do the same for our health care (and quite possibly for India and Thailand). "Medicine has always been so locally driven that it can't think out of the box and ask, How does this globalize?" he complains while we watch translators, collectively fluent in two dozen languages, admit patients into Bumrungrad. "What it's looking at right now is the beginning of the beginning, which is individuals who are franchised, voting with their feet and heading out of the country."
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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.