En route recently to Nepal for a medical mission, I stopped in Bangkok and had an opportunity to view Bumrungrad International Hospital, long known as a first mover and market leader in medical tourism. Strengths and weaknesses surrounding Bumrungrad’s proven model highlight changing sands and fresh opportunities for health and wellness tourism in Hawaii.
Bumrungrad, a 580-bed hospital founded in 1980, is a state-of-the-art facility by any modern standard. It is conveniently located in the middle of Thailand’s largest city with ready access by a quality mass transit system. Unfortunately, the city, like so many in Asia, is shrouded in thick smog, and the three-block walk to the hospital is like a gauntlet through congested traffic and strong, foul smells of fresh sewage.
The hospital, broadly known to Western expats, is well built and attractively designed. The lobby has the appearance of a quality hotel, and concierge care is the standard. It is a full-service facility with an emergency department, inpatient services and outpatient offices. It offers comprehensive diagnostic equipment and a broad range of specialist and subspecialist services. There is one floor entirely dedicated to executive-type comprehensive physical exams. The physicians, many of whom have trained at Western institutions, have excellent training. Services are extremely well coordinated, and the English-speaking staff has a compassionate sense of service for which the Thais are so well known.
Every year my health care group, Manakai, sees two or three patients who have had emergency services or elective surgery at Bumrungrad. Feedback has been uniformly complimentary, and copies of electronic medical records reflect excellent clinical judgment and comprehensive care.
Obviously, the hospital is frequented by Western expats living in Thailand and other parts of Southeast Asia. It also sees many uninsured Americans who come to pay cash, although Obamacare may be beginning to temper this demographic. However, comparable cash prices for the uninsured at a private American institution would be roughly threefold what one would pay at Bumrungrad. There is also a large patient base from other modern Western countries where the majority receive their care from a national health service. Although they may be fully insured in their own countries, the wait for a total joint replacement or elective cardiac bypass surgery can be unacceptably long and the cash price at home too high.
The largest demographic, though, appears to be the wealthy elite from developing countries, particularly in the Middle East, where wealth disparities are great and sophisticated health infrastructure is not readily accessible even for those who can pay for it.
While Bumrungrad is set up for emergency and acute care, as well as chronic disease, services are heavily weighted toward comprehensive physicals and elective surgery. High-volume procedures include cataracts, cardiac bypass surgery and total joint replacements.
While Bumrungrad remains a leader in this niche area of health care, competition is mounting. Malaysia, India and South Korea all offer facilities meant to pick up much of the same patient population. Unfortunately, many competitive sites are also compromised by severe environmental pollution, infrastructure challenges and/or government instability.
The most senior U.S. envoy for Asia, Daniel Russell, just met with Gen. Prayuth Chan-ocha, leader of the Thai junta, who has been running the country since May. Russell conveyed concerns that the recent impeachment and criminal indictment of the democratically elected Yingluck Shinawatra appeared politically motivated.
In recent years, evolving conditions in Asia have given Hawaii a more formidable opportunity to be successful at health and wellness tourism. Certainly, a clean, beautiful and safe physical environment is harder to come by. Hawaii’s sand and surf combined with stable government and the rule of law are increasingly precious and sought after. In comparison with other engines of the global economy, the U.S. boasts great strength and strong prospects for the intermediate term. Finally, after decades of high growth year on year, particularly in much of Asia, there are unprecedented numbers of people with resources to spend on quality health care.
Social networking and information technology make it easier to showcase a new, strong brand or distinct refinements of an existing one. It is also less resource-intensive to target — through information technology — specific segments of the global health tourism sector. Hawaii does not need to be all things health care to all people. It would be unwise to try to replicate the array of services at Bumrungrad or, for that matter, those at the Mayo Clinic (at a higher price). The way forward for Hawaii is to begin with selected, targeted medical tourism services, integrate them with the existing brand that is Hawaii, and strive for impeccable quality of care and service.
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Dr. Zunin is away on a medical mission in Asia until the end of February. The clinic remains open and continues to offer full services.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
