The medical-tourism business took off more than four years ago, with Bangkok's Bum-rungrad Hospital among the pioneers, Kasikorn Research Centre (KResearch) said in a recent study.

Over the past years, the annual growth rate has averaged 14 per cent, said Dr Prapha Wongphaet, president of the Thai Private Hospitals Association.

While the tourism sector is happy to see business booming, critics have raised concerns over the potential negative consequences to the country's medical-care system.

For instance, more and more physicians will be drawn by higher financial rewards to work for private hospitals, especially those catering to foreign patients, leaving state or lower-end private hospitals understaffed.

"There will be a brain drain due to the fact that doctors treating foreigners will get more money than those treating Thais. Unless we have effective measures to manage this problem, there will soon be a shortage of doctors at hospitals serving only the locals," said Dr Damras Tresukosol of state-owned Siriraj Hospital.

"Don't forget that the cost of educating and training each Thai doctor is very high and it's all financed by taxpayers' money," he said.

Prapha's perspective is rather different.

"The type of service that we provide for foreign patients and tourists is not exactly the same type of service for the majority of Thais because the former is more costly. So they're different groups of patients," she said.

"As it is, only 33 of the 218 private hospitals grouped under our association target foreigners. The rest are still serving Thais as usual."

Medical tourism is unlikely to hurt the national healthcare system since most Thais, 47.5 million, are covered by the Bt30-per-visit universal healthcare programme, she said.

Of the others, 8.5 million rely on the social-security system, while 4.2 million are covered by the government's own funds.

"In this sense, private hospitals target Thais who are willing to pay more for better service," Prapha said.

However, Saree Ongsomwand, president of the Consumer Foundation, said the number of doctors compared to the entire population was not high, maybe even lower than the world standard.

"In other words, the number of doctors is already insufficient. As a result, I don't think the 'go-for-foreigners' trend can fail to have an effect on the quality of our medical services."

Siriraj's Damras said specialists or physicians experienced in several areas of medicine were already in short supply while private hospitals serving foreigners needed a lot of these experts to entice patients from overseas.

Norachai Luekulwattanachai, a researcher at KResearch who is familiar with the medical-tourism sector, said many specialists were now compelled to work at least two jobs.

"Many work full time at a state hospital and part time at a private hospital."

According to KResearch, the medical-tourism sector covers expatriates in Thailand and neighbouring countries, as well as tourists who spend part of their trip here on an annual medical check-up and foreigners who fly in specifically for medical treatment.

Prapha said the attraction was lower prices and Thai hospitality. For the same service and standards, hospitals here are an eighth cheaper than those in the US and one-third cheaper than those in other Asian countries.

Chatree Duangnet, CEO of Bangkok Hospital, said the difficulty and unwillingness to travel to Western countries due to the global war on terrorism is another reason for many, especially those in the Middle East, to come here for medical services.

"In the past our customers were mainly Japanese; now Middle Eastern patients are dominant. Our better infrastructure and service is the main appeal for them. We also provide activities for their relatives like spas and traditional massage, tour programmes, transportation and a hotel in front of our hospital."

Over the past few months, foreign patients at his hospital have doubled in number while Thais have risen only 10 per cent, Chatree said.

John Lee Ko Seow, CEO of Samitivej Sukhumvit Hospital, said foreign patients kept coming and he aimed to raise their proportion from 37 per cent now to 40 per cent of total patients by year-end.

Curtis Schroeder, CEO of Bumrungrad International, said that each day his hospital treated 120 foreign patients on average, making up 60 per cent of all patients.

Against the impressive growth of this business, KResearch warns of three risks and challenges: increasing competition at both domestic and international levels, rising costs from hikes in loan interest rates and electricity charges, and diminishing reserves of doctors and other personnel.

Saree of the Consumer Foundation said the government had to come up with measures to manage the brain drain in medicine if medical tourism was to continue.

Kamol Sukin,

Sopaporn Kurz

The Nation