Thailand is in danger of losing its crown as the world's top destination for medical tourism if foreigners looking for low-cost, quality healthcare are scared off by political unrest, especially at a time of growing competition from Asian rivals.
The army seized power in a coup on Thursday after failing to prod bitter political rivals into a compromise to end six months of turmoil, prompting several governments to warn their citizens to think again before travelling to Thailand.
Tourism accounts for 10 percent of the Thai economy and, of the 26.5 million people who visited last year, about 2.5 million came for medical reasons, including spa and healthcare services, according to figures from the Department of Export Promotion.
About a third of those medical tourists come from the Middle East, another quarter from Southeast Asia and nearly 15 percent from Europe.
The months of unrest, which began with anti-government protests in Bangkok in November, already appear to be having some effect, and that could worsen if the army's intervention fails to put a stop to outbreaks of disorder.
Top-end Bangkok hospital Bumrungrad attracts a lot of patients from the Middle East and competes with SG Raffles Medical Group and Healthway Medical Corp in Singapore. It saw a 12 percent drop in foreign inpatients in the first quarter and an 18 percent fall in outpatients.
"News of violence that leads to adverse travel advisories or perceptions of personal safety risks can cause some medical tourists to postpone their trips for treatment, hoping that conditions will soon improve," Kenneth Mays, senior director at Bumrungrad, said in an email to Reuters before the coup.
Thailand earned $4.31 billion in revenue from medical tourism in 2013, after average growth of 15 percent a year over the past decade.
That is clearly in danger, with arrivals at Bangkok's international airport down 15 percent in the first quarter.
Although travel to the country's beaches and islands was holding up before the coup - as, indeed, it did after the army last seized power in 2006 - the Department of Tourism said the overall number of visitors still dropped 4.9 percent in the first four months of the year.
Days before the military stepped in, the Tourism Authority of Thailand cut its forecast for foreign arrivals this year to 26.3 million, which would be a five-year low, from 28 million.
"Hospitals in Bangkok are particularly hard hit, as that's the epicentre of the unrest, while those in Phuket and other destinations are reporting downturns of 20-40 percent," said Josef Woodman, CEO of Patients Beyond Borders, a U.S.-based website that offers consumers information about medical travel.
It estimates Thailand, with health costs 50-75 percent lower than the United States, for example, attracted 1.3-1.8 million medical tourists in 2013, making it the world's top destination.
JUST A HICCUP
Earnings at Bangkok Dusit Medical Services Pcl, the country's largest hospital group, held up in the first quarter but Chatree Duangnet, chief operating officer, is worried about what he described as "a small hiccup in the short term".
Bangkok Dusit has seen a drop of more than 30 percent in patients from the Middle East this year and 7 percent fewer patients from the United States, although it has welcomed 10 percent more from Japan and 3.8 percent more from neighbouring Myanmar, where healthcare is underdeveloped.
Renee-Marie Stephano, president of the U.S.-based Medical Tourism Association, said inquiries about travel to Thailand for medical purposes had fallen 20 percent in recent months.
If trouble persists, Thailand risks losing market share to countries such as Malaysia, the Philippines and India.
The Philippines and South Korea are already seeing more medical tourists from China, Russia and the Middle East in particular.
Kim Kyung-joo of South Korea Tourism Organisation's Medical Tourism Department said it may benefit from Thailand's instability, noting that many Chinese tourists came for plastic surgery such as facelifts and nose jobs.
Kim Hee-jeong of Korea Health Industry Development Institute, said more Russians were coming. "Russian patients go on medical tours for treatment rather than sightseeing. Mongolian patients are the same."
SPIKE IN MANILA
Manila also thinks it is winning custom from Bangkok.
"There is a spike in surgery for orthopaedics because of what's happening in Thailand," Phlippine Tourism Secretary Ramon Jimenez told Reuters, adding the travellers included Filipino-Americans coming home.
Manila wants to promote niche markets in orthopaedics, eye surgery, dentistry and cancer care, Jimenez said.
In Malaysia, government promotion of the country as a medical destination has helped the number of health tourists to double since 2010 to 770,134 last year, official figures showed.
The Kuala Lumpur Sports Medicine Center has seen an increase in foreign patients in the past four months but Eric Woo, its chief operating officer, played down the impact of Thailand's unrest, attributing it rather to promotions and good treatment.
Healthcare Berhad, one of Malaysia's largest private healthcare providers, said it had been "aggressively promoting" its services in the Middle East.
Singapore, with some of the best diagnostics and care in the world, is also a threat to Thailand, said Woodman at Patients Beyond Borders, even if costs have risen for some years.
Mays said Bumrungrad had seen some rebound in April and May - prior to the coup - and, in the longer term, especially with Southeast Asia moving to closer economic union, most operators in Thailand remain upbeat.
"The world's ageing population, combined with the inadequate or troubled health systems in many countries, will continue to drive medical travel. Our sources of growth will change as the geography of demand and supply evolves," Mays said.