Thailand and Medical Tourism

I just got back from several weeks of vacation in Thailand, the homeland of my parents, also where my brother lives and works. See the family, tour the countryside, a temple here, beaches there, easy smiles and many drinks with pink umbrellas. Overall, a wonderful trip. Much has changed about this Third World country since I was a child.

Bangkok is filled with state-of-the-art shopping centers, high tech freeways, savvy urban dwellers and an ultramodern, brand spanking new airport. In some ways, the whole place was almost MORE modern than where I live in the US. The people so forward looking, so tech-focused.

Another thing caught my eye as I appreciated how far Thailand has come from its poverty of the last century. ALL OF THE SUPER-NEW HOSPITALS EVERYWHERE...

I asked my brother, "what's going on with all of these mega-hospitals?" He answered, "medical tourism". Thailand, like India, has become a destination for medical tourism from around the world. Many of the physicians, like my father, are US trained, having come to America during the Vietnam War. Now, fully trained, many have returned to a booming Thailand to work in the private, for-profit hospitals. These are opportunities that didn't exist when they were growing up.

Thailand is extremely friendly to tourism and foreigners. It is stable politically, or at least, it has been until this past year or so (with some ethnic/religious tension in the South). And, while parts are developed, it is still Third World by many standards and remains quite inexpensive in Western eyes (and pocketbooks).

So, you have had an explosion in the development of for-profit healthcare, that caters to the West. Indeed, 60 Minutes, the American news show, did a profile on medical tourism and cited Bumrungrad Hospital, a prominent private hospital in Bangkok. Some insurers on the West Coast of the US will pay for patients to go to Thailand rather than get care in the US. A total knee replacement or a coronary bypass procedure are probably a third as expensive in these countries as they are in the US. Indeed, my sister-in-law's father had his bypass done in Bangkok by a Thai surgeon who had spent decades at the Cleveland Clinic in Ohio.

So, is anything wrong with this? It's cheap for the US people. It redistributes wealth to a poorer country like Thailand. The care is good. I'm not sure how I feel about this.

One problem in my mind is that this takes something that is already a problem in the US and transplants it to another country. Namely, the proliferation of highly expensive, boutique medical care at the expense of preventive care. Also, it provides yet another service for the wealthy and insured at the expense of the indigent and unconnected. As hospitals in Thailand and/or India make a dash for the dollars and euros from Western countries, as they tailor their services to meet the needs of the more lucrative foreign market, what is to happen to their own people, the majority of whom are quite poor and lack basic medical care?

Indeed, funding for HIV prevention and other basic health services in Thailand have been recently cut, even as these for-profit skin centers and plastic surgery units have proliferated.

One of the major problems with the US health care system, as I've delineated elsewhere, is the stratification of health care based on wealth and insurance status. Some people get gold-plated, very expensive, often unnecessary health care, while others get nothing. Both get care that is focused on end complications, rather than preventive medicine. It is simply more lucrative and sexy to "treat" disease than prevent it.

I hope that this medical tourism will be a passing fad. It is just a symptom of the greater pathology within the American medical system. It threatens the viability of the health care delivery system in Thailand and other Third World nations.

It's one export from the US that the world can do without.