Accidental Tourist: Visiting the Bumrungrad Hospital in Bangkok

There’s been a lot of recent speculation that more Americans will be taking their elective medical problems overseas. In 2008, Deloitte’s Center for Health Solutions estimated that 750 thousand Americans travelled overseas for medical care in 2007, and forecast a eight-fold increase by 2010 In a 2009 update, Deloitte found that the 2008 financial crisis devastated overseas medical travel, but still forecast 1.6 million US citizens going abroad for medical care in 2012.

Among overseas medical destinations, no facility is mentioned more than Bumrungrad (last syllable rhymes with “hot”) Hospital. Bumrungrad is a privately owned but publicly traded 550 bed acute care hospital in central Bangkok. On a recent trip to Thailand, I stopped at Bumrungrad to find out what all the shouting was about and was really impressed with what I saw.

Bumrungrad’s CEO is a courtly, silver-haired Virginian named Mack Banner, who spent most of his career in the US investor-owned sector. Though the hospital was founded in 1980, it moved into its new facility in 1997, just in time for the Asian financial crisis. The facility was Joint Commission (International) certified in 2002, and one fifth of its physicians are US Board certified in their respective specialties.

In 2008, the hospital opened a beautiful 21 story Clinic building next door, housing 30 specialty clinics and most of its medical staff. Bumrungrad’s Clinic Facility is Mayo-esque, enabling patients with particular specialty problems to be worked up, evaluated and cared for on a single floor. The hospital subsequently renovated its inpatient rooms, which resemble those of the Asian-themed Washington DC Park Hyatt in elegance. The hospital is a sunny, happy place, with apparent high morale and very high service standards. English is spoken widely throughout the hospital.

Bumrungrad’s physicians are independent of the hospital economically, though the hospital provides billing and other clinical support for its medical staff as if they were a group practice. Bumrungrad’s home grown electronic medical record system was impressive enough to be purchased by Microsoft, and it became the core of their Amalga product.

According to Banner, Bumrungrad sees one million patient encounters in a given year (which include inpatient admissions, outpatient clinic visits and diagnostic tests). Perhaps not surprisingly, given that it’s on the other side of the world, only about 5% of those patient encounters are Americans, divided roughly 50-50 between the American expatriate community in Thailand and near Asia and American tourists in Asia.

Most of the latter group of Americans Banner referred to as “accidental tourists” who encountered a medical problem while traveling and ended up at Bumrungrad for their medical care. He put the number of American patients who travelled to his facility for elective care at “a couple thousand” in a given year, hardly a flood, but understandable given the lack of non-stop air service from the US. American patients are outnumbered two to one by patients from the Middle East, whose numbers have grown ten-fold in the past decade.

Fully 71% of Bumrungrad’s patients pay cash for their services, and the hospital defines its trade area as a six-hour flight circle around Bangkok. So Tokyo, Beijing, Shanghai, Taipei, Manila, Seoul, Kuala Lumpur, Singapore, Sydney, Nairobi, Mumbai, Dehli and the United Arab Emirates all fall inside the circle. The hospital maintains sales liaison offices in seventeen cities inside the circle that connect to the business and diplomatic communities in those cities. One of the most active of those offices is in Mongolia!

However, Bumrungrad is also a significant urban hospital serving central Bangkok. It operates an emergency room, a neonatal ICU and has extensive urban hospital service lines and obligations. Its physicians do medical outreach to long suffering Burma, next door, and its Medical Foundation funds care for indigent patients in Thailand.

Package prices for medical care at Bumrungrad are remarkable by American standards. A total joint replacement (hip or knee), including diagnostic tests, all physician fees and hospital care, can be done at Bumrungrad for around $16 thousand. US and coronary bypass graft surgery for a little over $30 thousand. Low Thai pay scales certainly help make the care affordable. Veteran ICU nurses at Bumrungrad make about $2500 a month US, plus health insurance, while starting nurse salaries approximate $800 a month.

Complication rates and infection rates are lower than or equal to those in comparable US and international health facilities. The hospital maintains a Cost Estimator on its website enabling interested patients to see the range of charges for recent patients with 46 different clinical problems.

Bumrungrad’s medical staff is virtually 100% Thai national. The father of Thailand’s King Bhumibol Adulyadej was a physician who trained at Harvard. (The present King of Thailand was actually born at the Mt. Auburn Hospital in Massaschusetts.) For this reason, Thai culture highly values medical training. One gets the impression that the Thai medical community is virtually 100% self-sufficient, though it maintains proud linkages to international training venues.

Thai medical education standards are very high, and a significant number of Thai medical graduates do their fellowship training in Britain and the US. But rather than seeking employment in the British National Health Service or entering practice in the United States as their elders did, an increasing number are returning to practice in Thailand.

Bumrungrad is seeing increased domestic competition for international travelers from the massive Siriraj Hospital, a principal teaching facility of the Mahidol University (named after the King’s father) whose formidable campus looms over the West Bank of the Chao Phraya River. Many of Bumrungrad’s physicians trained at Siriraj. Siriraj cares for the Thai royal family, and recently built a shiny new 345 bed private pavilion for its medical faculty.

Banner acknowledged that competition for the international medical tourist is also heating up. A decade ago, their main Asian competition was the Mt. Elizabeth Hospital in Singapore. But Duke, Johns Hopkins, Cornell and Cleveland Clinic are opening projects in China, Qatar and the United Arab Emirates that will enable middle Eastern and Chinese patients to receive state of the art private care in locations closer to their homes.

While it is not reasonable to expect massive numbers of Americans to travel half-way around the world to Thailand, Bumrungrad made an impressive case that world medical standards have caught up to America’s. While the US continues to supply much of the rest of the world with biomedical research and clinical innovation, it’s not obvious why citizens of the Pacific Rim or central Asia need travel to America for world-class health care. It’s available to them in their own back yard.

Note: Author received no consideration for his visit or writing this posting. Bumrungrad’s management graciously endured his visit.

Originally published on The Health Care Blog.