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Over The Sea, Then Under The Knife


Shaun Reese's bad knee had been nagging him for months. He had torn a ligament a couple of years earlier that never healed properly, and the pain was getting worse. But the 48-year-old building contractor from Wyoming didn't have health insurance, so he kept putting off dealing with the problem. Then a friend suggested he fly to Thailand for some sun -- and a spot of surgery on the side.

After some investigation, Reese took the advice, and in January he hopped a plane for Bangkok's Bumrungrad Hospital, where he had arthroscopic knee surgery. Total cost: $5,000 -- half for the surgery and the rest for airfare and three weeks recuperation on the beach. Back home, he would have paid $6,500 for the operation alone. In Thailand, he says, "the people are supernice, and the facilities are nice and clean and convenient." So nice, clean, and convenient, in fact, that Reese says he may return next year for a hip replacement.

Welshman Cyril Parry's problem wasn't the cost of surgery. He had coverage from Britain's National Health Service but had been waiting more than four years for a hip replacement. As his pain increased, he decided to take matters into his own hands. Online, he found the Web site of the Apollo Hospital in Madras, India, and discovered that a doctor there had worked with a pioneer of hip-replacement surgery in Britain. "His credentials were impeccable," Parry says. Although his family thought he was daft, 59-year-old Parry flew to Madras in November and had the operation. Less than two weeks later, he was home. Total cost: $8,300, which he paid out of pocket. He is thrilled with the results. "I could not have gone anywhere better," says Parry. But he notes that, upon his return, "the nurses at the NHS gave me an attitude of near-hostility for going overseas for my operation."

FEARS OF AVIAN FLU. Those NHS nurses -- and their counterparts elsewhere in the developed world -- may have to shed their attitude. Parry and Reese are among a growing army of patients traveling to Asia for medical care. Thailand's private hospitals treated more than 308,000 patients from abroad in 2002, generating some $280 million in revenue, according to the Thai Private Hospital Assn. And the business is growing. While just around 10,000 international patients checked in to Indian hospitals for everything from hernias to heart surgery last year, health-care tourism in India could become a $1 billion business by 2012, according to a 2002 report by McKinsey & Co. and the Confederation of Indian Industry. Singapore attracted 200,000 foreign patients in 2002 and aims to treat 1 million annually by 2010. Medical care "will be a global business," says C.E. Tan, marketing manager at Parkway Group Healthcare, a chain of hospitals in Singapore that treated 122,000 foreign patients last year.

One potential hitch in the global ambitions of Asian hospitals: The region is seen as a breeding ground for infectious disease. This year's avian flu outbreak will surely cause some would-be patients to check into local hospitals rather than fly to Asia. Last year's SARS epidemic took a big bite out of business for many facilities in the region. Although Thailand had no reported cases of the disease, "SARS kicked us quite badly," says Ralf Krewer, marketing manager at the International Medical Center of Bangkok Hospital. "Nobody wanted to get on a plane." And many foreigners are concerned about the safety of the blood supply in developing nations, although officials say those worries are unfounded. The blood used in Thai hospitals is monitored "by the International Red Cross, and every blood-donor clinic is inspected," says Surapong Ambhanwong, former president of the Thai Private Hospital Assn. and a board member of the country's National Blood Donor center.

Those are valid concerns. But on price alone, you don't have to be a brain surgeon to do the math. In India or Thailand, a heart bypass costs $8,000 to $15,000, cataract surgery $500 per eye, and a root canal $80 to $225 per tooth. Those prices are a fraction of what U.S. hospitals or dentists might charge. And in both countries, privately run hospitals often provide foreign patients with live video consultations before they arrive, a personal paramedic, airport transfers in either a limousine or ambulance, and a couple of weeks in a hotel to recuperate.

While people have long traveled to far-flung, exotic locales for nose jobs, tummy tucks, and breast enhancements, Thailand wants to woo foreigners in need of nonelective medical treatment. A key catalyst for private Thai hospitals was the financial crisis of 1997-98. With their own middle-class clientele devastated by the economic collapse, they were faced with a sharp drop in local business. So the hospitals started courting foreigners living in Thailand to help fill their empty wards. That campaign was so successful that they began targeting expatriates and nationals from countries lacking high-quality medical facilities, such as Vietnam and Bangladesh. Last year, more than 150,000 international patients (including those seeking outpatient care) from 140 countries came to Bumrungrad, generating 20% of its $112 million in revenue. Now, Bumrungrad is reaching even farther afield, with referral offices in Oman, Australia, and the Netherlands.

India has similar ambitions. Naresh Trehan, executive director and chief cardiac surgeon of the Escorts Heart Institute & Research Centre Ltd. in New Delhi, in August led a mission to Britain to pitch the NHS the idea of sending patients to India for everything from reconstructive surgery to cancer treatment. The NHS says it's not interested, but Trehan says some private insurers are considering the proposal. Although India's public hospitals are often rundown and underequipped, Trehan is confident that private Indian facilities can hold their own in the global operating theater. "We stand tall with the rest of them in the world," says Trehan, who spent 20 years practicing as a cardiac surgeon in New York. "People's impression of India's health care is the 1940s and 1950s," he says. But in recent years, high-end medicine there has "taken a quantum leap."

To ease the concerns of potential patients, some of these hospitals are pursuing accreditation from the same groups that oversee medical facilities in the U.S. and Britain. Escorts is accredited by the British Standards Institute. Both Escorts and the Apollo Group hospitals are seeking certification from the U.S.-based Joint Commission on Accreditation of Healthcare Organizations. And Bumrungrad has already received accreditation from the Joint Commission. "We are trying to position ourselves as the Mayo Clinic of Asia, to be known as a referral center in this part of the world for patients from all over the world," says Ruben Toral, Bumrungrad's director of international programs.

The facilities are spending big bucks to attract more paying clients from abroad. Bangkok Hospital is building a $7.7 million, 104-bed heart center to be reserved entirely for foreign patients. In December, Escorts inaugurated a $20 million, 170-bed cardiac wing. To keep their customers satisfied, the hospitals often look more like luxury spas than sick bays. Bangkok Hospital features single rooms only (with adjoining quarters for family members) and offers in-room Internet access. It serves four different cuisines -- Thai, Japanese, and two Western selections -- every night. Bumrungrad's soaring lobby features a Starbucks caf?, a soothing fountain, and dozens of comfortable armchairs where patients and guests can relax. "I would give this five stars," says Yvonne Wilmink, a native of the Netherlands who traveled from her home in Sri Lanka for knee surgery.

True, even five-star hospitals aren't for everyone if they're thousands of kilometers from home. Those with decent health insurance will probably stay put for surgery. But Asian medical facilities are betting that for people in developing markets where health care is subpar, or for those on long waiting lists, or for anyone with inadequate coverage at home, the trip might be just what the doctor ordered. By Frederik Balfour in Bangkok and Manjeet Kripalani in Bombay, with Kerry Capell and Laura Cohn in London


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