The interview took place at the World Health Care Congress and both a podcast and a transcript lay out the conversation below.

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• DOWNLOAD INTERVIEW WITH KENNETH MAYS–BUMRUNGRAD (WMA) (4 MB)

Kenneth Mays
Bumrungrad International Hospital: Medical travel

Vijay Goel: Hello, this is Vijay Goel with Consumer-Focused Care. I’m here with Kenneth Mays from Bumrungrad International, and Kenneth, could you tell me what Bumrungrad is, for the audience, and give us a sense of why people come to Thailand for health services.

Kenneth Mays: Okay, we’re a big multi-specialty hospital—the biggest private hospital in Southeast Asia. We see about 3,000 outpatients a day. People come to their doctors here so we’re a large multi-specialty practice and we have about 500 beds, so we’re also a Class A Tertiary care hospital. We were the first hospital in Asia to be accredited by the joint commission, which is the accrediting organization that accredits US hospitals. We’re probably the poster child for medical travel. We have about 400,000 international patients a year. I don’t know if any other hospital has that many.

VG: That’s a staggering number! So where are these people coming from and why Thailand, of all places?

KM: Well, it’s interesting—they come from all over the world. We have patients from about 190 countries, so that’s virtually all of them. The big areas that people come from are Europe, about 35,000 a year, the Middle East, 95,000 a year, we see about 65,000 American patients a year—about half of those coming from America, the others are expatriates that are in the region that use us as their hospital.

VG: Okay. Tell me a little bit about why people would come to Thailand for services. Is it cheaper? Are the facilities better? Are there more options as a consumer of healthcare? Tell me about how you are different from what they can get in the US.

KM: Right. Well, patients come to us from outside of Thailand for one of three reasons. They come for either quality, or for price, or for access. Our quality is equivalent to top US hospitals. We have 220 US board-certified doctors. We’re really kind of the top doctors in Southeast Asia. But the quality of service is probably a more important reason that US patients come to us, because they find the service in Asia, in particular, Thailand, is great. Access people come to us from Canada, and some countries with socialized medicine because they can see a doctor much faster—they can see a doctor within days rather than wait for months—and cost is the biggest single factor that Americans come to us, because procedures at our hospital typically cost from 1/6th to 1/10th of what they would cost in the US. So for example, a hip replacement that might cost $60,000-$65,000 in the US, would cost $15,000 in our hospital.

VG: So the people that are coming, are you finding that they are the insured who are coming to Thailand as another option, or are you getting the uninsured, that otherwise couldn’t afford these services in the US? What is the kind of mix that you are seeing?

KM: Depends on what kind of patient you’re talking about. I think, for American expatriates that use us as their local hospital, many of them have local insurance plans or insurance plans under the multinational branch of a big American insurer. Patients who are what we call “accidental tourists” who are traveling to Thailand as tourists and didn’t plan on needing medical care, but they get the flu or they break a leg or something like that. They are covered by their US insurance plan because they’re traveling. But the bulk of them are coming as medical travelers, so they come for the primary purpose of medical care, their insurance won’t cover that. They either are uninsured, underinsured, or their insurance back in their home country typically doesn’t cover that. So they’re coming because they are looking at an operation that might drain their retirement savings if they had it done in the US, or they could come over to Thailand and have it done and go back and still have their bank account intact.

VG: It sounds like they might have a nice vacation in the middle as well.

KM: Well they do. It’s a nice place to recuperate, although it’s kind of a myth of medical tourism that you kind of come and have a heart surgery and recover on the beach, and any doctor will protest that, as well they should.

VG: That’s really interesting. What types of procedures do people tend to come for? So obviously, if they’re in the region and something happens, you’ll see more of the acute cases, but what elective type of things do people travel to Thailand for?

KM: Right, well, for the medical traveler that is really coming to get a procedure done, they fall into a few different areas. Some of them are orthopedic, so we do hip replacements, knee replacements, ACL, spinal fusion and back operations. Another category is cardiac, so we’ll do bypass surgery, we’ll do angioplasty and stents–a lot of those. We’ll do some GI surgery, we’ll do hysterectomies, it is something that American patients come for. Checkups, obviously, is very popular, because you can get that done while you’re there as a tourist. And finally, plastic surgery. So we’ll have liposuction or face lifts, we always do that, that’s not a major part of our business, but that is one operation that Americans come for.

VG: That’s interesting. So you mention that you are largely non-insurance covered if people are coming overseas for some of these elective procedures. Is your financing consumer-like, in terms of credit cards? Is it that you have financing programs? How do people arrange and pay for these services when they come?

KM: Something that is very different about our hospital than an American hospital, a lot of people come to our hospital say, “oh, it’s like a big modern American hospital with wonderful service and amenities.” But one thing that is very, very different is that about 70% of our patients pay upfront and you just put down a credit card and we give you an estimate for how much it’s going to cost so that they know how much it’s going to cost upfront and pay upfront for their services, like going to a hotel and having an imprint of your card and getting an estimate, and when you leave, that’s about what it costs.

VG: So that model is very different than the US model, which tends to be reactive. So do you have, say, a list of set prices that you post on the door, that the people can even access before they go to Thailand? How does that work?

KM: In some cases we do, where there is a package price, and some of those are listed on our website. And we’re going to launch something in the next few months that will allow patients to go to our website and get the actual median price and range of what people paid who got a certain procedure so that they can see the actual costs out the door, including the doctor’s fees and surgical fe
es and room and everything. But, in the majority of cases now, you just get an estimate upfront, and our estimates are based on actuals, and we say, “well, you’ll probably pay 350,000 baht, which might be about $10,000 for this operation, or you’ll pay $4,000 for this operation, or $2,000,” whatever, and it comes very close to that.

VG: So it sounds like you are already light years ahead of the US system in that you kind of created one bundled bill with one bundled estimate, instead of just seeing all kinds of different bills from different people much later in the process.

KM: Right, it’s a very interesting laboratory for health care reform, because it’s such an ideal thing. We have a number of American administrators and managers who said this is the way it should be. It’s very consumer-driven, and that was based before the medical travelers came, the Thai consumers are used to. They have about 100 private hospitals to choose from in Bangkok alone. So they come in, they want to have an estimate, and if you’re too much, then they’ll go and call another hospital and get their estimate and go over there. So it’s very, very consumer-driven.

VG: Wow! That’s a very different world–very different from here. And so, for a consumer that’s interested, what’s the way that this happens? Is it coordinated with their primary care physician? Do they just show up in Thailand? How do they get in touch with you, arrange for the services, arrange for the transportation, and make all this happen?

KM: Well right now, a lot of these medical travelers are actually going to our website, which is just bumrungrad.com, and finding us there or they are typing “Thai hospital” or “Thailand Hospital” into Google and find us right at the top of that list. And our website will walk them through everything—you can make appointments on our website, choose a doctor on our website, find some cost guidelines on our website, have a primer about what are the steps you go through in preparing for your trip and so forth. We have a group called International Medical Coordination Officer, which is kind of like a medical concierge, which is seven doctors, about 20 nurses, which don’t do clinical care but just help the international traveler get ready and make sure they have the documents and make sure that we can arrange for aftercare when you go back home and so forth. That’s the way it’s happening now. In the future, we think we’re going to start seeing health plans in the US start to offer this as an option, in the Global Care options, which basically allow you to maybe waive your deductibles, wave your co-pays and so forth, and save quite a bit of money if you’re willing to come to a hospital like ours for care.

VG: Terrific! Well, this is a very interesting option for patients these days. So, thank you Kenneth for joining us and we look forward to catching up with you later!

KM: Thank you!