Healthcare — Global Options

It’s been two years since you’ve had a physical exam. You need to have your vision checked and your teeth cleaned. But you are one of 44,000,000 U.S. citizens without health insurance.

Who ya gonna call?

Your local travel agency for an airplane ticket to Thailand – or a handful of other developing countries with top-rate medical care at rock-bottom prices.

Bangkok, Thailand

It was news to me when I heard about Bangkok’s world-class hospitals. Wasn’t Thailand a third world country? I was preparing to return home after living in Asia for eight months when I learned that my U.S. health care policy had expired.

No worries. The word among expats in southeast Asia was that in Bangkok, I could get state-of-the-art health care for as little as $10 per doctor visit.

I learned that over the past seven years, the number of private hospital beds in Bangkok had doubled to over 16,000. Twenty years ago the major Asian health care destinations were Singapore and Hong Kong. But in the past 20 years, Thailand has moved ahead with a vastly improved medical infrastructure. And the devaluation of the baht, which makes medical care a bargain for foreigners.

From over 24 hospitals, I chose Bumrungrad because of its focus on international patients. On a computer in Bali, I logged into the hospital’s website at www.bumrungrad.com. There I set up appointments with various specialists as well as a dentist. Two days later, I pulled up in a taxi in front of Southeast Asia’s Number 1 certified hospital, Bumrungrad, in Bangkok, Thailand.

In the circular drive fronting the 12-story hospital, the largest private hospital in all of Southeast Asia, uniformed doormen and a concierge loaded and unloaded passengers. A soft-spoken Thai woman dressed in a suit and high heels greeted me at the door and directed me to the International floor. As I was being swept up the wide escalator, I took in the 5-star hotel-like lobby with its teak columns, plush seating , computer kiosks, and a Starbucks Cafe. The second floor atrium was ringed with French, Japanese, and Indian restaurants -and a McDonald’s.

Starbucks coffee shop in the lobby of the Hospital.

The International lobby felt like a convention of the United Nations. Egyptians in white turbans filled the waiting room alongside Indians in saris, Muslims in kabalas, South Africans in colorful caftans, and Westerners in shorts and tennis shoes.

I saw two familiar faces – Peter, an American who lives in Bali and Kathryn who lives in Katmandu. I also met an family of four who told me they were from Florida but were living in India while Dad worked as an agriculture consultant for a National Government Organization. They were in Bangkok to get their visa’s renewed and so had added a trip to the hospital. The day before the children had seen a dentist, dad had had a physical exam, and Mom was seen by an OB-GYN and had an ultrasound. Their total bill was $125.

Out of 850,000 patients treated at Bumrungrad last year, 300,000 were foreigners from more than 100 countries – a number expected to increase 10% in 2004. Most physicians at Bumrungrad are either American or U.K.-trained and all speak some English. Translators are provided for over 22 languages. The average cost for an operation is 50-80% below the cost in Europe or the U.S. And at Bumrungrad there is no wait. As if all of this were not enough, add Thailand’s renowned hospitality and you have a prescription for a luxurious healing environment that won’t break the bank.

Connected to the hospital by a sky walk, BH Residence is a convenient housing option for recovering patients and their families . But in the hospital, private rooms have marble countertops, plush couches, cable-TV, internet connections, and refrigerators full of sodas and soy milk – with price tags as low as $80 per night. I was ready to move in. At what other hospital could I send a postcard home saying “Wish you were here?”

Chefs from the city’s finest restaurants prepare meals to order for patients and their guests. The Mandara Spa offers bedridden patients body work to help with healing . Mothers in labor are given a choice of delivery styles, complete with nurses who massage them throughout labor.

… The pediatric wing, dubbed “Kid’s Village” looks more like Disneyland’s Main Street than a scary hospital ward. The curved ceilings have been painted with clouds, and the hallways leading into pediatricians’ offices are a splash of bright contrasting colors. The Village is completely self-contained with its own Treatment Rooms, Children’s Pharmacy and Cashier for one-stop service. A host of kid-sized and parent friendly features include “The Kids Zone” a play area with jungle gym , a miniature movie theater, and child-scaled computer modules. The Center is home to almost 50 highly qualified pediatricians representing all pediatric specialties from general pediatrics to specialists in pediatric cardiology, pulmonary, nephrology (kidneys), allergy, endocrinology (growth & diabetes), genetics, neonatology, psychiatry, neurology, oncology (cancer), gastroenterology and rheumatology. There are 29 beds in the pediatrics inpatient wing, a pediatric intensive care and a complete newborn nursery including a Level III regional neonatology center treating premature and sick babies from throughout Thailand and the ASEAN region.

Bangkok is known world wide as THE place to go for sex reassignment surgery. It makes sense then, that if Thailand’s plastic surgeons can convincingly turn a man into a woman and vice versa, erasing a few wrinkles would be a cinch. So after my appointment with the dermatologist, I slipped into The Plastic Surgery Center across the hall to pick up some brochures for future reference. I noted that the most expensive procedure, a complete facelift including eyes, neck, brow, nose, lips (and what ever else is left) including pre and post doctor visits and hospital stay, is $3,500.

The Pediatric Center and the Plastic Surgery Center are just two of over 30 “Centers” in the hospital. There is also The Wellness Center that focuses on preventative health care. Low lights, meditative music, and rich wood walls give the clinic a serene ambience. In the Wellness Center vitamins and mineral compounds are prepared individually for patients depending on their needs.

American-born director of the International Center, Rubin Toral, told me that in 2002, a year when most hospitals world-wide had growth rates of just 3%, Bumrungrad’s revenue grew by 22%.

“Unlike the US ,” Toral said, “where doctors often have their own practices, all our services are offered under one roof – the family practitioner, the surgeon, a physical therapy center, the lab, the pharmacy… During the 1997 economic crisis, we invested in a state of the art computer software system which digitizes everything from patient registrations, clinical systems, operating room scheduling, billing, purchasing, inventory management, and gives doctors instantaneous access to medical records, including digital x-ray’s. Thailand’s labor costs are low, as is overhead, and there is virtually no litigation. The result is world class health care at rock bottom prices.”

Director of the International Center, Rubin Toral.

A Day In the Life Of A Patient At Bumrungrad Hospital

Upon my arrival on the International floor, I approached the desk, where they printed up a patient card with my name along with a list of my prearranged appointments (remember, I had set them up online two days earlier). There were no forms to fill out. A woman was assigned to be my guide for the day. I had signed up for Bumrungrad’s “comprehensive exam”. She took me first to the waiting room where I would see a general practitioner. Thai kick boxing was on the overhead TV. A nurse in a uniform and triangular cap rolled a cart my way and asked, “Would you like some fruit juice or water?

As the afternoon progressed, she guided me from appointment to appointment. Each doctor had on his or her desk a computer which he referred to and to which he added his own notes. My x-rays and ultrasound were there along with all doctors’ notes for each doctor to access with the click of a keyboard.

By the end of the afternoon, I’d seen eight specialists including a dentist, and had had every inch of my body from my toenails to my scalp scanned, poked, and tested. My final appointment was with the general practitioner I began the day with. He opened a 10 page bound medical report with my name on the front, just under a photo of the hospital, and we proceeded to go through the report line by line, word by word until he was satisfied that I understood everything from the significance of my blood count to my HDL levels to my liver function.

Next stop was the pharmacy. I handed the pharmacist my I.D. card, and he handed me my meds in a small chic shopping bag with the Bumrungrad logo on its front.

My last stop was the cashier.

“That will be $470,” she said.

With my personal medical report tucked under my arm, and my shopping bag of meds in the other, I took the escalator to Au Bon Pain for a croissant and a cappuccino and thought to myself that I’d never had so much fun in a hospital.

Note:

I have focused on Bumrungrad’s International services in this article because of the nature of this magazine. The hospital also offers outstanding outreach programs to locals including heart replacement valves for local children.

Bumrungrad Hospital, multilingual, interactive website www.bumrungrad.com.

Bangkok Hospitals:

www.traveller2000.com/bangkok/hospitals.htm

BRAZIL

I asked Jim Kirby, a part-time resident of Brazil and a writer for this magazine, to talk about health care in Brazil.

He said, “The health care value in Brazil can far surpass that available in the USA for everyone, especially for the local rich and those who have dollars.

Drugs cost a fraction of what they do in the U.S., especially considering you can buy them without a prescription. For a very small fee ($5), you can get a piece of glass taken out of your foot or an even drug injection right in the pharmacy. Eyeglasses cost probably 1/5th what they do in the U.S. A dentist will clean your teeth for $15, fill a tooth for $30. And the dentist does it herself, not a dental technician.

Along with the Argentines, Brazilians are the world leaders in cosmetic surgery, teaching physicians from around the world. A nose job in Sao Paulo will cost you about $900.

The big news lately is that the Brazilians lead the world in combating AIDS. They dishonor HIV-drug patents and produce and distribute generics themselves at very low cost.

There are several tiers of general care available, from free community clinics spread around the neighborhoods, to crowded, but cheap public hospitals, to world-class private hospitals. The three southern states of Paraná, Santa Catarina and Rio Grande do Sul maintain the highest standards.”

To read James P.Kirby’s story about Brazil in this magazine, go to:

http://www.escapeartist.com/OREQ5/Real_Estate_Brazil.html

For more information about health care in Brazil, type “hospitals in Brazil” or something similar into a search engine. There is loads about medical services in Brazil available online – unfortunately most of it is in Portuguese. If you find information in English, please let me know!

SOUTH AFRICA

In the March 28, 2002 issue of the BBC online, a headline reads “Britons Head for South African hospitals”. The article reports that hundreds of British patients are flying to Cape Town, South Africa to avoid National Health Service waiting lists in the UK. The treatment they are seeking ranges from major heart surgery and cancer operations, to cosmetic surgery and they have found that the low cost is worth skipping the wait.

In the September, 2003 issue of Elle Magazine, Nancy Hass reported on a travel tour company called “Surgeon & Safari”.  Trips to big game reserves are combined with a trip to the doctor – in this case a plastic surgeon in Johannesburg. Because the Rand has been greatly devalued since apartheid, a multi procedural cosmetic surgery/safari trip costs about the same as an eye lift on Park Avenue. Manhattan surgeon Alan Matarasso says that South African doctors are among the world’s best. The Elle article concludes, “The combination of large game preserves and affordable surgery has made South Africa the newest winner in the overseas cosmetic surgery sweepstakes, a game that for years has been played in places like Thailand, Mexico, and Brazil.”

CONCLUSION

“It used to be that someone from France or the United States would never leave their country for health care in another country,” Rubin Toral of Bangkok’s Bumrungrad Hospital said. “The ease of travel today allows people to access health care wherever they wish. ”

And I would add, if you are a foreigner living in a “medical vacation” country, all the better.