Medical tourism in Asia
Combine a holiday with an executive check-up, or surgery, in Thailand, Singapore, or India. It won’t break the bank. And doctors are good. Our guide.
updated by Ambika Behal
Fortis Escorts Hearth Institute, Delhi/ photo: hospital
LINDA BEIER, an expatriate living in Hong Kong, had long been unhappy with the appearance of her teeth, so when she had the chance to join a friend for a 10-day break in Thailand, she scheduled in a visit to a well-known Bangkok dental practice, where the problem was fixed for a fraction of the cost in her adopted home. Linda’s cosmetic dental procedure was just a tiny cog in the global medical tourism wheel, which – according to some estimates – is a US$40 billion global industry.
Several hospitals in Asia have carved such outstanding reputations for themselves that medical tourism has become a major money-spinner. In countries such as Singapore and Thailand, government agencies have been set up to help market their expertise globally. Special medical travel agencies have sprung up around the world, and top Asian hospitals routinely have special “international” desks and services to assist overseas patients with everything from doctors’ appointments to accommodation.
One US-based medical tourism agency, MedRetreat (www.medretreat.com), “facilitates the healthcare needs” of North Americans by arranging treatments at hospitals in 10 destinations ranging from Latin America to South Africa to the popular Asian destinations: Thailand, Malaysia and India. Trained “destination programme managers” accompany patients to all medical appointments, and the agency arranges transfers and accommodation for clients.
It is hardly surprising that Americans are looking at alternative healthcare solutions. A 2014 report from the Commonwealth Fund, and widely cited, ranked the US at the bottom of a list of 11 industrialised nations with the most inaccessible and expensive healthcare.
Bumrungrad Bangkok: plush lobby surrounds
US-based Medical Tourism Association (MTA) collaborated with The George Washington University to compile data on the benefits of travelling abroad for healthcare, in a 2013 MTA Medical Tourism Survey.
The survey concluded that medical tourists spend between US$7,400 and US$15,000 per trip – inclusive of travel and hospital expenses. In comparison, just the average simple hospital stay in USA costs around US$18,000. Mexico and India are considered the most popular travel destinations for medical tourists.
Thailand medical tourism: beaches and bosoms
Bangkok’s Bumrungrad International (www.bumrungrad.com) hospital has won international acclaim and is Thailand’s best-known facility for health tourism. It was the first genuinely international hospital in Asia to be accredited by the US-based Joint Commission International (JCI, an organisation aiming to elevate healthcare delivery standards through evaluation and accreditation of healthcare organisations), in 2002. The hospital, which began expansion in 1997 with a US$100 million investment in the building, design and medical hardware, including a 21-storey outpatient facility, complete with a spacious 10th floor Sky Lobby, was forced to look aggressively overseas after the 1997 Asian financial crisis dried up local business. This proved fortuitous for travellers.
Over a million patients are treated annually, with just over half a million of those being international patients from over 190 different countries, according to hospital statistics for 2013. Procedures included everything from comprehensive checkups and cardiac surgery to cancer treatment and cosmetic enhancements. Patients hail from all over – from the United Arab Emirates and Vietnam to Australia and the United States.
In 2014, the cost of the entire package for a Coronary Artery By-pass Graft Cardiac Surgery at Bumrungdrad Hospital was priced at around US$18,440 – the average cost of the entire procedure in the US is about US$44,800.
Complex checks at economical rates: Bumrungrad/ photo: hospital
According to a Bumrungrad spokesman, the hospital delivers a "Mercedes product at a Toyota price”. Indeed it is more hotel than hospital on first looks. Find a comfortable lobby, restaurants, coffee and more. Three things that Bumrungrad takes prides in are: high quality, international-standard medical services, immediate access to those services and specialists, and affordable prices. (Bladder surgery that would cost US$25,000 in the USA, costs only around US$3,000 at Bumrungrad, for example). The hotel is focused on the "intentional medical traveller, not the accidental traveller" who might walk in with a muscle sprain.
These people can come in, undergo complicated procedures and "still have their savings intact". A big plus on the hospital's website is its "real-time" average cost data that offers a rule-of-thumb on actual average cost for specific procedures over a period.
The hospital says it is a one-stop medical centre where patients have access to over a thousand internationally trained medical specialists under one roof. Patients arriving for treatment might well be guests checking in at a five-star hotel: there are concierge-style services on tap and an electronic medical-records system that eliminates paper and waiting. This “total experience” is what attracts clients. New “medical tourism packages” are being developed and sold by travel agents, and the hospital also has a kiosk inside Bangkok’s international airport.
Another Bangkok institution providing international services and help to streamline the arrival and accommodation of overseas patients and their families is the Bangkok International Hospital (www.bangkokhospital.com), which says a “considerable portion” of its patients are foreigners. The hospital has an International Medical Center (IMC) catering specially for overseas patients (it has treated patients from more than 100 nationalities) and includes a team of multi-lingual interpreters to help overseas visitors. There’s also a special Japanese Medical Centre with Japanese-speaking doctors and nurses. Another advantage is that the hospital runs its network of private hospitals in 17 locations across Thailand – with Phuket and Samui being the obvious choices for those looking for a spot on the beach after treatment.
To some tourists, the beach-laden Phuket has another attraction: sex-change surgery. In fact, this is one of the top 10 procedures that patients visit Thailand for. The Bangkok Phuket Hospital (www.phukethospital.com) offers “sexual reassignment surgery”, as well as extensive health-check facilities (it has the equipment to perform full-body CT scans and 4D ultrasounds).
BNH Hospital, Bangkok/ photo: hospital
Some years ago, the hospital set up a subsidiary travel agency, Phuket Health & Travel (www.phuket-health-travel.com), offering packages for plastic surgery procedures, dialysis treatment, hip or knee replacements, annual checkups and other procedures.
Also in Bangkok, the BNH Hospital (www.BNHhospital.com), originally opened to offer healthcare to expats living in Thailand, offers a range of medical services, from orthopaedic surgery and ophthalmology to paediatrics and dentistry. Various check-up programmes are on offer for set package prices. It’s one of Thailand’s oldest medical care centres and sees over 75,000 patients visiting from over 150 different countries, annually. The hospital’s International Travel Medicine Clinic provides full medical travel services and immunisations - and what the hospital says is the “first comprehensive spine centre in Thailand”.
Singapore, medical tourism in safe hands
Singapore is another major player in the Asian medical tourism market – hardly surprising, given the city-state’s reputation for sophisticated facilities and advanced technology, not to mention safety and efficiency. Critics say costs are 30 to 50 percent higher than those in Thailand, but even so they remain appreciably lower than in the US and the UK. The additional draw is that English is widely spoken across the city.
Singapore set out on its quest to create the nation-state as an international medical hub, not only for medical travellers, but also research conventions and education, in 2003. The World Health Organisation ranks Singapore as number one for best healthcare system in Asia, and number six in the world.
Today medical travellers can begin their journey by contacting the Singapore Tourism’s Medical Travel Team (www.stb.gov.sg/industries/healthcare). According to the Singapore Tourism Board (www.stb.gov.sg), Singapore received 850,000 foreign medical patients (including business and holiday travellers as well as expats) in 2012. The number is expected to rise. Popular healthcare services ranged from the very high-tech (like transplants) to the standard (hip replacements) to the “medical fringe” (including medical spas). Singapore has a quarter of all JCI-accredited facilities in Asia.
Gleneagles Suite/ photo: hospital
Singapore is a popular healthcare destination for many reasons, from “touristy” add-ons to leisure or business trips (for example, health screening or medical spas), to specific procedures (such as knee or hip replacement or cancer treatment), to emergency evacuations after natural or man-made disasters.
eMenders (www.emenders.com) is a group of more than 50 specialists based at the Mount Elizabeth Medical Centre in Singapore, covering more than 25 speciality areas. All the doctors have internationally recognised qualifications and have received their speciality training, or additional training, at leading institutions in those countries.
According to eMenders, it is important to differentiate between the terms “medical tourism” and “medical travel.” Most eMenders patients fall into the category of medical travel (they travel to Singapore primarily because of medical reasons). While some patients also come for medical services because it is incidental to their trip to Singapore, people in this category mainly go in for elective, cosmetic or minimally invasive procedures, such as dermatology, dental, general health screening and “aesthetic” procedures.
While most of eMenders’ international patients are either Indonesians or expatriates based in Indonesia, a “significant number” also come from Malaysia, Myanmar, Pakistan and Bangladesh. The fields most popular with the group’s international patients are cardiology, urology, gastroenterology, dermatology, orthopaedic surgery and neurosurgery. Many patients also come to seek second opinions on treatments or on diagnoses made by their doctors back home.
The Mount Elizabeth Hospital (www.mountelizabeth.com.sg) is owned by the Parkway Group, which also owns the Parkway East and Gleneagles Hospitals in Singapore, and a network of hospitals in Malaysia, India and Brunei. Patients come to these hospitals for treatment from as far as China, Vietnam, India, the US and the UK. Parkway’s Central International Patient Assistance Centre (www.parkwayhospitals.com/plan-your-visit/international-patient-guide) helps patients to access the right channel of expertise and helps with travel and other arrangements.
Raffles Hospital, Singapore
Dentistry also draws international patients to Singapore. The Specialist Dental Group (www.specialistdentalgroup.com), formerly known as Henry Lee Dental Surgery, has been providing dental services at the Mount Elizabeth Medical Centre for over 30 years. Now run by Dr Henry Lee’s daughter, Helena Lee, the practice has expanded to four locations and has a team of 11 dental specialists, almost all of whom have received international training. Overseas patients come from Indonesia, Malaysia and Hong Kong and from as far afield as Australia and New Zealand. The practise also has a growing number of patients from Russia, Canada, the UK and the US. Typically, international patients seek procedures such as dental implants, crowns, veneers and dentures.
Run by Singapore’s largest private practice, the Raffles Medical Group, its flagship Raffles Hospital (www.rafflesmedicalgroup.com.sg) offers an international patient portal in 11 languages ranging from Arabic to Bahasa to Russian and Japanese. The hospital also has a Japanese Clinic for tourists and residents from Japan. The hospital offers a whole range of fixed-price packages, from screening for osteoporosis (about S$100) to total knee replacements. The package price for a coronary artery bypass graft here runs S$17,500 for up to eight nights’ stay with two nights in the ICU.
Yes, India can be a cheap and safe bet
Think of India, and images of ancient temples, tigers, call centres and the IT boom might jump to mind. Health care is also on the list. India has some excellent medical care providers, and foreign patients have been streaming in over the past decade. Accurate figures are hard to come by, but in 2014 and estimated 150,000 medical tourists were treated in India. Get a check-up and holiday in Goa.
Apollo Hospital: caring treatment
Cardiac care is one specialty that is drawing overseas patients to India. The Fortis Escorts Heart Institute (www.fortisescorts.in) in Delhi, formerly known as The Escorts Heart Institute and Research Centre, is a state-of-the-art heart institute. At Escorts, open-heart surgery costs around 200,000 Indian rupees (US$4,500), compared to around US$60,000 or more in USA. Like most international hospitals in Asia, the centre helps foreign patients with visa arrangements, airport pick-ups, accommodation, travel arrangements and other logistics.
According to the Indian Department of Tourism, the average cost of healthcare in India is about one fifth that of the West, multi-organ transplants are done for a tenth the cost in the West and there is “zero waiting time”. A bone marrow transplant in India would cost around US$26,000 in India, compared to about US$250,000 in the US. Hip replacements are also popular (in the UK, patients often have to wait many months on national healthcare waiting lists before they can have the operation, or pay out of their own pocket at private institutions).
The acclaimed Apollo Hospitals Group (www.apollohospitals.com) has hospitals across India, including Delhi, Hyderabad, Chennai, Bangalore and Kolkata (Calcutta). The hospitals in Delhi, Chennai and Hyderabad all have JSI accreditation. Foreign patients are met at the airport on arrival and taken to the hospital or a hotel.
Popular among foreigners living in India is the Max Healthcare group (www.maxhealthcare.in), which operates 11 hospitals across North India, including five in the Delhi-NCR (National Capital region) area. The hospital estimates they have received about a million international patients. Foreign patients are offered access to an International Services desk, and the hospital is allied with health insurance providers around the world.
Some patients are drawn to India’s holistic approach to healing, where techniques like yoga and meditation are sometimes used alongside the latest medical techniques. Various city hospitals around India now have Ayurveda natural healing centres. One of these is the excellent Medanta Hospital (www.medanta.org), set up by one of India’s foremost heart surgeons, Dr Naresh Trehan. Each hospital has an ayurvedic health department as well as an offering of other natural healing options, including homeopathy.
Grab a surgery and a holiday in India
The Wockhardt Hospitals Group (www.wockhardthospitals.com) has a chain of “super-speciality hospitals”, such as the Wockhardt Eye Hospital, Wockhardt Bone and Joint Hospital and Wockhardt Heart Hospital in Mumbai, and others in Bangalore, Hyderabad, Kolkata and Nagpur. The group has an association with Partners Medical International, who also develop programmes for Harvard Medical School affiliated teaching hospitals.
Other Indian hospitals that are treating increasing numbers of foreign patients are Jaslok Hospital (jaslokhospital.net) in Mumbai, which is highly regarded for heart procedures with a team of excellent doctors, Global Hospitals (patientcare.globalhospitalsindia.com/LKP/), a dedicated centre for multi-organ transplants also focusing on cardiology, liver diseases, oncology and haematology, in Hyderabad, and the well-regarded Dr LV Prasad Eye Institute (www.lvpei.org), a World Health Organisation Collaborating Centre for prevention of blindness - headquartered in Hyderabad, but with locations across India.
The Ruby Hospital (www.rubyhospital.com) in Calcutta, offers extensive services for international patients, and even has an exclusive “lifestyle” floor, The Enclave, housing private apartments with kitchenettes, computers with 24-hour Internet and TV and DVD.
While the Indian medical tourism market clearly has vast potential for growth, some critics say it still has its drawbacks, such as poor infrastructure and challenges travelling in and out of the country.
Malaysia - catering for foreign visitors
Penang Adventist, heart procedures
At the forefront of medical tourism in Malaysia is the state of Penang, where the state government is actively promoting its private healthcare facilities for cosmetic surgery and other medical treatments. Hospitals drawing international patients include the Gleneagles Medical Centre (www.gleneagles-penang.com) with its own foreign patients service and a range of services and packages (a standard executive health screening test including examination, electrocardiogram, chest X-ray and blood and other tests run at around RM455). The 220-bed Penang Adventist Hospital (www.pah.com.my) is a private hospital that is part of an international network of more than 600 facilities and claims to be the first private hospital in northern Malaysia to have performed procedures such as coronary bypass and laser heart surgery.
Another Penang hospital that has established an international reputation in southeast Asia is the modern Island Hospital (www.islandhospital.com) which, apart from the usual facilities, also has a heart centre, urology centre, fertility centre and laser vision-correction centre. A standard executive screening programme here costs RM340 (and a premier programme RM600). While some US and other Western health travellers are starting to take advantage of Malaysian medical care facilities, the main market is still other countries in Southeast Asia and nationals from the Middle East.
Philippines a popular medical tourist pick
The Philippines is also starting to cash in, with an official Philippine Medical Tourism (www.philmedtourism.com) Programme accredited by the Departments of Tourism and Health. At this point, international patients to the Philippines come mainly from around Africa, Asia, Micronesia and the Middle East. According to a 2010 Philippine Institute for Development Studies report, the country ranks at number 11 in the top 15 medical tourist destinations in the world.
The Max group of hospitals, Gurgaon, India/ photo: hospital
A number of healthcare facilities are participating in the Philippines programme, but so far St Luke’s Medical Center with locations in Quezon City and Global City (www.stlukesmedicalcenter.com.ph) is considered the country’s top medical institution. Like Bumrungrad in Thailand, St Luke’s is accredited by the US Joint Commission International (JCI). Jose Ledesma, the president and CEO of St Lukes, has said that the hospital’s “latest and most advanced medical equipment” made it “better equipped than 95 percent of hospitals in the US”. Medical specialties include cardiovascular medicine, neurology and neurosurgery, cancer, ophthalmology, and digestive and liver diseases.
South Korea cosmetic considerations
South Korea recently launched a Council for Korean Medicine Overseas Promotion, to be funded by the government and private hospitals, but any booming medical tourism sector is yet a long way off. However, South Koreans have been willingly going under the knife for years, with girls as young as 14 flocking to have eyelid operations (blepharoplasy, involving a procedure to create a Western-looking crease in the upper eyelid) to make themselves “more beautiful”. Experts say this operation, sometimes even given as gifts by family members, makes up 80 to 90 percent of plastic surgery procedures done in South Korea. However the nation has suffered immensely from unqualified doctors practicing as cosmetic surgeons, and assistants performing surgeries – a number of which are going horribly wrong. So be warned if you choose to head here for any cosmetic work.
Medicare procedures in Vietnam
An unusual option, this time in Ho Chi Minh City, Vietnam, is the FV Hospital (www.fvhospital.com) with 100 percent French ownership. This is an internationally accredited hospital with 220 beds and a team of over 400 doctors (including French, Belgian and Swiss) as well as Vietnamese doctors. Another plus is the hospital’s partnership with Singapore’s excellent National University Hospital.
While the institution is equipped to deal with a broad range of requests, medical and non-medical, the specialty areas that may interest those searching for Asian medical tourism options in Vietnam include regular executive health check-up, plastic surgery, joint replacement, spinal surgery and Lasik eye operations. FV is a contemporary structure with modern medical facilities and a host of hotel-like amenities including an Internet café, in-room high-speed Internet, cable TV and spa. The hotel’s partner travel agency can customise a holiday or hotel stay during treatment or during your recuperation.
Dubai’s desert hospital roundup
Dubai Healthcare City
Moving to the Middle East, the emirate of Dubai is famous for its luxury beachfront hotels, shopping and over-the-top towers. No surprise that its medical services aren’t left behind. Launched in 2002, Dubai Healthcare City (www.dhcc.ae) is the world’s “first health-care free-zone” and aims to become an “internationally recognised location of choice for quality healthcare and… research”. Still up to a third more expensive than its counterparts in Asia (which explains why many Emiratis flock to Malaysian and other Asian hospitals for surgery), Dubai’s rates are competitive when compared with Europe – and the city is tax-free.
One centre that offers cosmetic and plastic surgery for patients who want discreet treatment combined with a holiday in the sun is the Al Khayal Surgical Clinic, part of The American Academy of Cosmetic Surgery Hospital (www.aacsh.com). It was the first hospital to open in Dubai’s Healthcare City and received its Joint Commission International (JCI) accreditation in 2009. Patients can stay in a range of accommodation types, from the “six-star” Burj al Arab to less pinching apartments in the city. Tummy tuck or face lift, anyone?
A word of warning. Do your homework before you fly. Asia is home to many top international-standard hospitals, but if you don’t choose well, your “medical holiday” could end in disaster. In the southern Chinese city of Shenzhen, for example, there are thousands of unlicensed centres offering all sorts of plastic surgery. Don’t fall for it. That cut-price procedure might just be the final cut.
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