Medical tourism: Looking ahead to 2015

by Duangkamol Buranasomphop


            Medical tourism is a star industry in Thailand, but serious shortages of healthcare professionals may keep Thailand from being the medical hub of Southeast Asia, especially after the Asean Economic Community (AEC) comes into being.

            It is undeniable that Thailand is an important destination for medical tourism. Every year Thailand receives 1.4 million foreign patients who visit the country as tourists. The figure is far higher than those of our regional peers: Singapore and Malaysia treat 600,000 and 300,000 foreign patients a year respectively. Thanks to Thailand's international standard of health care and its comparatively lower costs, the medical tourists are from a good selection of countries, like Japan, the United States, United Kingdom and the United Arab Emirates.

            Despite its popularity as a medical hub for international visitors, Thailand still draws far fewer medical tourists from within Asean than its two closest competitors. Around two-thirds of foreign patients in Singapore and Malaysia hail from Asean countries, largely because of an emerging Indonesian middle class who wish to get their medical treatment abroad. Yet, opportunities that will arise with the arrival of AEC are going to change all this. 

            On the supply front, Thailand's reputation among international visitors as an attractive destination for medical tourists will draw new service providers from other Asean countries to participate in the lucrative business. Healthcare is one of the four AEC priority service sectors for which the foreign ownership cap for investors of Asean nationality will be raised to 70%. Currently, hospitals in Thailand have only 15% foreign equity participation on average.

            The fact that Asean entities can become majority stakeholders and the proven profitability of private hospitals in Thailand may usher in innovative medical care and tailored services to better cater to Asean customers' medical needs.  Domestic patients will also benefit from competition in the form of a better standard of services, more choices andenhanced medical technology. 

            However, there is a significant obstacle to this notion - Thailand's shortage of medical personnel, both in terms of quantity and quality. This could hamper the country's hopes of becoming the medical hub of Asean. 

            To put it simply, Thailand cannot produce adequate numbers of medical workers - doctors and nurses included - to satisfy even domestic medical needs. In addition, many of these workers are not well prepared to face the cultural challenges that will arise from the integration of the AEC and globalization in general. Deficiency in second-language skills - English, Mandarin and other regional languages will increasingly become a major disadvantage that will end up plaguing Thailand's medical tourism industry. 

            A recent study by the Health Systems Research Institute found that Thailand needs 50,000 more registered nurses to meet demand, the result of declining numbers of new nursing graduates in the past decade. Even after efforts to produce more practical nurses (i.e. caregivers) who assist doctors and registered nurses and who only need to complete one-year training as opposed to the four that is required of registered nurses, the number of medical personnel is still far below satisfactory levels. 

            Yet, Thailand could benefit from the AEC by importing nurses from other Asean countries, such as the Philippines where nurses are in surplus and currently receive lower pay. The labor movement would be made easier under Mutual Recognition Agreements (MRAs), which aim to facilitate the movement of skilled labor in priority sectors, among which medical personnel are included. These imported nurses who would be treating mostly foreign patients would relieve pressure on domestic healthcare services which would otherwise face greater competition for resources from hospitals that cater to international patients. 

            However, despite the MRAs, foreign nurses will still need to be proficient in the Thai language to pass the examination for a full nursing license in Thailand, which is taken in Thai. Shouldn't such regulatory limitations be relaxed as it is not in the interests of the patients, domestic or foreign? Foreign patients naturally prefer nurses who can speak their mother tongue or an international language. Meanwhile, domestic patients should not be left wanting as a result of a greater shortage of medical personnel. Medical tourism and domestic healthcare would not be indirect competition if medical workers could easily come to Thailand to work. In fact, the two could complement each other by improving the availability and quality of health care for all. 

            Regulatory barriers such as this exist in medical services, but also in other sectors. They need a thoughtful review by the authorities concerned and any changes should align with the needs of consumers.

            Nonetheless, the private sector could do with more training of medical professionals to combat the labor shortage. Helping fund the education of medical and nursing students in exchange for future jobs, or allowing them paid training in a real work environment are possibilities. They can also help design curricula that equip students with relevantprofessional skills as well as marketable skills such as a second language or cultural awareness.

            The AEC provides a new opportunity to promote Thailand's medical tourism, but critical adjustments must be made both on the regulatory front and in the long-term planning for producing new medical personnel.

            The shortage of skilled labor is also common among other sectors with less of a competitive edge than that of medical tourism. With the imminent arrival of the AEC, skilled labor will be under intense competition. And time is not on our side.  Sutapa Amornvivat is chief economist and executive vice president at Siam Commercial Bank. She has international work experience at IMF, ING Group and Booz, Allen, Hamilton. She received a BA from Harvard and a PhD from MIT.


Duangkamol Buranasomphop

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