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International Journal of Tourism Sciences

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Lessons from Thai International Medical Tourism:Its Market Analysis, Barriers and Solutions

Seongseop (Sam) Kim, Nuntasaree Sukato, Aswin Sangpikul & Jinsoo Hwang

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Hwang (2013) Lessons from Thai International Medical Tourism: Its Market Analysis,Barriers and Solutions, International Journal of Tourism Sciences, 13:2, 148-174, DOI:

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International Journal of Tourism Sciences, Volume 13, Number 2, pp. 148-174, 2013

Tourism Sciences Society of Korea. All rights reserved.

Lessons from Thai International Medical Tourism:

Its Market Analysis, Barriers and Solutions

Seongseop (Sam) Kim† Sejong University,

Nuntasaree Sukato

Dhurakij Pundit University,

Aswin Sangpikul

Dhurakij Pundit University,

Jinsoo Hwang

Dongseo University

ABSTRACT: Since the Thai government established a 5-year medical tourism

promotion plan in 2004, Thailand has become a global leading country as a international

medical tourism hub. Thus, this study attempted to assess Thailand’s medical tourism

market, which is the largest in the world in terms of the number of foreign medical

tourists and revenues. Strengths include strong government support, effective marketing policies, and high quality hospitals and infrastructure. Opportunities are globally

increasing senior population, quick medical treatments, and development of digital

technologies. However, weaknesses are found as having not cooperative teamwork

between public and private medical sectors, language barrier, distrust on medical

facilities or services, no regular quality assessment program for hospitals, and existence

of only a few internationally well-known Thai hospitals. Thailand is also committed to

threats such as uncontrollable global factors, intense competition in an Asian medical

tourism market. Pursuant to attract more foreign medical tourists to Korea, this study

suggests potentials of benchmarking Thai medical tourism market.

Keywords: Medical tourism; Thailand; Market analysis; SWOT; Competitiveness

† Corresponding Author. College of Hospitality & Tourism, Sejong University, South Korea.

E-mail: [email protected],

** Department of Marketing, Faculty of Business Administration, Dhurakij Pundit

University, Thailand. E-mail: [email protected],

** Department of Hotel and Tourism, Faculty of Arts, Dhurakij Pundit University, Thailand.

E-mail: [email protected]** Assistant Professor, Department of Hotel Management, College of Tourism, Dongseo

University, South Korea. E-mail: [email protected]

D o w n l o a d e d b y [ U n i v e r s i t i T e k n o l o g i M a l a y s i a ] a t 0 4 : 4 6 1 5 A

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Introduction

Thailand has been one of the most popular tourism destinations in Asia for

many years, with most tourists coming from East Asia and Europe (Thailand

Tourism Report Q2, 2011). The country expected 18 million international

tourists in 2011, generating USD 23,000 million in revenue for the Thai

economy. The Tourism Authority of Thailand forecasts an increase in the

number of international tourists to 19.5 million and an increase in revenue to

USD 25,000 million in year 2012 (MCOT.Net, 2011). Tourism has played a

major role in the social and economic development of Thailand. During the past

several decades, the tourism sector has been the third-largest contributor to the

gross domestic product (GDP) of Thailand, accounting for as much as 9% of

revenue and more than 6.4 % of employment (Euromonitor International, 2011).

Thailand has actively marketed itself as a leisure tourism destination. The

two major public agencies that are responsible for tourism promotion in

Thailand are the Tourism Authority of Thailand and the Ministry of Tourism

and Sports, which was established in 2002. As shown in Table 1, Thailand

managed to increase the number of tourists, the average length of their staysand daily personal spending from 2009 to 2010. However, the increase in per

capita tourist spending was only 10.03% during this period, compared with a

12.63% increase in the number of tourists. This can be seen as evidence that

Thailand is becoming a mature destination that attracts international tourists.

Thailand has sought to increase both the numbers of tourists and tourism

revenue by reducing its dependence on leisure tourism. Instead, the country

aims to diversify its tourism market to include other types of travelers, such as

those traveling for medical reasons and business travelers (including

convention and exhibition travel). In 2004, the Thai government established a5-year plan to become a center for medical tourism. Thailand has seen itself as

a medical tourism hub of Asia and has officially placed this goal on its national

agenda (Reisman, 2010). To this end, various government entities have

increasingly cooperated with private health-care providers to promote the

country to the international medical tourism market.

The aim of this study is to identify Thailand’s medical tourism market,

which is the largest in the world in terms of the number of foreign medical

tourists and revenues. More specifically, this study has four objectives. First,

this study analyzes the Thai medical tourism market for foreign tourists.

Second, it conducts a SWOT (Strengths, Weaknesses, Opportunities, Threats)

analysis and explains this market in detail. Third, it finds solutions to the


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150 Seongseop (Sam) Kim, Nuntasaree Sukato, Aswin Sangpikul, and Jinsoo Hwang

obstacles that impede the market. Fourth, the results of this study are helpful for

understanding the strategic advantages and disadvantages to maintaining the

country as the most popular destination for medical tourism.

Table 1. Tourism Arrivals in Thailand 2009 and 2010

Countries

of

residences

Tourism arrivals (tourists) Length of stay Per capita spending (USD/day)

2010 2009 Change% 2010 2009 Change% 2010 2009 Change %

East Asia 8,304,478 7,265,837 +14.29 5.90 5.68 +0.22 133.91 121.33 +10.37

ASEAN 4,595,893 4,074,668 +12.79 5.28 5.15 +0.13 126.84 114.83 +10.46

South Asia 985,098 809,300 +21.72 6.24 6.14 +0.10 145.06 128.40 +12.98

Europe 4,329,583 3,920,013 +10.45 14.54 14.24 +0.30 117.88 107.90 +9.25

The America 792,190 795,110 -0.37 13.45 13.52 -0.07 135.63 126.69 +7.06

Middle East 615,006 523,343 +17.51 9.98 9.94 +0.04 143.05 128.16 +11.62

Africa 121,816 107,837 +12.96 9.27 8.64 +0.63 144.68 130.59 +10.79

Oceania 788,229 728,401 +8.21 11.79 11.24 +0.55 144.84 129.66 +11.71

Total 15,936,400 14,149,841 +12.63 9.12 8.99 +0.13 128.71 116.98 +10.03

Source: Office of Tourism Development (2011). Tourist Arrivals in Thailand. Bangkok: Tourism Authority of

Thailand.

This study employed qualitative research methods that facilitate analysis of

the fluid relationships among the diverse perspectives of medical tourismstakeholders. Qualitative research methods are appropriate for situations in

which studies are not conducted actively or for contexts in which a new social

issue stimulates interest. This study primarily adopted a content analysis, or

hermeneutic, approach that involved a textual analysis of industrial or academic

texts pertinent to international and Thai medical tourism. The sources of the

content analysis included reports, newspapers, magazines, advertising materials,

websites, books, and company or government documents that address medical

tourism. This extensive body of texts addresses the strengths, weaknesses,

opportunities, and threats related to medical tourism and offer ways to

surmount obstacles identified in the analysis of the demand and supply sides of

medical tourism in Thailand.

Medical Tourism

Medical tourism is a newly emerging sector in the tourism industry and has

become an important industry in recent years. According to surveys and reports,approximately 2 million U.S. citizens participated in medical tourism in 2008,

and 6 million participated in medical tourism in 2010 (Kher, 2006). Youngman


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151

(2010) reported that the demand for medical tourism involves approximately 5

million people internationally per year, according to the top-25 countries that

receive medical tourists. Information on the demand for medical tourism differs

because exact statistics have not been collected on the medical tourism industry.

According to Youngman (2010), Thailand, India, and Singapore have been

successful in attracting some 2.2 million medical travelers. Medical tourists are

drawn to these countries because they provide less expensive but high-quality

medical services. In addition to these Asian countries, Colombia, Argentina,

Bolivia, Brazil, Costa Rica, Mexico, and Turkey are also establishing

themselves as health-care destinations.Studies related to medical tourism have only recently been conducted, and

there are less than 20 academic studies on the tourism journals. Before

exploring the literature, medical tourism should be defined. Earlier, Van

Sliepen (as cited in Hall, 1992) listed three components of health-care tourism:

staying away from home, health care as a main purpose, and staying in a leisure

setting. Therefore, the main purpose of health tourism is health care, and it

requires that the tourist leave home and stay in a location that provides health

services.

Mueller and Kaufmann (2001) defined medical tourism differently,distinguishing between wellness tourism and health-care tourism. They viewed

medical tourism is an activity to restore health, whereas wellness tourism as an

activity to prevent diseases. Health-care tourism is defined as an activity to both

prevent diseases and to restore health. A study of Henderson (2004) considered

medical tourism part of health-care tourism and included plastic surgery, spas,

and alternative therapy. Plastic surgery includes breast augmentation or

reduction and wrinkle removal. The spa and alternative therapy category

includes aroma therapy, yoga, and massage. Henderson noted that medicaltourism also includes medical services, such as cancer treatments, heart surgery

or organ transplants, and health exams. More recently, Connell (2006) viewed

medical tourism as a combination of medical care and the tourism industry. In

other words, medical tourism combines characteristics of the private medical

sector and characteristics of the public and private tourism industry. This view

is consistent with those of other researchers (Heung et al., 2010, 2011;

Horowitz and Rosenweig, 2007; Singh, 2008).

Medical treatments in medical tourism can be divided into three categories:

simple surgeries, such as dental operations and cosmetic surgery; complexsurgeries, such as cancer treatment, heart surgery, and organ or bone

replacement; and medical checkups or health screening. These operations


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require knowledgeable medical staff, state-of-the-art medical facilities, and

high-quality patient services on the supply side. On the demand side,

consumers of medical tourism must have the funds necessary to pay for the

high costs of medical treatment.

In addition to studies that have defined medical tourism or measure the

scale of the market, a few studies have attempted theoretical approaches or

applied tourism theories to the medical tourism field (Caballero-Danell and

Mugomba, 2007; Heung et al., 2010; Smith and Forgione, 2007: Ye et al.,

2008). A study by Smith and Forgione (2007) classified factors affecting the

choice of international medical tourism destinations and factors affecting thechoice of international medical facilities. The factors affecting the destinations

include economic conditions, political climate, and regulatory policies, and the

factors affecting medical facility include costs, physician training, quality of

care, and accreditation. A conceptualization of medical tourism by Caballero-

Danell and Mugomba (2007) indicated a market structure of medical tourism

that considered various stakeholders. Their model emphasized a need to explore

medical tourism-related issues between patients (customers) and medical

tourism destinations. They included customer benefits, branding, legal

frameworks, infrastructure, target markets, products, communication channels,operators, and social issues.

Ye et al.’s (2008) study explored the motivational factors and barriers to

medical tourism among potential tourists in Hong Kong. They divided medical

tourists’ motivations into four categories: push factors, pull factors, facilitating

factors, and other considerations. Their framework seems to be well organized.

For example, family, partners and companions were considered facilitating

factors. Other considerations included destination attributes, time, and service

attitude and quality. Most of these factors are likely to be pull factors or pushfactors. As a result, this classification is vague, and the motivations identified

do not include the most important components. A study by Heung et al. (2010)

approached medical tourism from both demand and supply perspectives. On the

demand side, potential medical tourists are informed about medical tourism

through advertising and distribution channels that influence the selection of the

medical staff, hospital, and country. The supply side of medical tourism

includes factors such as infrastructure and superstructure, promotion, quality,

and communication.

Several studies have focused on identifying the psychological states ofmedical tourists, such as satisfaction, motivations and constraining factors

(Hunter-Jones, 2005; Muller and Kaufmann, 2001; Sayili et al., 2007; Ye et al.,


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153

2011) and cultural differences (Yu and Go, in press). Hunter-Jones (2005)

explored the motivations for tourists seeking cancer treatment, and

Moghimehfar and Nasr-Esfahani (in press) examined the reasons why infertile

Muslim couples traveled to Muslim countries for treatment and their reasons

for medical travel. Yu and Go (2012) analyzed how Korean, Japanese, and

Chinese tourists approached medical tourism. Among other results, they found

that Japanese tourists preferred to travel abroad for major surgery, and Chinese

tourists preferred to travel abroad for minor surgery. Chinese respondents

showed a high interest in aesthetic services, whereas Japanese tourists indicated

a high interest in rehabilitation services.

Market Analysis of Thai Medical Tourism

As shown in Table 2, medical tourism in Thailand has dramatically

increased in recent years. The official figures indicate the number of

international arrivals for medical treatment and medical tourism spending. The

number of foreign patients and the amount of medical tourism spendingincreased by approximately 20% and 116% from 2007 to 2010, respectively

(Travel and Tourism Medical Tourism, 2011), and the majority of medical

tourists came from Europe, Asia, and the Middle East (Health and Wellness

Tourism-Thailand, 2011).

Table 2. Number of International Medical Tourists and Spending from 2007 to 2010

Year Number of medical tourists Medical tourism spending (USD)

2010 1,580,000 635,000,000

2009 1,260,000 487,000,000

2008 1,360,000 390,200,000

2007 1,325,000 294,200,000

Source: Travel and Tourism Medical Tourism (2011). Global medical tourism briefing: a fast growing niche

market. Euromonitor International, pp. 1-36.

This increase has been attributed to the high quality of care offered by

highly trained doctors and nurses, the use of sophisticated medical technologies,

and a high level of hospitality offered to clients (Connell, 2011). In addition,

the cost of medical treatment in Thailand is significantly lower than the cost of

similar treatment in developed economies. As a result, individuals fromdeveloped countries who are uninsured, underinsured, or wish to receive

uninsurable medical procedures actively seek opportunities to receive medical


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treatment overseas where the cost is lower and the waiting time is significantly

shorter (International Medical Travel Journal, 2010). Table 3 compares the

costs of medical treatment provided in the U.S., Thailand, Singapore, Costa

Rica, India, and Mexico.

Table 3. Comparison of Medical Treatment Costs

Treatment USA Thailand Singapore Costa Rico India Mexico

Angioplastry 61,500 14,500 14,500 11,000 10,500 16,500

Heart bypass 127,000 13,000 22,500 29,000 11,000 26,500

Heart valve 170,000 11,500 15,500 18,000 12,000 21,500

Hip replacement 44,500 13,000 13,500 13,500 10,500 17,000

Hysterectomy 20,000 5,000 7,000 5,000 5,000 7,000

IVF 14,000 No data 9,500 No data 5,000 No data

Mastectormy 24,000 10,000 14,500 No data 9,000 10,000

Source: SureryPlanet (2011). Comparison of medical treatment costs. Retrieved December 17, 2011.

www.surgeryplanet.com

Despite these impressive statistics, attracting medical tourists to developing

countries is not without its challenges. Studies have suggested that the majority

of people in developed countries tend to believe that developing countries donot have high standards of medical care and hygiene (Heung et al., 2011; Singh,

2008). However, there has been little published research on the specific issue of

consumer behavior in the context of medical tourism. As a result, managerial

decisions on medical tourism in host countries tend to be based on intuition and

information from relatively unreliable literature. However, some reliable

research has focused on the reasons why medical tourists travel abroad for

medical treatment, such as finances, waiting times, and the unavailability of the

desired treatment in the medical tourists’ countries of residence (Heung et al.,

2010, 2011; International Medical Travel Journal, 2010).In recognition of the potential for further growth in medical tourism, the

Thai government decided to promote the country as a hub for medical tourism

in 2004. The government aimed to emphasize two categories: medical

treatment, such as conventional medical operations and treatment, and health-

and-beauty therapy, including traditional therapies for general well-being, such

as Thai massages and spas (Euromonitor International, 2011). Thailand has

since aggressively promoted both categories of health-tourism products to a

range of potential medical tourists, including general tourists, health tourists,

diplomats in Thailand and neighboring countries, and expatriates in Thailand

and neighboring countries. The country has accomplished this promotion by

leveraging its advanced therapeutic technologies, the quality of its medical


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155

personnel, its price advantages, and its reduced waiting times (Ramirez de

Arellano, 2007).

According to Euromonitor International (2011), the Thai government

continues to develop medical services to meet international standards with the

ultimate aim of making Thailand a major medical tourism hub in Asia, a

campaign that has been successful since its inception in 2004. The promotion of

medical tourism in Thailand is expected to continue. For instance, the Thai

government planned to introduce a one-stop shop for various medical spas at

Suvarnabhumi Airport in 2011. This project is expected to be the first such

medical spa in the world and will provide medical information and services tointernational tourists. Medical tourism is growing impressively, with sales of

Baht 2.1 billion (USD 70 million) and an increase in value of 22% in 2010.

However, the number of medical tourism outlets remains low; only 30 medical

tourism providers operated in Thailand in 2010.

The major markets for Thai medical tourism are the U.S., Japan, the U.K.,

and oil-producing Middle Eastern countries. Medical tourists travel to Thailand

for treatment of general medical illnesses, cosmetic surgery, and dentistry.

These individuals represent a high-spending tourist segment, with each person

spending approximately AUD$1000 per visit (including non-operativetreatments) (Jotikasthira, 2010). Private Thai hospitals offer one-stop services

for medical tourists, including immigration services, airport offices, foreign

market offices, and interpreting services (Strategic and Marketing Magazine,

2007 cited in Jotikasthira, 2010). To gain the confidence of medical tourists

from developed countries, private Thai hospitals have also affiliated with

health-care institutions and medical schools with good international reputation.

One of the leading private Thai hospitals that competes for foreign patients

is Bangkok General Hospital, which has divided its operations among severalhospitals that specialize in various diseases, including cardiology and cancer,

by investing considerable resources into sophisticated equipment. Medical

schools utilize these hospitals for clinical research, and the hospital has become

associated with significant research work in major academic seminars and

publications. Another leading Thai hospital is Piyavet Hospital, which has

established units that specialize in cardiology, neurology, and gynecology

(Strategic and Marketing Magazine, 2007 cited in Jotikasthira, 2010).

Bumrungrad may be the Thai hospital with the best reputation in the

international medical tourism market. This hospital is considered as havinghigh medical standards by international patients and is recognized worldwide

for quality through the Joint Commission International (JCI) accreditation. This


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hospital has 484 beds and treats more than 420,000 international patients each

year from more than 200 countries (Bumrungrad International Hospital, 2011).

Its main 22-story building and 700 parking spaces were opened in 2008 to

comply with U.S. hospital building and safety standards. The hospital has 2,100

medical personnel, most with international training and certification

(Bamrungrad International Hospital, 2011). In addition, 200 physicians are U.S.

board certified (Medical Tourism in Thailand, 2011), and a team of 900 nurses

assists with patient care. The hospital offers a variety of facilities, including

interpretation in more than 10 languages, and uses Global Care Solutions’

Hospital 2000, a sophisticated health information technology system. Thissoftware is designed to recognize and prevent dangerous drug interactions,

store patient records electronically and fully integrate all areas of patient

management and hospital operations. The hospital staff assists patients with

travel arrangements, airport pickup, interpreters and lodging, as needed.

Seventy-five percent of Bumrungrad’s patients pay cash for their services

(Bumrungrad International Hospital, 2011).

Thailand is attempting to differentiate itself from competing destinations

without indulging in intense price-discounting by moving into alternative areas

of tourism, such as medical tourism. Thailand is well suited for this type oftourism because of its advanced medical services, comparative costs, and

traditional Thai hospitality (Strategic and Marketing Magazine, 2007 cited in

Jotikasthira, 2010). Because medical tourism is a relatively new segment of

tourism for Thailand, it requires considerable further development. Two of the

key tourism agencies in Thailand, the Tourism Authority of Thailand and the

Ministry of Tourism and Sports, have yet to integrate their efforts to promote

the country as a medical tourism destination as they have successfully done in

the past with the business and leisure tourism sectors (Rittichainuwat et al.,2001). This delay is mainly because the promotion of the country as a medical

tourism destination poses novel challenges in aligning the destination image of

Thailand with the motivations and decision-making processes of prospective

medical tourists. To provide a foundation for the further development of

Thailand as a medical tourism market, the key behaviors of medical tourists,

which are likely to be fundamentally different from those of leisure tourists,

should be understood, especially with regard to destination choice.

Countries wishing to succeed in medical tourism must study the

environment and implement a strategic management process to maximize the potential of existing assets, thereby maximizing the gains. Below we discuss

some of the strengths, weaknesses, opportunities and threats for Thailand’s


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157

medical tourism industry.

Results of SWOT Analysis

Strengths

Strengths are inherent abilities that an organization can use to gain a

strategic advantage, such as superior research or a new development within a

service industry. The following five strengths have been identified in Thai

medical tourism. First, Thailand provides a wide range of quality medical

services that are affordable when compared with medical services in the West.

Thai hospitals offer world-class treatments in nearly every medical sector,

including cardiology and cardiothoracic surgery, joint replacement, orthopedic

surgery, gastroenterology, sex reassignment, plastic surgery, dentistry, and

other areas. For heart valve surgery, the medical treatment costs are 15 times

cheaper than in the U.S., 1.35 times cheaper than in Singapore, and 1.9 times

cheaper than in Mexico (SureryPlanet, 2011; Youngman, 2010).

Second, the Thai government has provided strong support throughcoordination because it quickly recognized the need for coordination across

various sectors to maximize the industry’s potential. Therefore, the government

developed a common vision, strategic direction, and shared objectives for

various sectors to facilitate better coordination among the concerned parties,

including the public sector (e.g., the Ministries of Health, Tourism, and Foreign

Affairs and Tourism Authority of Thailand (TAT) and the private sector (e.g.,

Thai Airways and Bangkok Airways).

Third, Thai medical tourism has continuously implemented effective

marketing programs. For example, the TAT has played a key role in providing

integrated marketing of Thai tourism abroad. The TAT has more than 18

offices worldwide and has won several international awards for developing

excellent marketing campaigns targeted at tourists. The TAT has been

extremely successful in marketing Thai health services as well.

Fourth, hospitals that specialize in medical tourism focus on hospitality to

provide a superior consumer experience and to build brand equity. For example,

the Bumrungrad Hospital, which is operated by Bumrungrad International

Limited, has 102 clinics in Thailand and other nations. This internationalhospital provides hospitality services that include transportation from the

airport, interpreters for 18 languages, and an in-house Starbucks and


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McDonald’s to cater to tourists from the U.S. and the U.K. The hospital is

eager to promote itself by offering loyalty cards, in-flight magazines, free

mileage through alliances with airlines and overseas representatives’ offices in

Europe, North America and Asia. In addition, Bumrungrad Hospital offers

amenities like those in a luxury hotel, such as food prepared by professional

chefs. The hospital cares for 3,000 patients a day, with average treatment times

of 45 minutes and waiting times of 17 minutes (Bumrungrad International

Hospital, 2009, p. 1). Another example is Bangkok Airways, the largest private

airline in Thailand, which owns three hospitals: Bangkok Hospital Medical

Center, the Bangkok Hospital Group, and Samitivej Hospital. The airline offersfrequent flyer points to patients and operates a wellness center and golf clubs.

Fifth, the medical infrastructure has also been improved. Thailand built a

strong health infrastructure during the economic boom by encouraging private

and public participation. According to the World Tourism Organization,

Thailand will be able to manage expansion only if it matches the increase in

visitors with a massive increase in accommodations and in the airport and

public transportation infrastructure. Thailand has already taken steps to

accommodate the expected growth with the new Bangkok Mass Rapid Transit

(MRT) metro system, which opened in 2004 (Thailand Tourism Report Q2,2011).

Weaknesses

A weakness is an inherent limitation or constraint that creates strategic

disadvantages. An example of a weakness is overdependence on a single

service line, which is potentially risky for a service industry in times of crisis.

Seven weaknesses have been identified in Thai medical tourism. First, there is a

lack of uniform pricing across hospitals in the kingdom. Thai hospi¬tals do not

offer fixed pricing, although prices are typically lower than in the West

(Herrick, 2007). Second, Thai medical services are limited due to the language

barrier. English is barely used in Thailand, making it difficult for tourists to

communicate with health professionals.

Third, Thailand is believed to be unhygienic and dangerous because of the

presence of fatal diseases, such as AIDS, cholera, and local epidemics. These

concerns lead potential tourists to distrust medical facilities or services in

Thailand. Fourth, although the Thai government evaluates hotels andrestaurants based on the quality of their service or facilities, there is no regular

quality assessment program for hospitals that treat medical tourists. An


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evaluation program for medical hospitals should be introduced to increase

credibility with potential foreign medical tourists.

Fifth, government agencies in charge of medical tourism are not well

integrated because medical tourism is dispersed among agencies in the

Ministries of Health, Tourism, and Foreign Affairs and the Tourism Authority

of Thailand (TAT). This situation leads to a delayed response in the event of a

medical accident because there is no central authority to address the situation,

and no agency wants to take responsibility for a complicated medical issue. In

addition, this decentralization delays the development of medical tourism

policies, the implementation of rapid action plans, and research. To addressthese concerns, a single government agency should control and integrate these

public and private roles together to further speedy decision making process.

Sixth, Thailand has a shortage of capable doctors and other medical staff

(Connell, 2006, p. 149) because patients requiring serious operations tend to

travel to more medically advanced countries. Current Thai medical procedures

include dentistry, gender reassignment, health exams, aesthetic treatments,

transplant operations and cardiac surgery. A lack of expert medical staff cannot

attract patients to pay expensive operation fees. Thus, the tourism industry

currently relies on non-surgical approaches, such as massages, saunas, bathingor alternative medical procedures that do not generate high profits.

Seventh, only a few well-known Thai hospitals, such as Bumrungrad

Hospital, Samitivej Hospital, Bangkok Hospital, Phuket Hospital and Dusit

Medical Services, Phuket and Koh Samui, are capable of attracting foreign

medical tourists. These are JCI-accredited hospitals and are mainly located in

Bangkok, Phuket and Pattaya. However, the medical quality in most public

clinics is not sufficiently high to promote these clinics to medical tourists. In

addition, waiting times in Thailand’s public clinics tend to be long becausecompetent medical staff move to private clinics that offer better salaries or that

compensate for their liability risk.

Opportunities

An opportunity is a favorable condition in a service industry that allows a

tourism destination to consolidate and strengthen its position. The following

eight opportunities were identified for Thai medical tourism. First, the aging

population has dramatically increased. Aging Baby Boomers, those born soonafter the end of World War II, have redefined the conventional view of the

elderly (Kotler, Bowen, and Makens, 2010). Despite their chronological age,


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Baby Boomers continue to live active lives and to care about their appearance.

These people, who often have high disposable incomes, are increasingly likely

to consume aesthetic products and seek cosmetic services (Yu and Go, 2012).

According to a survey, there are approximately 77 million aging Baby Boomers

in the U.S. alone. Of this population, 12% are uninsured (Fraser Institute, 2011).

In the U.S., these elderly patients are not receiving the care they need and

deserve, partly because their health-care system has low reimbursement rates,

focuses on treating short-term health problems rather than managing chronic

conditions and lacks coverage for preventive services or for health-care

providers’ time spent collaborating with a patient’s other providers. Healthtourism, which offers a lower price and an included holiday package, is one of

the better alternatives for Baby Boomers to obtain the medical care they need.

Second, there is shortage of supply in National Health Systems in countries

such as the U.K. and Canada. Waiting times to obtain medical attention have

become a significant problem in many Western countries. For example,

according to new research, a typical Canadian seeking surgical or other

therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high (Fraser

Institute, 2011). In another report, the median waiting time for knee

replacement after the operation was planned was three weeks in the UnitedStates and eight weeks in Canada. In the U.K., mean waiting times for persons

admitted for inpatient surgery, such as hip and knee replacement, is

approximately 200 days (Siciliani and Hurst, 2003). In contrast, Thailand offers

medical treatments in a few days.

Third, there is a demand for retirement homes for elderly people, especially

Japanese people. The Japanese constitute the largest proportion of medical

tourists to Thailand, although patients from the United States, the U.K., and the

Middle East also arrive in significant numbers. Thailand’s competitiveadvantage in this sector is pricing (Travel and Tourism Medical Tourism, 2011).

Corporations are another target of medical tourism (Moody, 2007; Smith and

Forgione, 2007). Many companies must pay large medical bills as part of the

fringe benefits they provide to their employees. In many cases, these bills

involve complicated and costly medical procedures. It can be an attractive

option for these firms to refer employees who require complicated procedures

to offshore medical service providers. Retirees who choose to spend their lives

as long-stay tourists in foreign countries can also be targeted as potential

customers of medical tourism (Norra, 2007; Pedersen, 2007). Japan encouragesits citizens to retire abroad, and these retirees often require frequent medical

care. In addition, Thailand has deliberately sought a Japanese market because


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161

many doctors have been trained in Japan, and nurses and other staff have been

taught to speak Japanese (Connell, 2006).

Fourth, the increased demand for cosmetic services in Western countries is

not restricted to the older population; for example, Botox injections have

become popular among young adults and teenagers (Healy, 2008). This

increased demand for cosmetic surgery pervades all age cohorts, but meeting

this demand is usually outside the scope of government policies and insurance

coverage (Norra, 2007). Prospective medical tourists choose to obtain overseas

treatment (both obligatory and elective) because these treatments may be

unavailable or difficult to access (or even illegal) in their countries of residence(Jones and Keith, 2006).

Fifth, globalization makes it easy for patients to travel to other countries.

The effect of these demand and supply factors in medical tourism is facilitated

by significant changes in the global business environment in recent years

(Heung et al., 2010). These changes include increasing globalization and trade

liberalization, enhanced communication through digital technologies,

increasing economic deregulation in developing countries, and a greater

propensity for Westerners to travel abroad (Awadzi and Panda, 2005; Fletcher

and Brown, 2002). As the demand for overseas medical treatment has increased, prospective medical tourists no longer perceive traveling abroad as difficult.

Higher levels of education, greater disposable income, and increased media

exposure to foreign countries make Westerners more likely to travel to

developing countries (Delinsky, 2005; Siciliani and Hurst, 2003). These

lifestyle and demographic changes in developed economies, together with the

increasing ease of international air travel, have increased the demand for

medical tourism.

Sixth, digital technology has played a crucial role in enabling real-timecommunication and diffusion of information. Prospective medical tourists are

therefore increasingly knowledgeable about medical procedures and the

availability of various services to address their health problems (Awadzi and

Panda, 2005; Caballero-Danell and Mougomba, 2006; Fletcher and Brown,

2002). In addition, digital technology has facilitated networking between both

providers and consumers of health-care services across borders (Jones and

Keith, 2006).

Seventh, free-trade liberalization and deregulation has facilitated the flow

of production factors across borders, including people, medical supplies, andtherapeutic devices (Percivil and Bridges, 2006). Free-trade agreements with

more countries increase the importation of medical supplies and devices


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because of deregulation. In addition, improved travel logistics make the

transportation of people and equipment faster and more accessible (Fletcher

and Brown, 2002; Horowitz and Rosenweig, 2007).

Finally, prices for medicine, operations and tourism in Thailand are lower

than prices in developed countries. For example, an MRI in Thailand costs

between $200 and $300, compared with more than $1,000 in the United States

(Herrick, 2007). In fact, the comparative cost advantage in Thailand allows

private health-care providers to design medical services that are very attractive

to medical tourists while remaining much cheaper than similar procedures in

developed countries or other competitive medical tourism countries.

Threats

A threat is an unfavorable condition in an industry’s environment that

creates a risk or potential damage to the industry (Kotler and Keller, 2006). The

following threats were identified in this study. First, threats may include

uncontrollable factors, such as internal political instability, disease epidemics,

natural disasters, and international conflicts with neighboring countries (Bank

of Thailand, 2009). For instance, internal political tensions led to a blockade ofthe Suvarnabhumi and Don Muang airports, which resulted in a significant

decrease in tourist numbers in the second half of 2008 (Monetary Policy Group,

2009). Sudden Acute Respiratory Syndrome (SARS) spread throughout Asia in

2003; the virus infected 1,755 people in Hong Kong and killed 299. These

political or otherwise unexpected incidents have damaged Thailand’s reputation

as the top medical tourism destination by discouraging potential patients from

visiting, reducing the credibility of medical clinics, and casting doubt on the

Thai government’s ability to solve problems.

Second, Thailand is in intense competition with neighboring countries, such

as Malaysia, Singapore, and India (Choo, 2002; Reisman, 2010). Singapore,

located approximately 1,000 miles south of Bangkok, has its own advantages:

English is widely spoken, and it is easy for medical personnel to communicate

with foreign patients. Furthermore, the number of JCI-accredited hospitals in

Singapore and Thailand are approximately equal; Singapore has 14 hospitals

accredited by the JCI, whereas Thailand has 16 JCI-accredited hospitals (Joint

Commission International, 2011). Moreover, India is competing with Thailand

in terms of medical treatment prices and quality (Herrick, 2007; Singh, 2008). New players, such as Malaysia and South Korea, also represent competition

in this industry. Strong financial and institutional support from governments


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163

has been leveraged to enhance the development of this industry. In 2005,

Malaysia’s Ministry of Health (MOH) was given a special allocation of RM

1.65 million by the Finance Ministry for the Malaysian Society for Quality in

Health (MSQH) for the accreditation of private hospitals (Health and Medical

Tourism, 2008). The MOH also organized a workshop on branding and quality

of services for 35 private hospitals in the country in December 2006, followed

by road tours and promotional trips to neighboring countries (Malaysian

Employers Federation, 2008).

Figure 1. Overall Evaluation and Strategies to Promote Medical Tourism in Thailand

Strategies to Solve the Current Problems

Collaboration between Public and Private Sectors

Medical tourism comprises three basic aspects: hospital and health services,

hotels, and travel and leisure. Thus, with attractive policies and appropriate


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marketing strategies, this emerging industry can provide a significant

opportunity for economic growth and infrastructure development for

participating countries. To achieve this goal, host countries must enact a policy

framework that is attractive to consumers worldwide. The framework must

include strategies to encourage customers to travel to the host countries to

receive the health-care treatment they desire. Cooperation between the public

and private sectors in health tourism in Thailand should be promoted (Thailand

Tourism Report Q2, 2011).

The public sector strategies comprise policies and regulatory initiatives,

such as quality standards for providers of health tourism services,improvements in immigration services, the development of relevant

infrastructures, the execution of immense promotional campaigns and reviews

of taxation and incentives for hospitals involved in medical tourism (Ramirez

de Areallano, 2007). Other strategies include increasing the supply of high-

quality human resources, such as medical specialists and professional nurses.

Acceleration of International Certification Achievement

Quality is a pivotal element in promoting medical tourism. Health-care providers in developing countries attempt to ensure that the quality of care they

provide is comparable to that in developed countries by obtaining accreditation

from recognized authorities (Chow, 2009; Marlowe and Sullivan, 2007). An

important organization in the regulation of health-care standards is the Joint

Commission on Accreditation of Health-care Organizations (JCHO), which

regulates the practice of health-care providers through an accreditation system

that requires renewal of registration every three years through inspection by the

staff of the JCHO (Pedersen, 2007).

Although it is quite costly for health-care providers to obtain accreditation

from the JCHO, most are willing to bear the additional cost because of the large

number of patients who are willing to pay more for properly accredited care

(Pedersen, 2007). In addition, an Association of Southeastern Asian Nations

(ASEAN)-wide system for the accreditation of high-quality hospitals could be

developed, which would address the concerns of public and private insurers in

covering medical expenses incurred in other ASEAN countries (M2Presswire,

2008).


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165

Conviction in Legal Practices Regarding Medical Services

In addition to reassurance regarding the quality of care provided by well-

qualified surgeons, prospective patients and insurance companies are concerned

about the possibility of post-operative complications because doctors in the

patients’ countries of residence might be reluctant to take professional and legal

responsibility for subsequent complications (Marlowe and Sullivan, 2007;

Reisman, 2010). To provide reassurance on this point, surgeons in developing

countries must assume professional and legal responsibility for all patients on

whom they operate, including post-surgical recuperation periods (Health and

Medical Tourism, 2008; Herrick, 2007).

The Medical Tourism Association (MTA), which is based in the United

States, was created to establish standards for regulating the quality of care and

ethical practices in medical tourism destinations (Pedersen, 2007). The

checklist for prospective medical tourists to evaluate medical tourism

destinations includes the following aspects: facilities and infrastructure;

qualifications and certifications of doctors; success and failure rates; mortality

and morbidity rates; and due diligence (whether patients deal directly with

health-care providers) (MacReady, 2007). Furthermore, the development ofrules regarding the privacy and confidentiality of patient information would

help to assure patients that foreign hospitals treat such information responsibly.

Well-planned Development for Infrastructure

Relevant infrastructure also requires attention. Existing infrastructure

should be upgraded and improved, and countries must consider expanding their

networks. Areas that should be continued or enhanced include the restoration

and conservation of historical sites, upgrading of tourism facilities andinfrastructure, beautification of tourism sites, development of medium-priced

hotels and provision of public amenities, pedestrian walkways and landscaping

of tourist spots (Macready, 2007). Various ministries of the government are

responsible for these projects.

Human Resource Planning for the Medical Industry

The government should not ignore the demand for professionals in the

health-care sector. Changes may be necessary in policies in postgraduate

medical education and nursing education to meet the growing need for highly

skilled workers.


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The qualifications of surgeons should also be reinforced (Awadzi and

Panda, 2005; International Medical Travel Journal, 2010). For example,

promotions for a hospital in Thailand that announce that it has more than 200

American-trained surgeons (and provides interpreting services in more than 26

languages) are very appealing to tourists (Awadzi and Panda, 2005, Service

Promotion Department, 2007; Ramirez de Arellano, 2007).

Improvement of Promotional Strategies

In Thailand, it is argued that the country’s reputation as a tourist destinationhas boosted medical tourism to such an extent that at the Bangkok Dental Spa,

which treated about 1,000 overseas patients in its first year, 90 percent of the

patients already knew Thailand and loved it as a holiday destination (Levitt,

2005). General tourism provides the basis for medical tourism. Thailand

primarily draws patients from Japan, Brunei, Singapore, Taiwan, Pakistan,

China and Bangladesh (Connell, 2011). Because private medical care depends

on the market, a suitable market should be sought for optimum profit.

Therefore, there is a need to focus on the clients’ countries of origin. Thailand

should recognize that a strategy that works for attracting patients from onecountry may not work for patients from another country because the patients’

expectations and needs are different.

Therefore, the industry should recognize this diversity in the medical

tourism patient population and devise strategies to tap into niche markets

(Percivil and Bridges, 2006; York, 2008). If the host country focuses on clients’

specific characteristics, the host will be able to provide exactly what these

clients require. In turn, the clients will be satisfied and will be more likely to

return to the host country for other treatments or for vacations. These clients

may also recommend the host country to their family and friends.

Focus on Customer Satisfaction

Treatment and services must be packaged so that patients are satisfied and

must include not only the medical treatment but also information, accessible

transportation, lodging and tourism. Everything should be planned in detail.

The more welcomed the patients feel, the more satisfied they will be. Further,

language plays a pivotal role in this aspect of the service. Everything should bemultilingual, from the promotional website about the participating hospitals to

in-house interpreter services. An example of this approach is practiced in the


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167

Bangkok Hospital International Medical Center. This hospital offers services in

26 different languages (e.g., English, Chinese, Japanese, and Dutch),

recognizes cultural and religious dietary restrictions and has a special wing for

Japanese patients (Danish Trade Council of the Royal Danish Embassy

Bangkok (2006).

Establishment of Strategic Alliances and Networks

Medical destinations can seek to allay the safety concerns of potential

medical tourists by establishing relationships with health-care providers in thecountries of origin. For example, some American medical insurance companies,

such as Optmed Health Group and Blue Cross/Blue Shield, now provide special

programs for self-insured employers and policy holders to receive medical care

at Bumrungrad Hospital in Thailand (Moody, 2007).

Discussion

Thailand has actively marketed itself as a destination in the leisure tourism

market for many years. The industry has shown signs of entering the maturity

stage in terms of per capita spending and the absolute number of tourists.

Therefore, Thailand has sought to enhance both its tourism numbers and

revenue by reducing its dependence on leisure tourism and diversifying its

tourist market to include other types of travelers, such as medical tourists.

The aim of this study was to analyze Thai medical tourism for foreign

tourists, to understand this market in more detail, and to identify ways to

overcome some of the obstacles that affect this market. The findings show the

successful factors in medical tourism in Thailand. In this study, SWOT analysis

was adopted as exploratory method to investigate the market of Thai medical

tourism. The analysis considered the strengths, weaknesses, opportunities, and

threats of this market. Consequently, this study has important implications for

the key players in the medical tourism industry in Thailand.

The following recommendations are made to remove the obstacles to the

development of medical tourism in Thailand. First, quality must be considered

a critical issue. Thai hospitals should focus on two areas to increase the numberof foreign patients in medical tourism: providing qualified physicians and

addressing post-operative complications. Thai hospitals targeting foreign


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patients should obtain accreditation from the Joint Commission on

Accreditation of Health-care Organization (JCHO), which regulates the practice

of health-care providers through an internationally accepted accreditation

system. In addition, joint ventures and alliances with overseas health

institutions and insurance players should be pursued to develop a significant

advantage and leadership position in the industry.

Second, foreign languages can be a problem in communication throughout

the treatment and recuperation process. To achieve an international medical

service standard, Thai hospitals should employ medical staff who can speak

foreign languages. The language barrier is not confined to English, although thedemand for other languages will depend upon the target market. The languages

that are commonly used in this business include English, Mandarin Chinese,

and Japanese. Finally, relevant infrastructures require particular attention. The

existing infrastructure must be upgraded and improved, and new ones must be

considered. These tasks are the responsibility of governmental agencies,

including the Ministry of Public Health, the Ministry of Transport, the Ministry

of Tourism and Sports, and the Ministry of Information and Communication

Technology.

Globalization has made health tourism possible and has contributed to itsgrowth. For participating countries, this new industry generates billions of

dollars a year and is worth developing. In the ASEAN region, Thailand is

making a mark on the medical tourism industry due to its availability of

medical and technical expertise, high-quality infrastructure, comparative cost

advantage, and scenic beauty. However, competition is becoming more intense,

and future success will largely be determined by the development and

implementation of a joint strategy by various players in the industry.

Acknowledgments: This work was supported by the National Research

Foundation of Korean Grant funded by the Korean Government (NRF-2011-

332-32A-B00277).


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169

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Received January 11, 2013

Revised July 17, 2013

Accepted July 30, 2013


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