Medical tourism: Looking ahead to 2015

Thailand leads Asean with 1.4 million foreign patients but Asian Economic Community in 2015 means changes in medical education & maybe importing nurses.

In photo above British national Richard Newman describes his condition to a nurse following his surgery to remove fat at Yanhee General Hospital in Bangkok. Thailand’s current medical staff shortage will become even more acute once the gates of the Asean Economic Community open in 2015 and competition for talent escalates.

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COMMENTARY

Medical tourism under threat

20/06/2012
Sutapa Amornvivat

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 and enhanced 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 globalisation 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 labour movement would be made easier under Mutual Recognition Agreements (MRAs), which aim to facilitate the movement of skilled labour 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 licence 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 in direct 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 labour 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 relevant professional 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 labour 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 labour 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.

(Source: Bangkok Post, COMMENTARY, Medical tourism under threat, 20/06/2012, Sutapa Amornvivat, link) 

Medical Tourism Vocabulary

medical tourism - (See Wikipedia)

threat - a danger อันตราย
under threat - facing some danger (something may cause damage or harm in the future)

medical tourism under threat

national - a citizen of a particular country ประชาชน
British national - a citizen of the UK (Great Britain)

condition - meaning: medical condition
medical condition - a disease or medical problem

nurse - the medical workers who take care of sick people พยาบาล (See Wikipedia)

describes his condition to a nurse

remove - to take something away เอาออกจาก
remove fat

surgery - medical treatment in which a doctor cuts open someone's body การทำศัลยกรรม การผ่าตัด
surgery to remove fat

staff - employees of a company, people who work for a company พนักงาน
shortage - when there is not enough of something การขาดแคลน
staff shortage

current - of the present time ปัจจุบัน
current medical staff shortage

acute - very serious เฉียบพลันและรุนแรง
become more acute

escalates - grows greater; grows stronger; increases in strength and intensity

talent - the natural ability to perform some job or task well; a natural ability to be good at something, especially without being taught ความสามารถพิเศษ
competition for talent escalates

In photo above British national Richard Newman describes his condition to a nurse following his surgery to remove fat at Yanhee General Hospital in Bangkok. Thailand’s current medical staff shortage will become even more acute once the gates of the Asean Economic Community open in 2015 and competition for talent escalates.

star industry - one of the most important and promising industries for the future of the country
shortages - when there are not enough goods for people to buy การขาดแคลน

healthcare - the treatment and prevention of diseases and other medical problems
healthcare professionals - highly trained workers healthcare (doctors, nurses, physical therapists, etc)

hub - the central or main part of something where there is most activity จุดศูนย์กลาง
medical hub

Asean Economic Community (AEC) - the plan for Asean countries to work closer together economically in the future, including reduced tariffs (taxes on goods imported from other Asean countries) and increased free movement of workers between countries

 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 comes into being.

destination - the place where someone or something is going จุดหมายปลายทาง ปลายทาง
destination for medical tourism

undeniable - you cannot say it is not true; a fact that you cannot argue about

patients - people receiving medical treatment, to cure a disease or medical condition
foreign patients

treat -
treat patients

figure - an amount of money จำนวนเงิน
the figure is far higher than those of our regional peers

peers - people or organisations at the same level and position but in a different place; people with the same age, job, or status as you เพื่อนร่ีวมสาขาอาชีพ
regional peers - people or organizations doing the same kind of work in other Asean countries

international - between countries ระหว่างประเทศ
international standard of health care

comparatively low costs

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.

popularity - many people like it
closest competitors

hail from - come from a place
emerging middle class - people who are moving from being poor to being middle class (because of a small business or a better job, for example)

treatment - the process of providing medical care การรักษา
medical treatment

opportunities - a situation where it is possible to do something that you want to do

arrival - when someone reaches where they are going (arrives) ขาเข้า การเข้ามา
the arrival of AEC

Despite its popularity as a medical hub for international visitors, Thailand still draws far fewer medical tourists from within Asean that 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 ... - talking about the "supply" of some good or service in a market

attractive - worth having or doing
attractive destination
attractive destination for medical tourists

reputation - the opinion people have about how good or bad someone or something is ชื่อเสียง ความนับหน้าถือตา  ที่เป็นที่รู้จัก
reputation as an attractive destination for medical tourists

draw - attract, get new people or organizations to enter some place or some new market
draw new service providers

participate - to take part in or become involved in an activity มีส่วน

lucrative - profitable, can make a lot of money doing it ที่มีกำไรงาม
lucrative business

draw new service providers from other Asean countries to participate in the lucrative business

priority - something important that must be done first สี่งที่สำคัญเป็นลำดับแรก การให้ลำดับความสำคัญ
priority sector
priority service sector
AEC priority service sectors

cap - limit (set largest amount that it cannot go beyond)
nationality - the official right to belong to a particular country สัญชาติ,เชื้อชาติ, ชนชาติ
foreign ownership cap for investors of Asean nationality will be raised to 70%

equity - the stock shares of company, the money put into a company by its owners; money for a business that comes from owners, not borrowed money (debt) เงินลงทุน ที่มาจากการระดมหุ้นของหุ้นส่วน และผู้มีกรรมสิทธิ กรรมสิทธิ์หุ้นส่วนในบริษัทห้างร้าน

participation - being involved in an activity (rather than merely watching it happen)
foreign equity participation

15% foreign equity participation on average

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.

stakeholders - 1. shareholders and others such as employees taken into account in corporate decisionmaking and governance; 2. all the people who will benefit or lose from a decision or outcome ผู้ที่ได้รับผลกระทบจากการตัดสินใจ  (See glossary) ผู้ถือหุ้น ผู้ได้รับผลประโยชน์  (See Wikipedia)

majority - more than 50 percent of a group ส่วนมาก เสียงส่วนมาก คนส่วนใหญ่
majority stakeholders

profitability
proven profitability
proven profitability of private hospitals

innovative - using new methods or ideas เกี่ยวกับการปรับปรุงใหม่, ที่เต็มไปด้วยจิตใจปฏิรูปใหม่
usher in innovative medical care and tailored services

cater to - serve, provide people with something they need; fulfil a need 
cater to customers' medical needs

benefit - to get help or an advantage from something ผลประโยชน์
benefit from competition in the form of a better standard of services

enhanced - made better; improved
enhanced medical technology

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 and enhanced medical technology.

obstacle - a difficulty or problem that prevents you from achieving something อุปสรรค ขวากหนาม; an object that you must move or go around in order to move forward อุปสรรค, สิ่งกีดขวาง

significant - important สำคัญ
significant obstacle

notion - belief or idea ความคิด, ความเชื่อ, แนวคิด

personnel - people who work for a company or organisation
shortage of medical personnel
shortage of medical personnel, both in terms of quantity and quality

hamper - prevent action; to stop someone or something from making progress or developing; to hinder ขัดขวาง, เป็นอุปสรรค

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.

adequate - good enough or large enough for a particular purpose;  good enough to do the job; enough to achieve goals พอเพียง
adequate numbers
produce adequate numbers
produce adequate numbers of medical workers

satisfy a need - when someone needs something and then they get it (so they don't need it anymore)

domestic - within the country ภายในประเทศ
domestic medical needs
satisfy domestic medical needs
satisfy even domestic medical needs

challenges - new and difficult problems to solve, that require effort and determination
cultural challenges
face cultural challenges

integration - the process of combining with others to create a single unit or system การรวมเข้าด้วยกัน, การผสมผสาน joining together into one unified whole; joining things together into one unit so that they work together
the integration of the AEC

in general

globalisation
globalisation in general

skills - a type of work or task requiring special training and knowledge ทักษะ ความสามารถเฉพาะทาง
second-language skills

deficiency
deficiency in second-language skills

disadvantage - something that makes someone or something less effective, successful or attractive ข้อเสียเปรียบ ข้อด้อย
a major disadvantage

plague
plaguing Thailand's medical tourism industry 

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 globalisation 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.

registered nurses

demand - the need and desire to buy goods and services by households and businesses
meet demand

decade - a period of ten years ทศวรรษ, ระยะเวลา 10 ปี
in the past decade

declining numbers of new nursing graduates in the past decade

efforts - people trying to accomplish something, achieve a goal ความพยายาม
efforts - the work done towards achieving some goal

practical - suitable for the situation in which something is used ที่ขึ้นอยู่กับความเป็นจริง
practical - useful for real people in real situations
practical nurses

efforts to produce more practical nurses (i.e. caregivers)

training - to teach people how to do an activity or job การฝึกฝน
one-year training
complete one-year training
only need to complete one-year training

satisfactory
satisfactory levels
far below satisfactory levels

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.

surplus - an amount above the required or necessary amount
nurses are in surplus

labour movement

Mutual Recognition Agreements (MRAs)

aim - purpose; goal; the thing you hope to achieve by doing something  เป้าหมาย จุดมุ่งหมาย
facilitate - help; to make it possible or easier for something to happen ทำให้สะดวกขึ้น
aim to facilitate the movement of skilled labour in priority sectors

relieve - to help improve a bad situation ผ่อนคลาย, บรรเทา
pressure - stress, cannot live comfortably (difficult decisions must be made) ความกดดัน ความตึงเครียด

relieve pressure
relieve pressure on domestic healthcare services

resources - things such as money, workers and equipment that can be used to help achieve something ทรัพยากร  things needed for proper functioning, to get a job done
competition for resources

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 labour movement would be made easier under Mutual Recognition Agreements (MRAs), which aim to facilitate the movement of skilled labour 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.

proficient - skilled and experienced เจนจัด, ชำนาญ, เชี่ยวชาญ
proficient in the Thai language

licence - official permission from government to do a business or some activity ใบอนุญาต
nursing licence - official permission from the government to work as a nurse (after taking an exam)

interests - people who gain or lose depending on how events turn out (example: business interests)
not in the interests of the patients

mother tongue- the first language you spoke with your language when you were young

in direct competition - are selling the same good or service and competing for exactly the same customers

complement - go well together (when they are used together, you get more benefit than using them separately; whole is greater than sum of parts)
complement each other

availability - when something exists and people can use it
improving availability
improving the availability of health care
improving the availability and quality of health care for all

However, despite the MRAs, foreign nurses will still need to be proficient in the Thai language to pass the examination for a full nursing licence 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 in direct 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

review
thoughtful review

authorities - government officials; the police or people in official organisations who have the legal power to make people obey laws or rules เจ้าหน้าที่ (ตำรวจ หรือผู้มีอำนาจ)
the authorities concerned - the government officials who deal with this problem or issue (example: if someone steals your money you contact the police, not the building inspectors)

consumers - people who buy things or services

align with - be in the same direction as; be the same as
align with the needs of consumers

changes should align with the needs of consumers

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.

sector - a part of the economy ภาค (ทางเศรษฐกิจหรือสังคม) (public sector = government, private sector = all businesses, household sector = families and consumers, banking sector,...) (See Wikipedia)
private sector

could do with - needs

combat - try to solve a problem (like you are fighting a serious war)
combat the labour shortage

fund - 1. to provide money for something ให้เงินทุน;  2. money provided for something เงินทุน กองทุน
fund the education of medical and nursing students in exchange for future jobs

work environment - the whole situation surrounding work and a job in a company or organization
real work environment
paid training in a real work environment

relevant - directly connected and important to what is being discussed or considered ที่เกี่ยวข้อง
relevant - directly connected with and important to what is being discussed or considered ที่เกี่ยวข้องโดยตรง

relevant professional skills
equip students with relevant professional skills

curricula - the list of topics covered and taught in a course or degree program in a school
design curricula 

marketable - is possible to or even easy to sell, because it has what buyers want
marketable skills - skills that companies and organizations want, that will help you get a job

awareness - the state of knowing about something การรับรู้, การทราบ
cultural awareness - knowing about how things work in other countries and cultures (so that you can function smoothly without problems)

Nonetheless, the private sector could do with more training of medical professionals to combat the labour 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 relevant professional skills as well as marketable skills such as a second language or cultural awareness.

opportunity - a situation when it is possible to do something that you want to do (See glossary)
promote - to move someone to a job at a higher level เลื่อนตำแหน่ง

a new opportunity to promote Thailand's medical tourism
 
critical - extremely important because a future situation will be affected by it สำคัญยิ่ง
critical adjustments - important small changes

on the regulatory front - in the area of regulation (government rules over the activities in an industry)

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.

common - seen or encountered often; happening often

competitive - involving competition มีการแข่งขัน
competitive edge - something that makes you compete better and helps you win  

imminent - expected to happen soon ในไม่ช้า จวนเจียน จวนตัว
imminent arrival of the AEC

intense - done with a lot of effort, energy, attention, etc. เข้มข้น
under intense competition

time is not on our side - we really do not have enough time to do what we want to do and achieve

The shortage of skilled labour 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 labour 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.