Medical Tourism under Threat

ผู้เขียน: Dr. Sutapa Amornvivat

Medical tourism is a star industry in Thailand, but serious shortages of health care professionals may bar Thailand from being a medical hub of Southeast Asia, especially after the arrival of AEC.

It is undeniable that Thailand is an important destination for medical tourism. According to recent estimates, Thailand hosts as many as 1.4 million foreign patients who visit the country as tourists every year. The figure is far higher than those of our regional peers: Singapore and Malaysia, which stand at 600,000 and 300,000, respectively.  Thanks to its international standard of health care services and the comparatively lower costs, these medical tourists are from a good selection of countries, notably Japan, the United States, the United Kingdom and the United Arab Emirates.

Despite its popularity as a medical hub for international visitors, Thailand still draws much fewer medical tourists from within ASEAN when compared to the two closest competitors. Around two-thirds of foreign patients in Singapore and Malaysia are from ASEAN countries, largely because of emerging Indonesian middle classes who wish to get their medical treatment abroad.  Yet, opportunities that arise with the arrival of ASEAN Economic Community (AEC) are going to change this.

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

The fact that ASEAN entities can become a majority stakeholder, and the proven profitability of private hospitals in Thailand, may bring in innovation of medical care and tailored services to better cater to ASEAN customers' medical needs as a result. Domestic patients will also benefit from competition in form of a better standard of services, more choices and enhanced medical technology.

However, therein lies a problem of the shortage of medical personnel, both in terms of quantity and quality. This could hamper Thailand's hope of becoming a medical hub of ASEAN.

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

A recent study by the Health Systems Research Institute (HSRI) finds that Thailand is in shortage of Registered Nurses by around 50,000, resulting in a large part from a decline in new nursing graduates in the past decade.  Even with an effort in producing Practical Nurses, i.e. those who assist doctors and Registered Nurses and only need to complete one-year training as opposed to four that is required of Registered Nurses, the number of medical personnel is still far below the satisfactory level. 

With thriving medical tourism, Thailand would have benefitted from the AEC by importing nurses from other ASEAN countries such as the Philippines whose nurses are in surplus and currently receive lower pay.

The labor movement would be made easier under the Mutual Recognition Agreements (MRAs) which aim at facilitating movement of skilled labor in priority sectors, among which medical personnel is included. These imported nurses who are meant to aid foreign patients will help relieve the pressure off the domestic health care services which would otherwise face greater competition for resources from international visitors who seek medical treatment in Thailand.

Despite the MRAs, foreign nurses still need to be proficient in the Thai language to pass the examination for full nursing license in Thailand, which is taken in Thai. Shouldn't such regulatory limitation 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 by a greater shortage of medical personnel. Medical tourism and domestic health care are not in direct competition; by allowing mobility of medical workers they complement each other by improving availability and quality of health care for all.

Not only do regulatory barriers such as this exist in medical services but also to other sectors. They need a thoughtful review by concerned authorities and any change should align with the benefits central to the consumers.

Notwithstanding, the private sector could do more with training of medical professionals to fight labor shortages. Financing medical and nursing students through their courses for later placement or allowing them paid training in the real work environment is a possibility. They can also help design a curriculum that equips 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 in the regulatory front and in the long-term planning on the production of medical personnel. The shortage of skilled labor is also common to other sectors with lesser competitive edge than that of medical tourism. With the imminent arrival of AEC, skilled labor will be under intense competition.  And time is not on our side.