Friday, August 17, 2007

Bumrungrad: Go Elsewhere For Medical Tourism

My colleague David Williams had asked for my comments on his MedTripInfo website posting about the world's best known medical tourism destination - the Bumrungrad Hospital in Bangkok. Alas, "best known" is certainly not "best choice" as far as I'm concerned. Here are my views that I also posted on David's website:

The best thing about Bumrungrad is its marketing success. The credit goes to its American managers and marketers, who have not only promoted the hospital well in the media, but have also included slick designs and features, streamlined administrative processes and generally made the interface with the foreign patients very user-friendly and reassuring.

Bumrungrad tends to charge well for each of its services, and includes handsome markups for services it arranges through its local service partners. For example their airport "meet and greet" costs $40 and the trip to the hospital costs extra - about twice as much as for a luxury taxi engaged directly at the airport (or six times what an ordinary taxi charges.) But patients may not mind paying all these extras which are complimentary or included in package costs in other international hospitals. Instead, a cause for greater concern are some of their "substance" issues like their quality of treatment.

The Bumrungrad death in Feb. 2006 of the 23 year old American Joshua Goldberg has drawn a lot of attention. This could arguably have happened anywhere, but I too had concerns about the hospital way before that. Joshua's dad has made many allegations against Bumrungrad in his website directed against them, including engaging in a trade for body parts, and sacrificing patients for that purpose. In the absence of any facts to support this I don't set any store by such statements, and attribute them to the rage of a grieving father.

My guess is that Joshua died because of a negative response to one or more of the medications given to him. It's quite possible that negligence was involved and that Bumrungrad management tried to cover up mistakes made, or stonewalled an investigation. On the other hand it may not be the case, but here are the reasons why I am leery of their treatment quality and their practices:
  • They don't seem to have outstanding doctors, particularly in areas of major surgery. I've read their policy is to hire primarily Thai nationals, which limits their talent pool. The bios of their doctors on their website is suspect as it mentions "fellowships" at US, etc. hospitals without mention of US residency (the US does not allow board certification or practice of medicine without US residency that spans several years.)
  • They don't mention how many procedures they perform, especially major orthopedic or cardiac ones. This number is known to be positively correlated to quality. After Joshua's death and the resulting publicity they have changed their website quite a bit, but even earlier I had noticed that their treatment packages were generally for the minor procedures, e.g., angioplasties, with no mention of heart bypasses.
  • They feed the media with claims that are clearly false or ridiculously exaggerated, though they are clever enough not to directly state these on their own literature or website. For example, the NY Times, the Pittsburgh Post-Gazette and other major publications quote them as having treated 58,000 Americans a year, of whom 70% come for major surgeries. A back of the envelope calculation shows they are exaggerating such numbers at least fifty-fold. For instance, see Tom Keesling's blog comments
  • They don't put out any quality or outcomes data for major procedures, as some top Indian hospitals often do, and US hospitals are now increasingly required to disclose. Coming to think of it and given their declarations of patient volumes, even if Bumrungrad disclosed outcome statistics I wouldn't believe them unless it is independently verified.
  • They don't have a pricelist of the standard procedures, unlike other top-tier hospitals popular with international patients. To get prices from Bumrungrad you have to go back and forth with one of their specialists assigned to your case. Their lack of up front estimates and transparent pricing makes me think, well, almost of used car salesmen. Or Bangkok's PatPong bargaining bazaar.

I've seen Bumrungrad from up close in addition to reading about it. I'd not go, or take a friend or loved one there, except if the outward patient experience (the tourism part of medical tourism) is a high priority. And the procedure is relatively simple, with inherently low risk. When I was visiting Bumrungrad their international lounge was a sea of women in black dresses and head scarves. I was told a large proportion of their foreign patients are women from the Middle East who come for nose jobs or other cosmetic treatments.

I worry because Bumrungrad on being exposed is likely to deeply undermine faith in other hospitals, including those in India, that are truly excellent and a better choice for medical tourists. The best outcome for the medical tourism industry would be for Bumrungrad to clean up its act quickly while acknowledging past mistakes, but I doubt this is going to happen with the current management in place.

9 comments:

Richard RothHaas said...

We are not an agent of Bumrungrad nor does Medical-Tourism-in-Thailand.COM send them any patients for one or two of the reasons you mention in your post.

However, your repeated pushing of Indian medical facilities seems biased and I wonder if it's self-serving.

I'm not Thai. I've lost children to blatant medical malpractice by doctors at Thailand's leading medical university. I almost lost my wife because of medical malpractice by Thai doctors. But I can still say that for international medical tourism best places to go, Thailand deserves high marks. Thai doctors have also saved my own life.

I have personally experienced both the best and the worst of what Thailand's hospitals and doctors have to offer international medical tourism and I think you have an agenda and are unfair.

Are caucasian people like myself supposed to cringe because Arabic women come to international hospitals in Thailand for medical help? Well I think it's great that Thailand welcomes medical tourists of any nationality and any race. And I don't mind sitting in the lobby of a Thai hospital with brown people, black people or any other color people.

You blast Bumrungrad but said nothing about the more than 399 other hospitals in Bangkok that offer high quality and affordable surgery abroad including all types of heart surgeries, orthopedic surgeries and neurosurgery.

And it's false that foreign doctors cannot work here or won't come here. Just a few days ago Professor Dr Sava Perovic performed some of the most advanced urological procedures in the world at Piyavate International Hospital. In fact, Dr Perovic said he had performed surgery all over the world and the Piyavate International Healthcare Facility was among the best anywhere.

So I wonder to whose opinion we should give more weight, your's or that of the best urologist in the world? Dr Perovic commented about the great hospitals in a number of countries and thinks Germany has really great medicine but said Thailand was right up there at the top for medical professionalism and Piyavate was among the best he's seen anywhere.

And since when did male to female Sexual Reassignment Surgery (SRS) become "easy" surgery? I'd be interested to know if all the surgeons in India put together have performed as many MtF SRS surgeries as the 3,000 performed personally by Thailand's Dr. Preecha Tiewtranon.

I agree that India's got some great doctors and some good hospitals that are a good option for a number of medical tourists. But Bumrungrad is just one of many hundreds of great Thai hospitals and world class dental clinics that can provide any health care services needed by the world community at prices competitive with India and from five-star quality medical facilities that compare favorably with any in the world.

Sandip Madan said...

Richard, your point about SRS is well taken. I've read about quite a bit of this being done in Thailand (in hospitals other than Bumrungrad) and there's hardly any mention of this in India.

I talked about Bumrungrad because I have seen it, followed its activities and coverage, and know about its management. My knowledge of other Thai hospitals is much less.

About the elite Indian hospitals, I recommend them because they have many top-notch doctors and high quality of care, with the best prices. And no, other than that I don't believe I have an agenda or a self-serving interest. Quite the contrary.

You see, India is probably the least paying proposition for medical tourism facilitators as of now. They are typically paid 10%-15% (and up to 20% demanded by some operators which most Indian hospitals refuse to agree to) of the billing by the hospitals. Since Indian hospitals are cheaper or much cheaper than those in other destinations, it means that much less money for the operators who bring patients here.

Anonymous said...

I suffered a stroke while in Thailand in May. Spent 5 days in Bumrungrad and have recovered fully. I cannot speak highly enough about the care I was given. I will return next mnonth for a follow-up

Sandip Madan said...

I moderate comments on these posts that are over 3 months old. The reason: many comments are spam or contain links apparently to promote certain sites and/or have them show up higher in searches through tricks like SEO (search engine optimization.)

I'm certainly happy to allow any "genuine" comments whether I agree with them or not. One way to ensure yours are posted is to exclude any links that seem to be shilling sites that you want to promote.

Anonymous said...

How could the author be seen as impartial and unprejudiced when he even failed to mention the "superbug" from Indian hospitals ?

How does Bumrumgrad compare to other similarly sized hospitals in terms of negligence or malpractice ?

Funny thing, the author clearly of Indian roots kept on pushing for India hospitals, whereas Singapore clearly has better hospitals, so much so leading Indian bollywood figures even picked Singapore ahead of India for medical treatment.
The author's bias, alas, is unmistakeable.

Anonymous said...

Bumrungrad is the worst choice in Thailand. The physicians are irresponsible and no competent, they get commission from every medicine that they write on the prescriptions. That's why they try always to write medicine which you dont need indeed. Physicians are temporary, most of them work part time in Bumrungrad. If the physician does mistake and you dont get treatment no where to complaint, the managers dont care and not afraid of your possible action. Thai people and Thailand is nice, but I dont recommend you get any treatment from Bumrungrad. If you really want to go Thailand for medical purpose try to get another hospital in Bangkok.

Anonymous said...

I agree,
I was treated by a negligent doctor at Bumrangrad. When I came in and told her I had pelvic pain, no diagnostic questions were asked. I was only asked what tests I wanted to have done. Not being a medical expert, I had to google my symptoms and guess at what I should be tested for. In addition, I had a serious infection that is a sign of cancer. The doctor completely over looked this and did not advise me to be tested for cancer.
I chose Bumrangrad because of its excellent reputation. I am applauded at the practice of this particular doctor. I would not recommend bumrangrad to any women.

The American Medical Money Machine said...

Hello,

I am the father of Joshua Goldberg who was murdered at Bumrungrad hospital. This crime is documented in my book, The American Medical Money Machine: The Destruction of Helathcare in America and the Rise of Medical Tourism.

Why was he murdered: to havrvest his organs! There exists a big black market trade in South East Asia. Dr. Peter Morley and the senior executives of Bumrungrad, refused to share their investigation with me. The police, since they are bought and sold by those in power in Thailand, refused to investigate or prosecute.

Read my book: available on Amazon: if you want to know the truth about Bumrungrad.

Contact me on goldjim1@mail.com for further information.

I spent three years investigating Bumrungrad. They are most likely owned by Tenet Healthcare of the United States, who in the early 90's operating as National Medical Enterprise, was fined for criminal fraud by the US Government for $3 Billion. They changed their names and continue to operate with impunity and under American management in Thailand and several other locations in Southeast Asia and the Arab states.

Don't beleve me? Read my book.

Dr. James Goldberg

Jacob said...

3) The conspiracy theories are a little much. I agree healthcare is a mess in a lot of ways. It's also really disorganized too--I don't think many companies could be as organized as you conspire them to be if they wanted too. If you're going to make an academic argument, you need to approach it academically with evidence and the right cohesive structure--right now your story is too biased, far too polemic, and disorganized to be taken as a sound argument.

4) To have a child in a hospital for 11 days without immediate escalation from a parent seems strange--perhaps it all just happened so fast. For a 23 year old to be in a hospital for more than few days should be a red flag, especially if you had awareness of a history of drug abuse. No one really knows what shape your son was in when he arrived (other than the hospital and what he told you, if that was even the truth).

5) If you want to raise awareness about healthcare, and become an advocate, then you can actively participate in a number of forums that don't involve personal profit. Publishing a conspiracy theory for sale at Amazon may not be the best way, and to be honest, is not in good taste.

James, I wish you well and hope you find the answers you're looking for; years later it seems you are still grieving and that's not good. You may not ever get the answers you're seeking; if you begin the process to accept that you may never know, I think you'll find you can move forward to more meaningful dialogue and contribution on what it is you hope to accomplish.