Slicing Into The Surgical Market

June 6, 2005
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GRAND RAPIDS — CBS News recently documented a story that is being heard more often in this country. In April, “60 Minutes Wednesday” correspondent Bob Simon told the tale of Byron Bonnewell, a middle-aged RV campground owner in Shreveport, La.

Bonnewell needed complex bypass surgery, a difficult procedure his doctor said would cost over $100,000. But Bonnewell, one of the 45 million without insurance coverage in this nation, decided he would rather die with a few dollars in his pocket than spend his life trying to recover from the heavy debt he would face if he had the surgery.

As his health deteriorated, though, Bonnewell discovered Bumrungrad Hospital in Bangkok, Thailand. Oddly enough, he learned of the hospital and the large number of international patients it serves while thumbing through a copy of Business Week in his doctor’s waiting room. He went online and hooked up with Dr. Chad Wanishawad, who once practiced at the National Institutes of Health in Maryland, and soon was off to Bangkok and the bypass that would save his life and only cost him $12,000.

Bonnewell returned home two weeks later, much healthier and much impressed with Bumrungrad.

“Every doctor I saw there has practiced in the United States,” he told Simon, while adding that he wished he had learned of the hospital sooner.

“I found it so strange in Thailand, because they were all registered nurses,” he added. “Being in a hospital in the United States, we see all kinds of orderlies, all kinds of aides — maybe one RN on duty on the whole floor of the hospital.”

Those who saw the “60 Minutes” report know that Bumrungrad isn’t a hospital on the cheap. It’s a pretty lavish place, a building that would give many of this country’s plushest hotels a run for the posh title. Viewers also know that Bumrungrad is the largest hospital in Southeast Asia, has an annual patient volume of more than 850,000, and leads the planet in the total number of international patients it provides care for each year. Patients from outside Thailand account for about 40 percent of the hospital’s volume.

“It’s sort of Ground Zero. I haven’t heard anybody yet who’s told us that they take more than 350,000 international patients a year,” said Bumrungrad CEO Curt Schroeder, who is 48 years old, a native of Los Angeles, a graduate of USC, and a health-care veteran who spent 17 years with Tenet Healthcare here before taking his current job at the private hospital.

Ruben Toral, the marketing director for Bumrungrad, told the Business Journal why his hospital has had so much success in drawing patients to Bangkok from every corner of the globe.

“In a word, it’s value,” he wrote in an e-mail. “We offer a Mercedes product at a Toyota price.”

Toral said the hospital follows international standards for care, has 650 internationally trained doctors, offers five-star facilities and works with state-of-the-art equipment. But at the same time, Toral said surgical prices at Bumrungrad run 50 percent to 80 percent less than what U.S. hospitals normally charge.

“Americans make up about 6 percent of our total patient population. In 2004, we treated some 40,000 Americans,” said Toral.

“Our American patient volume has increased an average of 10 percent per year for the past six years. Our American patient volume is growing because more Americans are looking for health-care alternatives outside their country. Good quality, private health care is quickly becoming a luxury item for Americans,” he added.

Toral said the hospital’s prices are lower because its expenses are less than those found at U.S. hospitals, and on several counts. One is wages. The medical staff is paid less than here. For instance, a registered nurse earns from $500 to $600 a month in equivalent U.S. currency. Payroll, though, is just one contributing factor to Bumrungrad’s lower expense ledger.

“Our 650 doctors use the same common facilities and equipment so there is very little duplication of resources. Malpractice insurance is a fraction of what it is in the U.S.,” he said, while adding that the largest malpractice payout from a Thai court is $25,000 in U.S. funds.

Lower costs means lower charges for patients. Bumrungrad charges $1,124 for a diagnostic coronary angiogram package that includes a one-night stay, and $3,500 for an angioplasty that includes a two-night stay. Coronary angiograms carry an average price of $13,500 here, while angioplasties normally run about $25,000 in the U.S.

On the hospital’s Web site, potential patients can request a price quote for a procedure. A direct round-trip flight on Thai Air from New York to Bangkok costs about $850.

The Business Journal asked the American Surgical Association if it considers overseas hospitals as serious competition, and if prices for most procedures need to come down for domestic hospitals to maintain its surgical market share. The ASA, however, didn’t respond by press time.

If surgical costs and insurance premiums continue to rise, there is a possibility that more Americans like Bonnewell will look for solutions overseas. There is also a chance that lower-cost hospitals and surgical clinics will be built closer to the U.S. in the near future and will give Americans more choices. If that happens, the domestic surgical market could go in the same downward direction as the U.S. automobile industry.

And Bumrungrad Hospital isn’t the only professional low-cost provider active in the international market right now. Two others are Gleneagles Hospital in Singapore, where angiograms run about $2,000, and India’s Apollo Hospital, where a hip resurfacing costs $5,800, or roughly $20,000 less than a replacement. Resurfacing isn’t allowed in the United States.

Competition to capture international patients, including Americans, has heated up recently and Toral felt it would likely get more intense in coming years.

“There are definitely more hospitals courting international patients. Indian, Malaysian and Singaporean hospitals are spending considerable resources to market their services abroad. They see the success of Bumrungrad in this arena and would like to participate,” said Toral.

“But again, saying you are international and being international are two different things, especially in medicine.”    

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