Bangpakok Hospitals are renowned for their high quality and rigorous cost controls. PM Communications speaks with Dr. Chareong Chandrakamol, Managing Director of Bangpakok Hospital Group, about the healthcare sector in Thailand and Bangpakok’s attractiveness for foreign medical tourists
International standards are always a point of concern when people are thinking about getting healthcare treatment. What steps does the Bangpakok Hospital take to ensure that the hospital provides care at the highest possible standards?
First of all, the clinicians, the doctors and the nurses are very involved in the healthcare community. I know this from my work on the board of Thai Red Cross, and as the two-term president of the medical school alumni. Thammasat and Chulalongkorn medical schools are pretty much synonymous with Bangpakok Hospital. We have the former deans of these schools on our staff here; we are more academic than on the clinical side, which is a different setup. In regards to our medical staff, we are very proud of our team and trust them to deliver international standards of treatment and care.
In regards to education, our staff are either trained or receive a post graduate education from abroad and fellow degrees from the FACA, FACS, the Royal College of Surgeons, etc. So, they receive an education on an international basis whether its from Germany, England, Sweden, or the US. So most of the faculty members have a post-graduate education.
On the operational side, there is an accreditation body from the Ministry of Health that has its own standards and is in compliance with the JCI (Joint Commission International). It is a holistic approach. We also have the latest version of the ISO (International Organization for Standardization). Then in small micro units, we have certification like HACCP (Hazard Analysis and Critical Control Points) for the catering system. And the labs have their own certification body. So basically, it means that each professional individual has been certified to international standards.
This is the system we employ. Our professionals are teachers from the medical schools and the process side is controlled by various compliance certifications. So we control 100% of our operation, the process, the guidelines, the certifications, the clinicians, etc. So if you’re asking how we guarantee our quality and our risks, this is how we do it.
Medical treatment in Thailand is very competitive from a price perspective. To what extent is it a challenge for you as managing director to balance the price competitiveness with the very high standards that you strive to offer?
The healthcare environment in Thailand is competitive, that’s true. And for Bangpakok Group, we are locked into this area. But the truth is that healthcare is a matter of trust; it’s not pricing alone. It’s a matter of how you take care of the community and where you have your outreach programmes. So, we create this trust in our own community, and this is extended over to our international patients as well. When you have this trust, the pricing is already competitive. One thing that we don’t do is a lot of advertising because fundamentally we are doctors, and we are here to treat patients. We do give our pricing consideration, but we always focus on the healthcare first. And this is why we feel that we are unique.
One more unique focus is that we are one of the few hospitals in the country that has a productivity centre. This is how we have implemented a lean management system, it’s from an engineering perspective, and we use some of the same principals as Toyota as a means to systematically control our costs. This transfers into things like low infection control on the clinical side, a direct outcome from the high process standards in the lean management of our programmes. So we feel that we are very unique in this area. So trust comes first and then we work on our own productivity. We control our own costs so we don’t have to pass that burden onto the patient. These are measures that are set in order to treat our patients in the right way, so that they can move on with their own lives.
From an institutional perspective, despite a very competitive environment, to what extent do you work together with other hospital groups, the medical council, the public health administration, the private hospital association and universities to demonstrate the quality of healthcare provision in Thailand?
We build strategic alliances. As a treasury care, we do open heart surgery, we have Cap Labs, our equipment is fully scaled up; and on the neo-natal side, we treat very small babies, very premature babies. So we are number one on the private side and we form strategic alliances because, as a treasury care, we take referrals. Not all hospitals can do open heart surgery, so we work with a lot of other hospitals in a feeder system and that creates a lot of trust as well. We also work with the government, but we have more collaboration on the private side.
During the floods, none of our four hospitals flooded, creating an unfortunate advantage, which means we were able to help people at that time. We were designated by the government as the emergency rescue hospital just in case of mass evacuation from inner Bangkok. We have a helipad here and the expressway nearby, so we’re strategically located. We signed an MOU with the government and the military was brought in, just in case we had to mobilise the patients. We were the western corridor in case of emergency. After that event, Bangpakok Hospital has been permanently designated as the centre for relief and evacuation on the western side of Bangkok.
What sort of activities does Bangpakok Hospital Group undertake in investing in local community development?
Well, we have been doing this for several years even before the promotion of CSR. Our logo is a heart, but it doesn’t only refer to heart surgery, it represents our caring concern for local communities. We have been making a lot of contributions all along, but we don’t publicise this a lot. During the floods, people were putting banners on the side of the trucks, which is not our style. We donate a lot of surgeries; we recently donated 500 knee surgeries and 500 open-heart surgeries for free. That’s our contribution to society. We do free surgeries for small babies as well.
With the current wave of consolidation in the healthcare sector in Thailand recently, how open is Bangpakok Hospitals Group to a merger?
We are self-dependent for the time being. Why? Well, the contributions that we make for society cost a lot of money. Then if we take the merger route, we’ll face the stock market, which means we’ll be pressured for profit. Right now, we are not pressured for the bottom line, at least not too much. If you go to the stock market, one big disadvantage is that balancing you do between the shareholders and taking care of society. In this case, the shareholders may be a stronger force and that’s just not a balance that will work for us.
In terms of mergers, we could get management skills, financial investments, connections and other nice things, but we don’t require these things right now. Fortunately, our size helps us to sustain ourselves. We’re not a standalone hospital, like some other hospitals. We have four hospitals and we are developing another three. We have our own business model, but at the same time, we always leave the options open for the future.
Can you tell me about the international strategy for the Bangpakok Hospital Group? What are you focusing on and how important are international patients for the business?
First of all, on the international side, the trust level is very important. Are we competitive? Yes, because the cost for patient care for our international patients is almost the same for our Thai patients. It’s not over inflated because we don’t have that extra cost and therefore, we pass these savings onto the patient.
The strategy is to move towards the Middle East and Russia, two big markets. We have calculated all that comes along with international travel for healthcare, and we are focusing on each required speciality. We are also looking at Australia and, of course, our neighbouring countries like Myanmar. So strategically, we are only looking at about four areas right now. We won’t be building hospitals and we probably won’t be creating alliances over there either. We have our own network and we work comfortably within these parameters. We will be opening small centres in each country where appropriate.
How will international patients find Bangpakok Hospital Group outside of Thailand? Will doctors abroad refer their patients to your network?
There will be representatives in each country. They will do certain activities, and secondly, we also have language specific websites in each country. If the patient is elderly, they will require that the international coordination is handled by their children, especially if they don’t speak English. Typically, if the patients are between 25 and 35 years old, they normally work through the internet and then, they work through our representatives, which handle all of the transferring of information, like medical records, and budgeting, etc.
In addition to interpreters and international call centres, what services do you have in place to make the process that much easier for international patients?
To be honest, we offer all of the standard services like interpreters and such. What we do that is a little bit different is that we provide activities outside the hospital. Some of the patients have favourite hot spots, like shopping places, so we provide special transportation and a personal guide that takes care of the patients’ activity needs outside of the hospital. This is very important because, often at times, we’re not just caring for one solo patient. Frequently, the patient comes with their family so it can be up to four or five people that you are assisting as well.
Have you considered insurance partnerships with major insurance companies in Europe and the USA who are now considering having treatments done in healthcare centres such as Thailand because the healthcare costs in the US or the UK are too high?
In those countries, there is a little bit of conflict of interest although the demand is growing. Right now, we are starting to sign some MOU’s with related institutions. I think that when it gets going, it will really take off exponentially. It is a cultural shift, but I think it’s unavoidable. In our recent trip to the US – we are also going to the UK very soon, there is a lot of discussion about this – they are trying to break some barriers about reimbursement issues overseas, but it’s taxiing right now and I think it will soon take off.
It seems that the economics make very good sense for the insurance companies and their bottom line, as long as the quality of care provides equal standards, but there will be challenges in exporting healthcare across borders. What do you think will be the biggest challenges that will keep this trend from taking off?
The cost control and the litigation process are the two biggest obstacles along with the regulation of the mobilisation and immigration process. Because the process will require pre-op and post-op and you have to control a lot of legalities there. For example, you may have legal issues if you overstay your visa even if you need to stay for rehabilitation and post-op services, which of course, will be necessary in many cases.
Also price control is another issue. On our side, we’re prepared because we do managed care. In addition to private, out-of-pocket care, we also do managed care. We are ready today for this system because we already have the US system in our hospitals. So we are able to do these types of calculations for the insurance companies.
In terms of the international market for healthcare for Thai hospitals, how competitive is the environment? Are hospitals actively competing for international patients?
We used to be very, very competitive. The problem is that the cost of healthcare is going up around here and you have a lot of newcomers, like India that have a relatively low cost structure, but their system and environment isn’t really there yet. Ours is a fully integrated system that expertly deals with medical tourism, for the patient and the family. In other countries, the cost is low, but the network isn’t there yet. And Thai service is very unique in our high standards that you might not find elsewhere.
I think the competition is growing, but at a slower pace. Basically, we have to keep our costs down. If we control that, the patients will come to us. We are currently blocked in Singapore and we have a lot of Indonesian patients. So, there are a lot of patients and we can take advantage of that demand to keep our costs low.
What is it about Thailand and Bangpakok Hospital Group that maintains their competitiveness for international patients?
First of all, the volume is still growing and there is the AEC (ASEAN Economic Community) coming into the picture although it seems that there might not be a lot of impact from the AEC at first. But the challenge for us is that our international patients aren’t that significant so we have a lot of room to grow. Like I said, we’re not very commercial, so we are here to treat patients. We are not looking to be a luxurious five-star hotel. We make sure that the families are here to comfort the patient and we control their budgets. So it’s very simple. We fix them and we send them home. So when we compare ourselves with other hospitals in the area, we are very, very competitive. For us, healthcare is a priority and we have a strong trust factor that makes us a leader.
There is a lot of talk of the country becoming a healthcare hub. How would you evaluate the growth potential in Thailand’s healthcare system? How will you integrate Bangpakok Hospitals Group into that future growth?
First of all, when talking about patient inflow, that’s only going to increase over time and in fact, it’s becoming fashionable now. If I want to get a treatment, I want to go to Bangkok. And unavoidably, the insurance companies will start pushing for that influx. And the patient will push for the cost and quality.
So what do we do? For our hospital group and for the country, we have to make sure that we have the staff to maintain the demand at a high quality. The interpreters have to have clinical knowledge, ethnically it can be very difficult, as well as the different languages like Arabic and Russian. So we have to make sure that the doctors and staff can communicate in an efficient and understandable way. So that nothing gets lost in translation.
Also, we have to look at the environment because each particular group has what they consider to be an appropriate environment. Even details like food preparation have to be considered.
Also the silver market is really growing now. It’s not just a “foreigner market”; it’s the aging generation that is coming from the Middle East. The life span is now longer; people are living longer and expect a healthy lifestyle way into their older years. So you have retirees that need to be treated. These people want to travel and be healthy, so we focus on preventative care and regenerative care. Regenerative tissue care is already here. It’s just waiting for FDA approval.
So, right now we are preparing for this new sector by expanding into international care, long-term care, assisted care, etc.
Do you work with universities and research institutions in developing some of these new techniques and treatments?
We’re going to Japan soon because as you know, Okinawa has the highest age group. So, the information is flowing. The former dean is coming in every day. We are talking about these projects on the research side. We also sponsor patients for clinical care to find results of new treatments and techniques. The aging population is an opportunity for the medical field to progress and make some great advances in our lifetime.