Good Research Award in Political Sciences and Public Administration, National Research Council, Thailand, 2009

By Anchana NaRanong, Viroj NaRanong and Sirachai Jindarak

Medical tourism in Thailand, despite some benefits, has negative effects that could be mitigated by lifting the restrictions on the importation of qualified foreign physicians and by taxing tourists who visit the country solely for the purpose of seeking medical treatment. The revenue thus generated could then be used to train physicians and retain medical school professors.


Medical tourism generally involves transporting patients from developed countries to developing countries where they can get treated at lower expense. These patients do not necessarily belong to the highest social bracket in their own countries,but they (and their insurers) generally have greater purchasing power than most patients in the destination countries.Most developing country governments see medical tourism as an opportunity to generate more national income and therefore support it strongly.15–17 However, without appropriate management medical tourism can become a heavy burden for the public health systems of these countries, especially those with universal health-care coverage. In Thailand, medical tourism has both positive and negative effects. For the

Thai economy, medical tourism generates a value added approximately equal to 0.4% of the GDP. It helps raise income for the medical services sector, the tourist sector and all related businesses, and it provides other intangible benefits. All of these direct and indirect positive effects for the Thai economy are well recognized in the business arena.The negative effects for Thai society stem from having to provide health-care services for 420 000 to 500 000 medical tourists annually with the same number of health-care staff. In this study these negative effects are evidenced by both a shortage of physicians and by increased medical fees for self-paying Thais, which are likely to undermine their access to quality medical services. The very same problems are likely to apply to other host
countries. In India, similar adverse effects have been detected.18,19 More importantly,the influx of medical tourists does not always lead to a “win-win situation” and to “windfall” income for host country governments, which may need to learn the hard way that they will have to increase their health budgets to meet the rising and highly competitive foreign demand for health services. To alleviate the shortage of staff and reduce health-care costs for Thais, Thailand needs to increase its health sector human resources, especially physicians,dentists and nurses. We recommend that the government: (i) allow certified foreign physicians to provide medical services– at least to foreign patients – without having to take a medical certification exam in the Thai language, as currently required; (ii) increase medical staff training in public universities to full capacity; and (iii)collaborate with private hospitals
in training more specialists.Medical education in Thailand is neither self-funded nor privately funded; rather, it is heavily subsidized by Thai taxpayers.With their much higher purchasing power, medical tourists can prevent Thai taxpayers from accessing quality health care. Thus, the Thai government has a responsibility to balance the welfare of Thai citizens against the extra income generated by medical tourism. The government has strong grounds for levying a tax on medical tourists, who, unlike Thai taxpayers and expatriates residing in Thailand,
reap benefits without helping to pay the taxes that support physician training. The revenue from this tax should be used to expand the training of physicians and other medical staff and to retain the best professors in public medical schools. In the short run, the taxes could also mitigate the adverse effects of the extra demand for
health-care services on the part of foreigners with higher purchasing power.