Balancing Thailand's healthcare resources: ageing, declining population, and medical tourism

Balancing Thailand's healthcare resources: ageing, declining population, and medical tourism

Thailand as a World Medical Hub

It's been known for decades that Thailand is the home to the world's most capable doctors and healthcare staff who can offer the best services, unlikely to be found anywhere else. Many famous Thai doctors have received their medical training in Western countries at renowned medical schools and institutions. They have accumulated their knowledge and experience along with the most advanced technology and techniques in healthcare. Coming back home from overseas studies, they have been able to gain more experience and reputation in their practice as specialists in many fields. There is still a lot of room to grow but competition is much less fierce than in the West.

However, the main attraction encouraging foreign patients to consider coming to undergo medical procedures in Thailand is the low price-point. Uninsured patients from the United States, Europeans who cannot tolerate the long queues for simple procedures in their own countries, or patients in low income countries looking for better healthcare services than they have back home, flock to Thailand seeking good quality and cost advantages.

Thai private hospitals are quick to respond with clearly defined and competitively priced procedure packages, special rates and services for corporate clients. Topping it all is the United States Joint Commissions International accreditation, or JCI, in almost all hospitals catering to international patients. This removes quality concerns that anyone may have.

Soon Thailand will be just a train-ride away from major markets

ASEAN is real and Thailand is already welcoming many foreign workers. The Department of Labour reported that the number of legal foreign workers doubled in the last half-decade from just over a million to more than 2 million today. Rail projects by the Ministry of Transport connecting Thailand to China, Laos, Vietnam and Singapore are ongoing and the first routes will be operational as soon as 2023. This would mean just a few hours to Bangkok from any of those countries. These routes may become regular weekly commutes for millions of people seeking employment opportunities. Accessible quality healthcare is a main consideration. Thailand already hosts almost 40 million visitors each year with an average stay of almost 10 days per person.

What about Healthcare for Thais?

According to the World Bank (2015 data), the United States and Singapore have similar numbers of physicians per head of population: 2.57 and 2.28 per 1,000 population, respectively.  China and Malaysia, at a lower proportion, are at 1.81 and 1.53, respectively. These figures seem reasonable and in line with average expectations. The number of physicians per 1,000 in Thailand, however, is at an unbelievably low 0.47, in the same league as some low-income African countries such as Nigeria and Sudan. The poor distribution of healthcare personnel is well known and a long-standing issue in Thailand. The stark difference in pay, living conditions and opportunities for work and training leads to an inevitable brain drain, and it is nowhere close to being solved.  The over a decade long attempt to increase the production of physicians, from just less than one thousand medical graduates a year from 10 institutions in 1998 to three thousand a year from 20 medical schools in 2014, has done little to reduce the scarcity of physicians in rural areas. The main cities offer much more in terms of specialty training and career opportunities.

Thailand is Ageing

According to the Foundation for Older Persons Development, 2018 marked the year that the number of elderly people, defined as aged more than 60, exceeded that of children, defined as under 15 years of age, turning Thailand into an ageing society. It is estimated that the existing workforce that is currently 60% of the population, or roughly 38 million people, will shrink to only 40% of the population by 2040 when Thailand becomes a truly aged society, where people over 65 years of age exceed 25% of the population. The very low population growth, at 0.3%, adds more to the concern. Thailand's productivity will surely take a big hit.

Retaining and Maintaining the Workforce

Obviously, the elderly will need more healthcare services, but it will get harder to find the means to pay for it. And with the dwindling workforce, there is no other solution than to try to retain the current working population as much and as long as possible. The elderly workforce will also need to go through re-skilling and up-skilling processes in order to keep up with new technologies and working environments. The Bank of Thailand reports that 71% of Thai elderly people are already in employment, higher than most Asian countries, including Japan. However, only 12% of those have high school education or above; much lower than most Asian countries. That means current Thai elderly workers are undertaking menial labour tasks unlikely to be suitable for their age.

For the health sector, this would mean expanding healthcare policies and practices to not just fix and restore health but putting more emphasis on maintaining a healthy state and avoiding illnesses. Organisations can benefit from extending the present retirement age of experienced executives in order to retain their services, and many companies have already established 65 as their formal retirement age, systematically and not on a per case individual basis. This can only be achieved through proper provisions in health promotion and maintenance. Thorough annual health check-ups, fitness memberships, healthy canteen food, promoting alcohol-free business gatherings, everybody can be included in the effort to prolong a productive workforce lifespan.

Filling the Workforce and Healthcare Gap

It would seem like medical tourism, despite the potential to bring in millions of dollars in revenue for incumbent players, will not bode well for the increasingly ageing society that Thailand is gradually becoming. Foreign patients will take away more attention from the already thin healthcare resources the country has, and more so when the population really ages and the country still needs them to remain productive.

But all is not lost, thanks to modern technology, and in this case, automation.

Because of automation, we are now seeing fewer people of advancing age performing roles that are considered repetitive and requiring lower levels of creativity such as bank tellers, insurance clerks, automobile assemblers, and electronic component manufacturers. Those in the workforce of younger age will be naturally forced to acquire more skills and move up to do more complex work, readying themselves to become valued executives. Automation also plays a role in healthcare. Whereas doctors spend hours each day screening hundreds of check-up cases to spot a couple of abnormalities, these tasks soon can be performed instead by artificial intelligence systems. Doctors can then channel that valuable time to other high-value clinical tasks. People may not have to wait to see their GPs to know whether they should be doing more or eating less because, with the help of personal health big data and advanced prediction capabilities, they can become automated but personalized health and behavioural advice based on their diet, activity levels and check-up results.

To keep the country balanced and viable, we will need more automation, enhancing productivity in the workforce and aim for healthcare comprehensiveness.


Author: Dr. Veerachat Petpisit, CEO, Healthcare Ventures, BridgeAsia, Email: veerachat_p@bridgeasiagroup.com

Series Editor: Christopher F. Bruton, Executive Director, Dataconsult Ltd, chris@dataconsult.co.th. Dataconsult's Thailand Regional Forum provides seminars and extensive documentation to update business on future trends in Thailand and in the Mekong Region.


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