Hi,

I've been giving some thought to arranging medical tourism trips to Thailand. Lots of things to consider obviously, but I assume the legal side of it is a big part. Perhaps someone here could help me along the way.

For example, at some point a customer may not feel he has gotten the correct treatment or even worse been mistreated or had his condition worsen. This is probably unavoidable unfortunately as people do make mistakes. Who would carry the blame here if someone wants to sue, the hospital or the agent or both? Would the travel agent be liable to lawsuits or even criminal persecution in a foreign country (not Thailand) even if the company does not have an office there?

How do you best help and protect your customers in case of malpractise while keeping a good relationship with the providers (i.e. hospitals and doctors)?

Do you need to be member of some kind of travel insurance guarantor fund in every country you sell to?

I'm not trying to get free legal advice, so no need to tell me to talk to a lawyer (I will do that). But any inputs from knowledgeable posters will be greatly appreciated.

Thanks!

Assuming you are neither a doctor nor a travel agent, you would be purely a broker and the contract with your customer would wave all liabilities for the treatments...

So you would contract with both travel agents and hospitals about supplying them with patients who need various treatments which you would then sell to your customers for a commission...

However... why should I - as your customer - make use of such a service and pay for your broker fees, when I can travel here, enter each and every hospital and get advice within minutes?

Assuming you are neither a doctor nor a travel agent, you would be purely a broker and the contract with your customer would wave all liabilities for the treatments...

So you would contract with both travel agents and hospitals about supplying them with patients who need various treatments which you would then sell to your customers for a commission...

However... why should I - as your customer - make use of such a service and pay for your broker fees, when I can travel here, enter each and every hospital and get advice within minutes?

Thank you for your reply.

You'd enlist my services for the same reason most people prefer to buy package tours instead of arranging it themselves:

1) You will usually get a better price, because I have negotiated rates in advance with the correct hospital for the correct procedure

2) You will have someone speaking your own language helping you out along the way, meeting you in the airport, getting you to your hotel, helping you out in a foreign country, someone to talk to if anything is difficult

3) The idea of arranging such a trip yourself seems daunting, particularly with a condition, and you don't mind paying a fellow countryman a commission for taking care of all of that

The only problem I see is when the patient returns home and things go wrong with the operation, what happens then, actually there's a mine field of stuff you would have to jump, from country of origin regs, relating to medical tourism, to Thailand government regs, the players are already in place , Malaysia and Singapore also do medical tourism in this region.Quarterly audits are carried out on Thai medical tourism hospitals , from specialist people in this field, from the US, all i know it's big business, for professionals in this field.

I looked into the medical tourism business in Thailand about eight years ago. Some people were doing well in it. However, I declined to get involved because of the litigation risk in the US. It would depend to some extent on the source of your clientele. The US is more litigious, but otherwise an attractive market because of the high cost of health care. Other English-speaking countries may be less litigious, but they also have national health systems that provide services a lot cheaper than the US.

You have to be willing to accept the litigation risk, at least in the US. No amount of liability waivers will protect you. American juries and expert witnesses are unlikely to be sympathetic to a medical care for profit business.

However, if you do decide to go into the business, it's a marketing game. You have to find a population that needs acute care, meaning surgery mostly, does not have insurance, but does have the cash to pay for treatment. The Thai hospitals will probably kick back 15% to you, at least that was the number one hospital quoted us. If it is indeed the US you are considering I would look at the population of small business owners. As I remember from the research I did, at that time there were 15 million people in the US who earned more than $75k/yr, but had no health insurance. Probably a lot of them were small business owners. You would need to find marketing methods to target a group like this effectively. Then you have to persuade them to go to Thailand for their bypass. Not so easy, but our approach was going to be to have a US doctor on staff to inspect the Thai hospitals and answer questions from prospective customers. US insurance companies get lobbied by doctors and hospitals not to pay for foreign treatment. Despite the cost benefit to the insurer, they mostly will not pay.

Then you would need to manage bilingual support people on the ground here in Thailand to take care of your customers, who will be sick people far from home in an alien culture. I would look to hire bilingual Thai nurses, but you would need to find people who can both take responsibility and deal effectively with unforseen problems that will arise. Such people are not so common among Thais. You would need someone with knowledge of Thai hospitals and their specialties.

In addition to the impact of the Affordable Care Act in the US, which will diminish the pool of prospective customers, some of the Thai hospitals have their own marketing departments, which would be your direct competition. And there are other risks. In 2008 when the yellow shirts closed Suvarnaphumi airport, I was glad that I was not in the medical tourism business.

Swiss 1960. I am afraid Mr Hammer does have a point and this may be an important and worthwhile agency service to people who need 'nursing' along the tortuous routes. Well done for Mr Hammer for business acumen.

I looked into the medical tourism business in Thailand about eight years ago. Some people were doing well in it. However, I declined to get involved because of the litigation risk in the US. It would depend to some extent on the source of your clientele. The US is more litigious, but otherwise an attractive market because of the high cost of health care. Other English-speaking countries may be less litigious, but they also have national health systems that provide services a lot cheaper than the US.

You have to be willing to accept the litigation risk, at least in the US. No amount of liability waivers will protect you. American juries and expert witnesses are unlikely to be sympathetic to a medical care for profit business.

However, if you do decide to go into the business, it's a marketing game. You have to find a population that needs acute care, meaning surgery mostly, does not have insurance, but does have the cash to pay for treatment. The Thai hospitals will probably kick back 15% to you, at least that was the number one hospital quoted us. If it is indeed the US you are considering I would look at the population of small business owners. As I remember from the research I did, at that time there were 15 million people in the US who earned more than $75k/yr, but had no health insurance. Probably a lot of them were small business owners. You would need to find marketing methods to target a group like this effectively. Then you have to persuade them to go to Thailand for their bypass. Not so easy, but our approach was going to be to have a US doctor on staff to inspect the Thai hospitals and answer questions from prospective customers. US insurance companies get lobbied by doctors and hospitals not to pay for foreign treatment. Despite the cost benefit to the insurer, they mostly will not pay.

Then you would need to manage bilingual support people on the ground here in Thailand to take care of your customers, who will be sick people far from home in an alien culture. I would look to hire bilingual Thai nurses, but you would need to find people who can both take responsibility and deal effectively with unforseen problems that will arise. Such people are not so common among Thais. You would need someone with knowledge of Thai hospitals and their specialties.

In addition to the impact of the Affordable Care Act in the US, which will diminish the pool of prospective customers, some of the Thai hospitals have their own marketing departments, which would be your direct competition. And there are other risks. In 2008 when the yellow shirts closed Suvarnaphumi airport, I was glad that I was not in the medical tourism business.

Hey Mr. Haddock,

Thanks for the excellent reply. I have no intentions about selling to Americans to begin with but rather Europeans with slow public health care. My hope is to be able to convince European insurance agencies to send people to Thailand instead of local private hospitals. For example an MRI costs 1/3 to 1/4 in Thailand. The airfare is covered by that alone. I can see a big market for this relating to many thing such as dental, knee,hip surgery and rehabilitation, diagnostic trips (get all done in one week instead of 6 months in Europe).

Yes, it would probably be nessecary to have a western doctor on staff, but it wouldn't nessecarily have to be an older expert, a younger adventerous doctor could probably do as he or she would only decide where to refer patients. Then a nurse or two to help with hotel care and similar.

Marketing is of course the alpha and omega as always. Fortunately I do have some experience in that regard.

Interesting topic.

My first reaction to your question was 'Legal Precautions???.... you want to find out who can be sued...?' And indeed, American 'culture' is to sue if you are not satisfied. I also understood from reading the thread that the subject for the thread is a wish to protect your business, Mr Hammer. Which of course I can understand. However, I believe you should re-think your concept.

The issues you mentioned - having someone receiving the client at the airport, translating etc are all perfectly well-thought-of issues. And your point of view concerning choosing the 'package tour' instead of arranging everything by yourself is also valid.

There are nevertheless issues you need to be aware of when using the Thai medical system:

1) Before undergoing a treatment, you (or your next-of-kin) signs a form, a waiver, by which you yourself accept the entire responsibility for your treatment AND that the doctors/hospitals etc cannot be held liable for any mistakes or problems that appear later due to the treatment.

2) Thai doctors form a 'white brotherhood', protecting their privileges - just like in the US or in Denmark, where I come from

3) Trying to penetrate this defense of privileges or making a lawsuit against a doctor in Thailand is next to impossible and those who have tried have had very little success

HAVING SAID THIS,

I also would like to highlight that having a doctor/hospital treating you, is something you let them do to you if you are in need - no matter where i the world you are - litigation culture or not! And many people make their choice of using Medical Tourism to solve their health problem irrespective of possibility to sue.

During the last 2 years, I have been having treatment at Thai Hospitals: Twice @ Bangkok Hospital (incl. orthopedic surgery of a meniscus) and once @ Asoke Skin Hospital (blepharoplasty - removal of lower eye bags). In all cases ABSOLUTELY first-class treatment! Nothing to put my finger on and be unsatisfied about.

And that brings me to the next issue: Thai doctors are good! ...often trained or specializing at US or European hospitals after their university education in Thailand. Most are up-to-date on education, treatment types, using state-of the-art equipment etc. as well as being active members of international societies within their field of health work. I have not at any moment had concerns putting my health into their hands or questioned their professionalism.

So let me ask the rhetorical question again:

Do people seek medical solutions for the sake of their health - or for the sake of being able to sue someone afterwards?

Like Chainarong also mentioned in the thread - actors are in place to ensure this important industry is working in a smooth way in a number of Asian countries where this is booming! So clients should as a starting point have trust in this industry doing a good job.

I don't know enough about US law in this field. However, if it was me starting a business like this, I would ensure that my business only handled the 'brokering' - connecting hospitals/doctors w clients AND ensuring in all contracts w client and the medical facility that the decision to make a treatment is the client's - and entirely an issue directly between the client and hospital/doctor - without your company involved. They can pay you the commission afterwards...!

Finally - your statement about European healthcare: Please understand that no systems in Europe are like the US system - in most countries there IS a public healthcare which might be experiencing cuts etc. but still is responsible for the treatment of the population (unfortunately often labeled 'communism' or 'socialism' by critics...) For some, an alternative could however still be healthcare provided in Asia. BUT ONLY IF PEOPLE CAN AFFORD TO PAY OUT OF THEIR OWN POCKETS!

Please remember almost 30 European countries are in the European Union and therefore have more or less same rules. And because of the EU, the deal is that as a citizen you can get your treatment in other EU countries, provided the treatment cannot be given in your own country (incl. issues of waiting lists) and that your public healthcare authority has made a contract of service delivery at x hospital in y country.... so the road to Asia is not open 'just like that'. Putting a European doctor on your payroll doesn't solve that problem...

Then there is the issue of which private insurance company pays for what and how.....indeed a jungle, and I am not sure it is worth while researching that...but up to you. Good luck!

Jesper Frovin Jensen

ps Another medical field - less in size per customer - but which has much more 'incentive' to pursue for more US citizens and ordinary citizens from a number of European countries is Dentistry in Thailand.

Read my article about this: http://bit.ly/X714lA