Description
Thailand is considered to be among the global leaders in the medical tourism market which has grown rapidly in recent years but has faced formidable competition from Singapore, India and other countries.
Journal of Tourism, Hospitality & Culinary Arts Vol. 3 Issue 2, 95-105, 2011
Marketing Strategies for Promoting
Medical Tourism in Thailand
Jutamas Rerkrujipimol and Ilian Assenov
Faculty of Hospitality & Tourism
Prince of Songkla University, Phuket, THAILAND
ABSTRACT
Thailand is considered to be among the global leaders in the medical tourism
market which has grown rapidly in recent years but has faced formidable
competition from Singapore, India and other countries. This exploratory research
was intended to evaluate the current marketing strategies of healthcare providers
and intermediaries through interviews with stakeholders and observation, and to
propose effective marketing strategies for preserving and enhancing Thailand's
position as a leading medical tourism destination. The paper identifies the
strengths of Thailand's healthcare service providers and points to a number of
problems that may reduce the growth opportunity of this industry. These include
lack of practical government policies with regard to medical tourism and of
other supporting regulations, lack of organization as a cooperation centre
aimed at promoting the medical tourism industry as a whole, remaining low
awareness of the opportunities presented by the industry among potentialfbreign
patients, and a shortage of doctors and qualified medical staff. Measures for
improvement are suggested.
Keywords: medical travel, medical tourism, Thailand, marketing strategies
INTRODUCTION
Medical tourism is a new form of niche market in the tourism industry which
has grown rapidly in recent years. The term "medical tourism" describes tourists
traveling overseas to obtain health care services such as medical, dental and
surgical care. They may or may not combine treatment with visiting the tourist
attractions of that country as well. The main groups of medical tourists come
from the industrialized countries of the world, especially Western Europe, Japan,
ISSN 1985-8914
© 2011 Faculty of Hotel and Tourism Managcmcnt, Univcrsiti Teknologi MARA (UiTM),
Malaysia.
95
Journal of Tourism, Hospitality & Culinary Arts
the U.S., Canada and Australia, where the cost of medical treatment is very
high and waiting times for some treatments may in some cases be months and
even years (Connell, 2006). Today's medical travel is mostly associated with
economically less developed countries, such as Thailand, India, Singapore,
Hungary, Costa Rica etc (Awadzi and Panda, 2006), which provide not only
low-cost high-standard treatment, but also the opportunity of combining it with
a vacation in a popular tourist destination.
According to Suthin, Assenov and Tirasatayapitak (2007), the reasons
for medical tourism gaining popularity in the above countries are as follows:
1. The long waiting lists in the developed countries, 2. The low cost of medical
treatments in medical tourism destinations, 3. The state-of-the-art technology
of health care services which have been adopted by the new service providers,
4. Affordable international air fares, and 5. The advance of the Internet and
the emergence of new companies and agents to serve as middlemen between
international patients and hospital networks which help patients to easily access
price and any other information.
Thailand has emerged in recent years as one of the leaders in the industry.
Data collected from 30 private hospitals by the Department of Export Promotion
of the Ministry of Commerce shows the increasing number of international
patients who have come to obtain medical treatment in private hospitals in
Thailand. In 1997 only 120,000 patients came for medical treatment; since
then, the number has drastically increased to 975,532 in 2003 and 1,356,000
in 2006 (see Figure 1).
The main competitors in the medical tourism industry of Thailand in Asia
are: Singapore, Malaysia, India, and Hong Kong (Bangkok Bank, 2005). Thailand
has a number of competitive advantages: it is already a well-known tourist
destination; it was one of the first countries to enter the medical tourism market;
it is known for its unique culture of service — the renowned Thai hospitality;
and also provides high quality services by qualified staff at a reasonable price.
1,600,000 -
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0,
,000
—4— Number of
patients
1997 2003
2004
2005 2006
Figurel: Number of international patients in Thailand, 1997-2006
Source: Data collected from 30 private hospitals by the Department of Export Promotion, Ministry
of Commerce (cited in http://mrd-hss.moph.go.th/ac/download.asp)
96
Marketing Strategies for Promoting Medical Tourism in Thailand
Under the guidance and regulation of the Ministry of Public Health, some Thai
hospitals have been recognized and approved for the standards set by the
Hospital Accreditation of both Thailand and International (Joint Commission
International or JCI), and also other international standards such as ISO and
Hazards and Critical Control Points Principle (HACCP).
The main competitors of Thailand in the region, as mentioned above, are
India, Singapore and Malaysia. India, with its lower cost of health services,
has emerged as an important competitor to Thailand. It had approximately
150,000 patients in 2004 and the Indian government predicted that this
industry could grow by l3% per year in the near future (Kaur, Sundar,
Vaidya, and Bhargava, 2007). However, it still lacks the quality standards
and infrastructure, and suffers from a negative image due to the low hygiene
and sanitation perception by travelers. Singapore has high living standards,
there is strong government support for the medical tourism industry, English
is widely spoken, and high quality medical services are offered at somewhat
higher price than in Thailand, but are still much cheaper than in developed
countries. In 2006, 410,000 patients traveled to Singapore specifically
for healthcare and the country hopes to attract 1 million medical travelers
annually by 2012 (www.singaporemedicine.com). Malaysia offers low
prices for healthcare services, and as a predominantly Muslim country
has competitive advantages, in particular in attracting patients from the
Middle East (Tirasatayapitak, Suthin, and Assenov, 2007). According to
the Association of Private Hospitals Malaysia (cited in Advertising and
Publicity Division, Tourism Malaysia, 2007), the number of international
patients seeking medical care in Malaysia has grown from 75,210 patients
in 2001 to 296,687 patients in 2006 when they generated USD 59 million in
revenue. Table 2, based on a publication by the Bureau of Policy and Strategy
Ministry of Public Health (2007) of Thailand provides a comparison of the
country with some of its major competitors.
In order to face the challenges of growing competition, Thailand needs,
among others, to improve its marketing of healthcare services. Therefore, this
research had the objectives of studying and observing the current marketing
strategies of service providers in medical tourism in Thailand (public hospitals,
private hospitals, clinics, and medical travel agents) and related parties such as
the Ministry of Public Health, the Tourism Authority of Thailand (TAT), and
the Provincial Health Authority, and to analyze and evaluate the marketing
strategies of Thailand and its main competitors in the region (Singapore, India,
and Malaysia) in order to come up with a proposal of effective marketing
strategies to develop and promote medical tourism in the country. This is the
first such study carried out in Thailand, and is expected to enhance knowledge
as well as to contribute to the development of effective planning in the future
and to enhance the co-operation between stakeholders.
97
- it
Journal of Tourism, Hospitality & Culinary Arts
Table 2: Competitive advantages: Thailand & Asian competitors
Competitive Advantage Thailand Singapore India Malaysia Hong Kong
Service & Hospitality xxxxx xx x x xx
Hi-technological Hardware xx xxxx xx x xx
HR Quality xxxx xxxx xx xx xxx
International Accredited Hospital xx xx x x
Pre-emptive Move xx xxx x x x
Synergy/Strategic Partner x xx x x x
Accessibility/Market Channel xx xxx x xx xx
Reasonable Cost xxxx x xxxx xxx x
Source: Bureau of Policy and Strategy, Ministry of Public Health, 2007 (retrieved from
http://203.157.19.191/HealthPolicy7.pdf)
METHODOLOGY
This qualitative research employed semi-structured interviews to examine the
current marketing strategies of Thailand's medical tourism service providers.
Interviews took place with healthcare service providers (public hospitals, private
hospitals, and clinics), medical travel agents and related parties, at several
popular tourism destinations of Thailand: Bangkok, Phuket, Pattaya, and Koh
Samui. Respondents were selected through purposive sampling, based on
information from secondary data and the researchers' experience in the area, as
well as observation of healthcare providers' websites. Criteria for inclusion in the
interview list included: membership in the Thailand Private Hospital Association,
the high number of international patients who received medical treatment,
active marketing on the Internet, and non-medical care service provided to the
patients. The interview topics included questions related to current and future
target markets and marketing strategies, channel distribution, positioning, main
competitors, threats to medical tourism in Thailand, industry collaboration,
involvement of new stakeholders, medical travel packaging, and other relevant
topics. In addition, observation of stakeholders' websites and online marketing
of service providers of competitors (Singapore, India, and Malaysia) were used
to accomplish the second objective of the study.
RESULTS AND DISSCUSSION
The findings from the interviews with the healthcare service providers and
observation of stakeholders' websites about the current marketing strategies used
by Thailand's health care service providers are described based on the 7 Ps of
98
Marketing Strategies for Promoting Medical Tourism in Thailand
the marketing mix proposed by Kotler and Armstrong (2008) and the Chartered
Institute of Marketing (2005): Product, Price, Place, Promotion, People, Process,
and Physical Evidence.
Product
Thailand's healthcare service providers offer specialized treatments such as
cardiovascular, cosmetic or plastic surgery, dental care, gender reassignment,
general surgery, ophthalmology, orthopedics, and health checks in accordance
with the needs of the patients in each target market. Well-trained medical staff
and specialists and cutting-edge technology are used to reassure patients about
the standard and high quality of medical treatment. The quality of treatment in
a less developed country is the major concern raised by the medical travelers
from industrialized countries. Most respondents commented that Thailand
is still considered a developing country among Westerners, especially those
who have never been in the country before, so the availability of high quality
medical care services is not easily recognized — unlike Singapore, with its
positive image as a high living standards country. However, the results of
the previous research of Suthin, Assenov and Tirasatayapitak (2007) about
satisfaction with the health service in Thailand indicated that most of the
patients who had been treated were very satisfied with the facilities of the
hospitals, the medical staff's professionalism, and quality of medical treatments
and were willing to recommend these to their friends/relatives and spread
word of mouth information to more potential patients. Another marketing
strategy used by service providers is to create more value through services to
differentiate themselves from their increasing number of competitors. Such
services include developing and intensifying customer relationships through
offering medical transportation both on land and air, serviced apartments for
patients' relatives, cafes and restaurants, online immigration service, services
for translating different kinds of languages, individual personal care services,
one-to-one nursing care service, online services for medical arrangements,
contact center, patient center, hotel selection, reservation, sightseeing tour
services, interne and WiFi services, etc. The unique culture and the inborn
characteristic of genuine hospitality of the Thai people are highly regarded
among the foreigners and are special and difficult to find in other countries.
The quality of Thai hospitality and its importance in differentiation were also
confirmed in reports by the Bureau of Policy and Strategy, Ministry of Public
Health (2007), and the Boston Consulting Group (2008).
Price
Thailand's healthcare service providers have a competitive advantage due to their
high standard of medical treatment and services offered to the patients at a very
99
It
Journal of Tourism, Hospitality & Culinary Arts
competitive price. Singapore offers medical treatment at a higher price than
Thailand because of its positioning with high end complex quality acute care
(Boston Consulting Group, 2008). India offers lower prices than Thailand but
still has the negative image of poor hygiene and sanitation. Kaur et al. (2007)
stated that in India complicated medical procedures are being carried out at only
one tenth of the cost in industrialized countries, but in terms of infrastructure
facilities such as roads, sanitation, power backups, accommodation, and public
utility services much more is needed for the country to become a medical
tourism destination. Malaysia offers prices lower than Thailand, partly due
to the favorable exchange rate but its focus is mainly on the Muslim patients
from Indonesia, Brunei and the Middle East.
While costs themselves are competitive enough, problems arise from
overcharging and overpricing of treatments by some Thai healthcare service
providers. Some patients complain of hidden costs that are not announced in
advance. The costs of medical services are also rising due to the high taxes on
imported medical technology or equipment. Therefore, the government has to
come up with a tax incentive policy which can not only solve the issue of the
cost but further encourage the healthcare service provider in the development
and implementation of high quality products and services. A good example is
given by the Malaysian government which provides tax incentives for building
hospitals, using medical equipment, training, promoting services, etc. to
encourage development of the healthcare industry (Leng, 2007).
Place
The internet is the main means for disseminating information related to
healthcare services offered by Thai healthcare service providers. It is the most
effective and inexpensive way to reach its target customers with its product
directly and at the same time help the patients acquire correct and valuable
information and allow them to make an informed decision. Informative online
marketing of each service provider creates awareness of the medical treatment
available and reassures potential patients. Interactive communication, treatment
description, description of services and facilities, quality assurance and other
concierge services are used on the websites to attract the patients who are on
a medical traveling program. At the moment Thailand does not have a central
organization to publicize valuable information on the health care services
to medical travelers. Singapore established an outstanding website www.
singaporemedicine.com as the center of the country's healthcare services. It
aims at promoting Singapore as a world class medical tourism destination, and
has proved very successful in this respect. The Thai government should support
or set up an official central website which combines all major healthcare
service providers together, for a focused promotion of medical tourism in
Thailand to the international market. Such a website would provide information
100
Marketing Strategies for Promoting Medical Tourism in Thailand
on treatment, facilities, links to healthcare service providers, medical travel
agents, and could handle inquiries from overseas patients.
Agents in the target countries are also used as representatives to provide
information and advice to patients on their treatment. The agents work as
the center between patients and hospitals for screening cases, sending all
necessary medical reports of the patients to the hospitals, spreading word of
mouth information, serving as a source of assurance, proving the reliability of
hospitals, etc. Some respondents expressed concerns about the services of the
medical travel agents, with regard to low accuracy in the medical correspondence
and over-promising to the patients which both lead to patients' subsequent
dissatisfaction and create a negative image of the medical service provider.
Therefore, healthcare service providers should choose high standard, professional
and ethical agent partners to promote their healthcare services as accurately as
possible. It is also recommended that the agent partners should be invited on a
familiarization visit by the healthcare service providers in order to be able to
disseminate correct and valuable information to the medical travelers.
Promotion
Attending trade fairs, travel markets/travel fairs, exhibitions, seminars and
conferences were used by the health care service providers to communicate
their products and services to the customers. Some of the trade fairs, travel
markets/travel fairs, and exhibitions were organized in cooperation with TAT,
the Ministry of Foreign Affairs, and the Department of Export Promotion (DEP).
But some providers participated on their own or with local organizations, local
institutes, medical schools, and universities in those target countries to establish
collaboration and to promote the available medical care services. Observations
indicated that the strategies to provide various information resources and
promotional services were implemented on the websites, so that patients seeking
medical treatments abroad could regularly visit to discover medical service
promotions, the latest developments of the medical service providers and also
to gain confidence in using their services in Thailand. The government and TAT
should come up with various supports and encourage more health care service
providers to participate in the trade fairs, travel markets and exhibitions in order
to promote their products and services. Moreover the media, journalists, travel
writers and book writers should be used to as a tool to develop a positive image
abroad. These could be invited for a free trip to the country and to specific
medical facilities. A strong network into overseas countries, e.g. through joint
venture partnerships, is also a measure to build the image of the products and
services of the Thailand. It is recommended that the Thai government and the
healthcare service providers cooperate more and work together in maintaining
the current standard of high quality products and services and further develop
and expand the image of the country as the "Medical Hub of Asia".
101
Journal of Tourism, Hospitality & Culinary Arts
People
Another strategy that health care service providers use to attract the international
patients for their treatments in Thailand is to emphasize its well-trained
medical specialists, with degrees from well-known overseas institutes. It was
acknowledged by all the health care service providers that having specialized
and qualified doctors and staff proved a competitive advantage for the hospitals.
This has been observed, for example on the websites of Bumrungrad hospital and
Bangkok hospital, where the qualifications of doctors and hospital nurses and the
medical staff were intensively promoted to attract and capture potential patients.
However, a shortage of doctors and trained medical staff was the major concern
currently commented on by the respondents. Moreover, language communication
skills — sometimes of doctors, but more often of nurses, receptionists, and
other relevant staff — and misunderstanding of the patients' culture were still
considered a problem and challenges for the medical tourism business for both
hospitals and clinics. Communication problems can lead to misunderstandings
between the patients and the medical staff and possibly to wrong diagnoses or
unsuitable treatment. These issues need to be addressed immediately by the Thai
government and the health care service providers. Development of the education
curriculum in the medical field should be emphasized and people encouraged
to pursue and specialize in medical studies by offering various scholarships for
studies in the country and abroad.
Process
Patients who seek medical treatment abroad are mostly concerned with the
quality of treatment and often want to make sure the hospital they select is
licensed and preferably accredited by a recognized international organization that
audits medical quality. The process of acquiring an international accreditation
with Joint Commission International (JCI) is one of the marketing strategy tools
for the health care service providers in Thailand. Such accreditation recognizes
that the practices of the doctors, nurses, medical assistants, the management
team and the facilities of the hospital meet or exceed the standards of medical
facilities in the US. The websites of the major hospitals aim to convince visitors
of the quality of the products, services and facilities through showing their awards
and accreditations such as JCI, ISO and others received from the international
organization and the government. So far in Thailand, Bumrungrad International
Hospital, Samitivej Hospital, and Bangkok Hospital Medical Center have
attained JCI accreditation, compared to 11 hospitals in Singapore (accounting
for one-third of all JCI-accredited facilities in Asia), and eight hospitals in
India (The Boston Consulting Group, 2008). There are other hospital assurance
schemes and awards which are also important to guarantee the quality of medical
care services, such as Thailand Hospital Accreditation Program (HA) conducted
102
Marketing Strategies for Promoting Medical Tourism in Thailand
by the Institute of Hospital Quality Improvement & Accreditation, and ISO.
In order to compete with the competitors both Government and Health care
service providers need to work in cooperation to further develop and enhance
the medical infrastructure, quality of products and services, management, etc.
of many more hospitals and clinics which should acquire similar international
accreditations. This will not only increase the number of visitors but will boost
the image of Thailand as a medical tourism destination.
Physical Evidence
Having developed its healthcare industry actively relatively late, Thailand's
healthcare service providers have had the advantage of learning and
understanding the needs and desires of patients better. The service providers
have developed and constructed outstanding hospitals equipped with the latest
advanced technologies, good ambiance with spacious and luxurious rooms, and
excellent amenities. This provides a competitive advantage over other medical
providers to market and gain the confidence of the patients in choosing the
hospitals. It has been observed that major health care providers have developed
significantly both infrastructures and facilities; however, there is still a need for
many other service providers to improve their infrastructure and facilities.
CONCLUSION
The medical tourism industry in Thailand is still growing and expanding in spite
of the high competition. Both online and offline promotion tools were used to
create awareness of the availability of high quality medical care and non-medical
care services, reassure patients about the standards and quality of medical
treatments, and offer alternative healthcare services for selection by potential
target customers. This research identified a number of other issues related to
the further promotion and expansion of the healthcare business in Thailand to
the overseas markets. These include the need for practical government support
and a common global strategy, adoption of appropriate laws and regulation,
and facilitation in the visa extensions procedures. The need for more qualified
specialists and staff, language training, cross-cultural training, and positive
PR for Thailand that remove the 'third-world country" image, the lack of
collaboration among service providers and of an organization to work as the
centre in this area are other relevant issues identified.
In order to maintain the high standards and to compete with the high
competition emerging from new medical tourism destinations every year,
the researchers hope that these issues will be given immediate attention and
addressed responsibly and appropriately by the Government, medical services
provider and the other related stakeholders in the near future.
103
Journal of Tourism, Hospitality & Culinary Arts
REFERENCES
Advertising and Publicity Division, Tourism Malaysia. (2007). Media Info
Health Tourism in Malaysia. Retrieved April 4, 2008, from: http://www.
tourism.gov.my/tourismbiz/mediacentre/articles/travelideas/PR%20
Health%20Tourism%206%20Nov%2007.pdf
Awadzi, W. & Panda, D. (2006). Medical Tourism: Globalization and the
Marketing of Medical Services. The Consortium Journal, 11(1), 75-81.
Boston Consulting Group. (2008). Overview of Medical Tourism — Give back
deck, BCG.
Bureau of Policy and Strategy Ministry of Public Health. (2007). Health policy
in Thailand 2007. Retrieved February 26, 2008, from: http://203.157.19.191/
HealthPolicy7.pdf
Bangkok Bank. (2005). Health Products and Health Services: Another Industry
in which Thailand is Competitive. Retrieved August 25, 2007, from:
http://www.bangkokbank.com/download/Health_Products_and_Health
Services.pdf
Chartered Institute of Marketing. (2005). Marketing and the 7Ps A brief summary
of marketing and how it works. Retrieved March 1, 2008 from: www.cim.
co.uk/MediaStore/FactFiles/Factifile7ps.pdf
Connell, J. (2006). Medical tourism: Sea, sun, sand and ... surgery. Tourism
Management, 27 (6), 1093-1100.
Kaur, J., Sundar, G. H., Vaidya D., & Bhargava S. (2007). Health Tourism in
India Growth and Opportunities. Proceedings, International Marketing
Conference on Marketing & Society. Retrieved September 2, 2007, from:
http://dspace.iimk.ac.in/bitstream/2259/345/1/415-422.pdf
Kotler, R & Armstrong, G. (2008). Principles of Marketing. The USA: Pearson
Education, Inc.
Leng, C. (2007). Medical Tourism in Malaysia: International Movement of
Healthcare Consumers and the Commodification of Healthcare. Asia
Research Institute Working Paper Series No. 83. Retrieved July 29, 2007,
from: http://www.ari.nus.edu.sg/showfile.asp?pubid=583&type=2
104
Marketing Strategies for Promoting Medical Tourism in Thailand
Thailand Medical Tourism. Retrieved October 4, 2007, from: http://mrdhss.
moph.go.th/ac/download.asp
Tirasatayapita
k
, A., Suthin, K., & Assenov, I. (2007).
Medical Tourism in
Thailand: Meeting Better the Needs
of
Japanese Tourists and Patients.
Thailand: Prince of Songkla University.
Suthin, K., Assenov, I. & Tirasatayapitak, A. (2007). Medical Tourism: Can
supply keep up with the demand.
Proceedings, APac-CHRIE & Asia Pacific
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Beijing, China.
105
doc_979963817.pdf
Thailand is considered to be among the global leaders in the medical tourism market which has grown rapidly in recent years but has faced formidable competition from Singapore, India and other countries.
Journal of Tourism, Hospitality & Culinary Arts Vol. 3 Issue 2, 95-105, 2011
Marketing Strategies for Promoting
Medical Tourism in Thailand
Jutamas Rerkrujipimol and Ilian Assenov
Faculty of Hospitality & Tourism
Prince of Songkla University, Phuket, THAILAND
ABSTRACT
Thailand is considered to be among the global leaders in the medical tourism
market which has grown rapidly in recent years but has faced formidable
competition from Singapore, India and other countries. This exploratory research
was intended to evaluate the current marketing strategies of healthcare providers
and intermediaries through interviews with stakeholders and observation, and to
propose effective marketing strategies for preserving and enhancing Thailand's
position as a leading medical tourism destination. The paper identifies the
strengths of Thailand's healthcare service providers and points to a number of
problems that may reduce the growth opportunity of this industry. These include
lack of practical government policies with regard to medical tourism and of
other supporting regulations, lack of organization as a cooperation centre
aimed at promoting the medical tourism industry as a whole, remaining low
awareness of the opportunities presented by the industry among potentialfbreign
patients, and a shortage of doctors and qualified medical staff. Measures for
improvement are suggested.
Keywords: medical travel, medical tourism, Thailand, marketing strategies
INTRODUCTION
Medical tourism is a new form of niche market in the tourism industry which
has grown rapidly in recent years. The term "medical tourism" describes tourists
traveling overseas to obtain health care services such as medical, dental and
surgical care. They may or may not combine treatment with visiting the tourist
attractions of that country as well. The main groups of medical tourists come
from the industrialized countries of the world, especially Western Europe, Japan,
ISSN 1985-8914
© 2011 Faculty of Hotel and Tourism Managcmcnt, Univcrsiti Teknologi MARA (UiTM),
Malaysia.
95
Journal of Tourism, Hospitality & Culinary Arts
the U.S., Canada and Australia, where the cost of medical treatment is very
high and waiting times for some treatments may in some cases be months and
even years (Connell, 2006). Today's medical travel is mostly associated with
economically less developed countries, such as Thailand, India, Singapore,
Hungary, Costa Rica etc (Awadzi and Panda, 2006), which provide not only
low-cost high-standard treatment, but also the opportunity of combining it with
a vacation in a popular tourist destination.
According to Suthin, Assenov and Tirasatayapitak (2007), the reasons
for medical tourism gaining popularity in the above countries are as follows:
1. The long waiting lists in the developed countries, 2. The low cost of medical
treatments in medical tourism destinations, 3. The state-of-the-art technology
of health care services which have been adopted by the new service providers,
4. Affordable international air fares, and 5. The advance of the Internet and
the emergence of new companies and agents to serve as middlemen between
international patients and hospital networks which help patients to easily access
price and any other information.
Thailand has emerged in recent years as one of the leaders in the industry.
Data collected from 30 private hospitals by the Department of Export Promotion
of the Ministry of Commerce shows the increasing number of international
patients who have come to obtain medical treatment in private hospitals in
Thailand. In 1997 only 120,000 patients came for medical treatment; since
then, the number has drastically increased to 975,532 in 2003 and 1,356,000
in 2006 (see Figure 1).
The main competitors in the medical tourism industry of Thailand in Asia
are: Singapore, Malaysia, India, and Hong Kong (Bangkok Bank, 2005). Thailand
has a number of competitive advantages: it is already a well-known tourist
destination; it was one of the first countries to enter the medical tourism market;
it is known for its unique culture of service — the renowned Thai hospitality;
and also provides high quality services by qualified staff at a reasonable price.
1,600,000 -
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0,
,000
—4— Number of
patients
1997 2003
2004
2005 2006
Figurel: Number of international patients in Thailand, 1997-2006
Source: Data collected from 30 private hospitals by the Department of Export Promotion, Ministry
of Commerce (cited in http://mrd-hss.moph.go.th/ac/download.asp)
96
Marketing Strategies for Promoting Medical Tourism in Thailand
Under the guidance and regulation of the Ministry of Public Health, some Thai
hospitals have been recognized and approved for the standards set by the
Hospital Accreditation of both Thailand and International (Joint Commission
International or JCI), and also other international standards such as ISO and
Hazards and Critical Control Points Principle (HACCP).
The main competitors of Thailand in the region, as mentioned above, are
India, Singapore and Malaysia. India, with its lower cost of health services,
has emerged as an important competitor to Thailand. It had approximately
150,000 patients in 2004 and the Indian government predicted that this
industry could grow by l3% per year in the near future (Kaur, Sundar,
Vaidya, and Bhargava, 2007). However, it still lacks the quality standards
and infrastructure, and suffers from a negative image due to the low hygiene
and sanitation perception by travelers. Singapore has high living standards,
there is strong government support for the medical tourism industry, English
is widely spoken, and high quality medical services are offered at somewhat
higher price than in Thailand, but are still much cheaper than in developed
countries. In 2006, 410,000 patients traveled to Singapore specifically
for healthcare and the country hopes to attract 1 million medical travelers
annually by 2012 (www.singaporemedicine.com). Malaysia offers low
prices for healthcare services, and as a predominantly Muslim country
has competitive advantages, in particular in attracting patients from the
Middle East (Tirasatayapitak, Suthin, and Assenov, 2007). According to
the Association of Private Hospitals Malaysia (cited in Advertising and
Publicity Division, Tourism Malaysia, 2007), the number of international
patients seeking medical care in Malaysia has grown from 75,210 patients
in 2001 to 296,687 patients in 2006 when they generated USD 59 million in
revenue. Table 2, based on a publication by the Bureau of Policy and Strategy
Ministry of Public Health (2007) of Thailand provides a comparison of the
country with some of its major competitors.
In order to face the challenges of growing competition, Thailand needs,
among others, to improve its marketing of healthcare services. Therefore, this
research had the objectives of studying and observing the current marketing
strategies of service providers in medical tourism in Thailand (public hospitals,
private hospitals, clinics, and medical travel agents) and related parties such as
the Ministry of Public Health, the Tourism Authority of Thailand (TAT), and
the Provincial Health Authority, and to analyze and evaluate the marketing
strategies of Thailand and its main competitors in the region (Singapore, India,
and Malaysia) in order to come up with a proposal of effective marketing
strategies to develop and promote medical tourism in the country. This is the
first such study carried out in Thailand, and is expected to enhance knowledge
as well as to contribute to the development of effective planning in the future
and to enhance the co-operation between stakeholders.
97
- it
Journal of Tourism, Hospitality & Culinary Arts
Table 2: Competitive advantages: Thailand & Asian competitors
Competitive Advantage Thailand Singapore India Malaysia Hong Kong
Service & Hospitality xxxxx xx x x xx
Hi-technological Hardware xx xxxx xx x xx
HR Quality xxxx xxxx xx xx xxx
International Accredited Hospital xx xx x x
Pre-emptive Move xx xxx x x x
Synergy/Strategic Partner x xx x x x
Accessibility/Market Channel xx xxx x xx xx
Reasonable Cost xxxx x xxxx xxx x
Source: Bureau of Policy and Strategy, Ministry of Public Health, 2007 (retrieved from
http://203.157.19.191/HealthPolicy7.pdf)
METHODOLOGY
This qualitative research employed semi-structured interviews to examine the
current marketing strategies of Thailand's medical tourism service providers.
Interviews took place with healthcare service providers (public hospitals, private
hospitals, and clinics), medical travel agents and related parties, at several
popular tourism destinations of Thailand: Bangkok, Phuket, Pattaya, and Koh
Samui. Respondents were selected through purposive sampling, based on
information from secondary data and the researchers' experience in the area, as
well as observation of healthcare providers' websites. Criteria for inclusion in the
interview list included: membership in the Thailand Private Hospital Association,
the high number of international patients who received medical treatment,
active marketing on the Internet, and non-medical care service provided to the
patients. The interview topics included questions related to current and future
target markets and marketing strategies, channel distribution, positioning, main
competitors, threats to medical tourism in Thailand, industry collaboration,
involvement of new stakeholders, medical travel packaging, and other relevant
topics. In addition, observation of stakeholders' websites and online marketing
of service providers of competitors (Singapore, India, and Malaysia) were used
to accomplish the second objective of the study.
RESULTS AND DISSCUSSION
The findings from the interviews with the healthcare service providers and
observation of stakeholders' websites about the current marketing strategies used
by Thailand's health care service providers are described based on the 7 Ps of
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the marketing mix proposed by Kotler and Armstrong (2008) and the Chartered
Institute of Marketing (2005): Product, Price, Place, Promotion, People, Process,
and Physical Evidence.
Product
Thailand's healthcare service providers offer specialized treatments such as
cardiovascular, cosmetic or plastic surgery, dental care, gender reassignment,
general surgery, ophthalmology, orthopedics, and health checks in accordance
with the needs of the patients in each target market. Well-trained medical staff
and specialists and cutting-edge technology are used to reassure patients about
the standard and high quality of medical treatment. The quality of treatment in
a less developed country is the major concern raised by the medical travelers
from industrialized countries. Most respondents commented that Thailand
is still considered a developing country among Westerners, especially those
who have never been in the country before, so the availability of high quality
medical care services is not easily recognized — unlike Singapore, with its
positive image as a high living standards country. However, the results of
the previous research of Suthin, Assenov and Tirasatayapitak (2007) about
satisfaction with the health service in Thailand indicated that most of the
patients who had been treated were very satisfied with the facilities of the
hospitals, the medical staff's professionalism, and quality of medical treatments
and were willing to recommend these to their friends/relatives and spread
word of mouth information to more potential patients. Another marketing
strategy used by service providers is to create more value through services to
differentiate themselves from their increasing number of competitors. Such
services include developing and intensifying customer relationships through
offering medical transportation both on land and air, serviced apartments for
patients' relatives, cafes and restaurants, online immigration service, services
for translating different kinds of languages, individual personal care services,
one-to-one nursing care service, online services for medical arrangements,
contact center, patient center, hotel selection, reservation, sightseeing tour
services, interne and WiFi services, etc. The unique culture and the inborn
characteristic of genuine hospitality of the Thai people are highly regarded
among the foreigners and are special and difficult to find in other countries.
The quality of Thai hospitality and its importance in differentiation were also
confirmed in reports by the Bureau of Policy and Strategy, Ministry of Public
Health (2007), and the Boston Consulting Group (2008).
Price
Thailand's healthcare service providers have a competitive advantage due to their
high standard of medical treatment and services offered to the patients at a very
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competitive price. Singapore offers medical treatment at a higher price than
Thailand because of its positioning with high end complex quality acute care
(Boston Consulting Group, 2008). India offers lower prices than Thailand but
still has the negative image of poor hygiene and sanitation. Kaur et al. (2007)
stated that in India complicated medical procedures are being carried out at only
one tenth of the cost in industrialized countries, but in terms of infrastructure
facilities such as roads, sanitation, power backups, accommodation, and public
utility services much more is needed for the country to become a medical
tourism destination. Malaysia offers prices lower than Thailand, partly due
to the favorable exchange rate but its focus is mainly on the Muslim patients
from Indonesia, Brunei and the Middle East.
While costs themselves are competitive enough, problems arise from
overcharging and overpricing of treatments by some Thai healthcare service
providers. Some patients complain of hidden costs that are not announced in
advance. The costs of medical services are also rising due to the high taxes on
imported medical technology or equipment. Therefore, the government has to
come up with a tax incentive policy which can not only solve the issue of the
cost but further encourage the healthcare service provider in the development
and implementation of high quality products and services. A good example is
given by the Malaysian government which provides tax incentives for building
hospitals, using medical equipment, training, promoting services, etc. to
encourage development of the healthcare industry (Leng, 2007).
Place
The internet is the main means for disseminating information related to
healthcare services offered by Thai healthcare service providers. It is the most
effective and inexpensive way to reach its target customers with its product
directly and at the same time help the patients acquire correct and valuable
information and allow them to make an informed decision. Informative online
marketing of each service provider creates awareness of the medical treatment
available and reassures potential patients. Interactive communication, treatment
description, description of services and facilities, quality assurance and other
concierge services are used on the websites to attract the patients who are on
a medical traveling program. At the moment Thailand does not have a central
organization to publicize valuable information on the health care services
to medical travelers. Singapore established an outstanding website www.
singaporemedicine.com as the center of the country's healthcare services. It
aims at promoting Singapore as a world class medical tourism destination, and
has proved very successful in this respect. The Thai government should support
or set up an official central website which combines all major healthcare
service providers together, for a focused promotion of medical tourism in
Thailand to the international market. Such a website would provide information
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Marketing Strategies for Promoting Medical Tourism in Thailand
on treatment, facilities, links to healthcare service providers, medical travel
agents, and could handle inquiries from overseas patients.
Agents in the target countries are also used as representatives to provide
information and advice to patients on their treatment. The agents work as
the center between patients and hospitals for screening cases, sending all
necessary medical reports of the patients to the hospitals, spreading word of
mouth information, serving as a source of assurance, proving the reliability of
hospitals, etc. Some respondents expressed concerns about the services of the
medical travel agents, with regard to low accuracy in the medical correspondence
and over-promising to the patients which both lead to patients' subsequent
dissatisfaction and create a negative image of the medical service provider.
Therefore, healthcare service providers should choose high standard, professional
and ethical agent partners to promote their healthcare services as accurately as
possible. It is also recommended that the agent partners should be invited on a
familiarization visit by the healthcare service providers in order to be able to
disseminate correct and valuable information to the medical travelers.
Promotion
Attending trade fairs, travel markets/travel fairs, exhibitions, seminars and
conferences were used by the health care service providers to communicate
their products and services to the customers. Some of the trade fairs, travel
markets/travel fairs, and exhibitions were organized in cooperation with TAT,
the Ministry of Foreign Affairs, and the Department of Export Promotion (DEP).
But some providers participated on their own or with local organizations, local
institutes, medical schools, and universities in those target countries to establish
collaboration and to promote the available medical care services. Observations
indicated that the strategies to provide various information resources and
promotional services were implemented on the websites, so that patients seeking
medical treatments abroad could regularly visit to discover medical service
promotions, the latest developments of the medical service providers and also
to gain confidence in using their services in Thailand. The government and TAT
should come up with various supports and encourage more health care service
providers to participate in the trade fairs, travel markets and exhibitions in order
to promote their products and services. Moreover the media, journalists, travel
writers and book writers should be used to as a tool to develop a positive image
abroad. These could be invited for a free trip to the country and to specific
medical facilities. A strong network into overseas countries, e.g. through joint
venture partnerships, is also a measure to build the image of the products and
services of the Thailand. It is recommended that the Thai government and the
healthcare service providers cooperate more and work together in maintaining
the current standard of high quality products and services and further develop
and expand the image of the country as the "Medical Hub of Asia".
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People
Another strategy that health care service providers use to attract the international
patients for their treatments in Thailand is to emphasize its well-trained
medical specialists, with degrees from well-known overseas institutes. It was
acknowledged by all the health care service providers that having specialized
and qualified doctors and staff proved a competitive advantage for the hospitals.
This has been observed, for example on the websites of Bumrungrad hospital and
Bangkok hospital, where the qualifications of doctors and hospital nurses and the
medical staff were intensively promoted to attract and capture potential patients.
However, a shortage of doctors and trained medical staff was the major concern
currently commented on by the respondents. Moreover, language communication
skills — sometimes of doctors, but more often of nurses, receptionists, and
other relevant staff — and misunderstanding of the patients' culture were still
considered a problem and challenges for the medical tourism business for both
hospitals and clinics. Communication problems can lead to misunderstandings
between the patients and the medical staff and possibly to wrong diagnoses or
unsuitable treatment. These issues need to be addressed immediately by the Thai
government and the health care service providers. Development of the education
curriculum in the medical field should be emphasized and people encouraged
to pursue and specialize in medical studies by offering various scholarships for
studies in the country and abroad.
Process
Patients who seek medical treatment abroad are mostly concerned with the
quality of treatment and often want to make sure the hospital they select is
licensed and preferably accredited by a recognized international organization that
audits medical quality. The process of acquiring an international accreditation
with Joint Commission International (JCI) is one of the marketing strategy tools
for the health care service providers in Thailand. Such accreditation recognizes
that the practices of the doctors, nurses, medical assistants, the management
team and the facilities of the hospital meet or exceed the standards of medical
facilities in the US. The websites of the major hospitals aim to convince visitors
of the quality of the products, services and facilities through showing their awards
and accreditations such as JCI, ISO and others received from the international
organization and the government. So far in Thailand, Bumrungrad International
Hospital, Samitivej Hospital, and Bangkok Hospital Medical Center have
attained JCI accreditation, compared to 11 hospitals in Singapore (accounting
for one-third of all JCI-accredited facilities in Asia), and eight hospitals in
India (The Boston Consulting Group, 2008). There are other hospital assurance
schemes and awards which are also important to guarantee the quality of medical
care services, such as Thailand Hospital Accreditation Program (HA) conducted
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Marketing Strategies for Promoting Medical Tourism in Thailand
by the Institute of Hospital Quality Improvement & Accreditation, and ISO.
In order to compete with the competitors both Government and Health care
service providers need to work in cooperation to further develop and enhance
the medical infrastructure, quality of products and services, management, etc.
of many more hospitals and clinics which should acquire similar international
accreditations. This will not only increase the number of visitors but will boost
the image of Thailand as a medical tourism destination.
Physical Evidence
Having developed its healthcare industry actively relatively late, Thailand's
healthcare service providers have had the advantage of learning and
understanding the needs and desires of patients better. The service providers
have developed and constructed outstanding hospitals equipped with the latest
advanced technologies, good ambiance with spacious and luxurious rooms, and
excellent amenities. This provides a competitive advantage over other medical
providers to market and gain the confidence of the patients in choosing the
hospitals. It has been observed that major health care providers have developed
significantly both infrastructures and facilities; however, there is still a need for
many other service providers to improve their infrastructure and facilities.
CONCLUSION
The medical tourism industry in Thailand is still growing and expanding in spite
of the high competition. Both online and offline promotion tools were used to
create awareness of the availability of high quality medical care and non-medical
care services, reassure patients about the standards and quality of medical
treatments, and offer alternative healthcare services for selection by potential
target customers. This research identified a number of other issues related to
the further promotion and expansion of the healthcare business in Thailand to
the overseas markets. These include the need for practical government support
and a common global strategy, adoption of appropriate laws and regulation,
and facilitation in the visa extensions procedures. The need for more qualified
specialists and staff, language training, cross-cultural training, and positive
PR for Thailand that remove the 'third-world country" image, the lack of
collaboration among service providers and of an organization to work as the
centre in this area are other relevant issues identified.
In order to maintain the high standards and to compete with the high
competition emerging from new medical tourism destinations every year,
the researchers hope that these issues will be given immediate attention and
addressed responsibly and appropriately by the Government, medical services
provider and the other related stakeholders in the near future.
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