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Medical Leave

Clean, Not Sterile: Patients come to Bumrungrad and Bangkok Hospital
for the surgery -- but stay for the espresso. | photograph by Steve Bronstein

"This doesn't look like a hospital," says Ruben Toral, showing me around. "It feels more like a hotel or an upscale mall." After studying the gleaming lobby of Bumrungrad International for a minute or two, I'm inclined to agree. Americans in shorts recline across from Arab couples in flowing white dishdashas and black abayas, the latter accessorized with designer handbags and sunglasses. We're in Bangkok in August, when even the asphalt is overripe and malodorous, but the only scent inside is a faint whiff of espresso from the Starbucks in the corner.

	Not a Hotel: The main lobby at Bumrungrad offers up a global cross section of humanity. Your recovery suite awaits. | photogragh by Tony Law

Toral is responsible for luring that cosmopolitan clientele here, thousands of miles from home, for a knee replacement or a triple bypass or even just a checkup. Before he arrived in 2001 as Bumrungrad's marketing director, "we were a Thai hospital serving a Thai community," he says. "Now we're an international hospital that just happens to be in Thailand."

Toral himself just happens to be a dead ringer for George Clooney, and he tells his story in similarly seductive tones. He's still amazed, seven years later, that folks who have never set foot on a plane, let alone owned a passport, will log a 24-hour flight -- in coach! -- to put themselves in the care of a hospital whose name they can't even pronounce. Overseas patients have more than doubled on his watch, to 430,000 in 2006, generating the majority of the privately owned hospital's revenue. "It's the high-school-cafeteria person," Toral says. "The independent businessman, the doctor, the lawyer. They tell me, 'We did the math. We can't afford to pay $1,200 for insurance every month.' "

The phrase "medical tourism" was once used to describe early retirees jetting in to Bangkok or Bangalore to have a little work done before recuperating on the beach. That image doesn't jibe with the numbers today. As many as half a million Americans streamed abroad last year in search of affordable alternatives for hip replacements or prostate surgery. And they went not for the postsurgical tanning but for the savings: up to 90% off the going rates in the United States. They went because 47 million Americans lack insurance and can't pay for surgery to fix a bad back or clogged arteries. Or because they have insurance but can't begin to pay the soaring deductibles a major surgery entails. They're fleeing a system that is by far the most expensive in the world and growing more so by the hour, with diminishing returns in quality of care.

"Your options are paying $50,000 to $60,000 in the States or coming here and paying $8,000," says Toral, an American raised in North Carolina. "That's the difference between putting it on your credit card or going into bankruptcy."

A journey to Bumrungrad is hardly a descent into some third-world medical hell. It was arguably a world-class hospital even before it became a world-famous one (thanks in large part to a 60 Minutes segment in 2005 orchestrated by Toral). Administrators have spent the past 15 years acquiring state-of-the-art technology, adding beds, and wooing Thai doctors abroad to come home. Bumrungrad replaced its paper records seven years ago with a homegrown, all-digital system, an upgrade U.S. hospitals have struggled with for years, despite the assistance of giants like Cerner, Siemens, and General Electric. (Replacing prescription pads with tablet PCs is harder than you'd think, which might explain why last year Microsoft bought the company that designed Bumrungrad's software. Toral now works for Bumrungrad in an advisory role; he has struck out on his own with MedNet Asia, a software startup helping insurers handle paperwork.) .