Neo-Liberalism, the Rise of the Unelected and Policymaking in Thailand: The Case of the Medical Tourism Industry

ABSTRACT

This article discusses how neo-liberal ideas about development take root when they encounter the very different political and economic context of a developing economy. It analyses Thailand’s medical tourism industry, earmarked by Thailand’s government as one of several priority industries to boost the economy in the aftermath of the 1997 Asian Economic Crisis, which ravaged Thailand and ushered in a group of unelected actors – “reign-seekers” – intent on disbursing supposedly de-politicised neo-liberal governance reform. This article makes three inter-related arguments. First, these unconventional actors function as a fluid intermediary linking various public agencies, private sector players and civil society actors, fostering dialogue and reconciling diverging interests. Second, the influence of neo-liberalism on the workings of the state has been relatively modest as the “reign-seekers” have primarily promoted welfare-oriented policies over pro-business ones. Third, the “reign-seeking” elites’ welfare-oriented stance underlines the fracture and heterogeneity within a group of supposedly neo-liberal proponents.

KEYWORDS:

• Medical tourism
• health policy
• reign-seeking
• policymaking
• globalisation
• Thailand

Acknowledgments

The authors thank the reviewers for their constructive comments on earlier versions of this manuscript.

Disclosure Statement

No potential conflict of interest was reported by the authors. The authors are responsible for all interpretations and any remaining errors in this article.

Notes

1. Although all definitions are contested, medical tourism is usually combined with some elements of vacationing. Activities covered under this broad umbrella include but are not limited to plastic surgery, traditional medical therapy and corrective dental work (see, for example, KPMG 2018).

2. This is the intention of the policy measures. While their longer-term impacts are important, they are not the main focus of this article, which seeks to illustrate the role of reign-seeking actors in fostering dialogue among divergent interest groups and to show their roles in managing the impacts of neo-liberalism.

3. To date, the Sophonpanich and Lamsam families retain control of their banks while the latter two families failed to do so. Bangkok Metropolitan Bank of the Tejapaibul family was acquired by the state. While the Ratanaraks controlled Bank of Ayudhya after the AEC, the bank was later bought by Bank of Tokyo-Mitsubishi UFJ, with the family holding only 20% of its shares in 2017 (Hewison 2019, 10–11).

4. The term “medical tourism” was not yet coined in the 1970s (Cohen 2008, 27).

5. While these firms have sold some of their shares to foreign investors on the stock exchange, Thailand’s 49% cap on foreign ownership in private healthcare services means that they have preserved a degree of control while tapping foreign capital and the expertise of foreign investors.

6. The Act’s Articles 25.1 and 25.2 outline the NHC’s responsibilities, which include creating the National Health System Statute (a legal text which formulates the country’s healthcare frameworks and strategies in all aspects) and advising the Cabinet on national health strategies and policies.

7. A major shortcoming of the NHC is unsatisfactory outcome tracking, meaning that policy initiatives and impact are diluted.

8. According to Suwit and Pachanee (2008, 12), Thailand does not face a serious problem with external brain drain (Thai healthcare professionals to other countries), at least compared to other regional economies such as the Philippines. This is due to Thai professionals having “[f]avourable income, good working environment, opportunity for career development and limited capacity in foreign language …”. Rather, the issue is internal brain drain.

9. Likewise, the will of the chair and vice-chair is unlikely to hold sway without the support of reign-seekers and their institutions. Thus, the relationship takes the form of a symbiosis.

10. As noted above, some public hospitals in the border areas offer services to medical tourists from the adjacent countries. For example, the better-equipped public (and some small private) hospitals in Udon Thani city are popular with wealthy Laos patients.

Additional information

Funding

The authors declare that they received no financial support for the research and publication of this article.