Even five years ago, Thailand's claim to fame in the medical travel world was as a cheap and reliable destination for sex change operations. Over the past few years, the Thai government and half a dozen private hospitals have gone into overdrive to change that image. They are now repositioning Thailand as Asia's premier healthcare hub for everything from cosmetic surgery to hip replacements.

The Thai Ministry of Public Health is working closely with the Thai Ministry of Tourism to promote medical tourism in Thailand. More interestingly, the Thai minister met his counterpart from Malaysia a few months ago to see if the two countries could mount some sort of joint-promotion to beat competition from other countries.

But the government initiatives pale before the kind of action that the private hospitals are taking to attract medical travellers. Bangkok's Bumrungrad Hospital is by far the clear leader in the field. With 554 beds on offer, it treated 300,000-plus expatriates and foreigners last year. In fact, a full 25% of all the patients that the hospital treats today are foreigners. To make itself attractive to foreigners, Bumrungrad offers a host of facilities. It offers assistance in 13 languages and it has got itself accredited from the JCAHO, an international certification recog- nised by most of the big insurance companies. It's even got a McDonald's and a Starbucks coffee shop in its compound to cater to the tastes of its foreign patients and their companions. "To facilitate patients, we have opened offices in Myanmar, Vietnam, Nepal, Sri Lanka, Maldives, Cambodia, the Netherlands and the Middle East," says Carl Schroeder, CEO, Bumrungrad Hospital.

The other private hospitals aren't sitting still either. The Phyathai hospital is hiring teachers from the British Council to train its staff, including the maids. It has also signed contracts with hospitals in the Netherlands and Bangladesh to bring in patients awaiting heart surgery there. Thailand provides specialised medical clinics, skilled nursing care, long-term care, nursing homes and rehabilitation clinics at costs that are a fraction of what it would cost in the US or Britain. "The cost of treatment in Thailand is less then half of what other neighbouring countries charge," says Surapong Ambhanwong, chief medical officer of Phyathai 1 hospital.

The Japanese still form the biggest chunk of medical travellers coming to Thailand, though the Americans and the British are now coming in significant numbers. After 9/11, it also got a huge share of the Arab traffic.