A hospital diagnoses and treats patiens in exchange for money to pay for staff and equipment and to repay and provide a return on investments.In free-market societies we like to think that the marketplace will dictate the return on the investment. results from procedures should bring a fair retun.What procedures at what expense should be used in the treatment of a patient? Most patients are ill-equipped to make this kind of decision. Decisions in this area are made by doctors. The doctors are sometimes second-guessed by insurance companies and perhaps influenced by hospital administrators. The insurance companies want to keep costs down; hospital administrators may have a different agenda.With patients being ill-equipped to make decisions about theri care and doctors being subject to influences other than what is needed medically, the questions of what procedures and expenses are necessary become difficult. One doctor and the hospital he runs have ansewrs to these questions.Dr. Sunya Viravaidya. the founder and leader of Pattaya International Hospital, has a set of policies in place that are designed to provide excellent care at a fair cost.The policies are centered around the attending doctor.Dr. Sunya Viravaidya his medical career as a single practitioner in a small office. He built his practice by being a good doctor and attending to his patients'needs. Because he responded to his patients needs, they became his patients and his practice grew. His doctor's office soon became a clinic with additional doctors and then a smal hospital and now, after 35 years, Pattaya Intemational Hospital. PIH is considered by many to be among the best hospitals in Thailand, if not the world.One of the reasons for this success is Dr. Sunys' insistence that each doctor practicing at his hospital respond to his patients' real needs. Each doctor must develop his or her own practice by successfully treating patients. The patients tell others and the word of mouth brings more people when treatment is needed. So the doctors are busy treating patients and because they charge for their work they make money. There is no need for unnecessary testing or procedures.Walking around the Pattaya Intemational Hospital, one cannot help but be impressed. It is well designed and beautifully set in its surroundings. And it has been done by one man. Dr. Sunya is rightly proud of his accomplishment and he intends to keep PIH a first-rate hospital. He also intends to make it sustainable.There is much talk in Thailand about medical tourism amd the good it can do for the economy. Dr.Sunya's position on medical tourism is that he welcomes patients from anywhere, but Pattaya International is a community hospital serving Pattaya and the surrounding areas first. He intends to keep PIH at a size that is sustainable within the Pattaya community. If tourists come, fine, but he is not going to add facilities for tourists that might or might not come.