Medical Costs for Thai Nationals

[Thaifly88]

I am trying to understand the way that medical costs for emergency treatment are charged to ordinary (as in wages) Thai nationals. I have had conflicting advice on this, so I thought I would ask the TV community.  I know in days gone by that medical costs were very low due to high government subsidy levels. I think that 30 baht was all that was required from the patient some years ago. I am told this is no longer in place, and Thai's must now pay for their medical treatment. My question is how much are Thai's expected to pay in the case of emergency treatment.

 

A friend was recently diagnosed with pneumonia and was told she needed 4 days overnight hospital stay. She told them she couldn't afford it, so they gave her a bag of drugs, told her to go home and take care. She has no insurance and works full time in a store, earning around 9,500 THB per month.

 

Her bill for the drugs, and other services (X rays, Dr consultation, use of oxygen) while she was at the hospital (Samrong Hospital) for a day (but not overnight) was just over 4,500 THB.

If she deteriorates and requires admission, what is her position regarding payment that she clearly cannot afford. In such circumstances, do they just treat her and require payment over time ?  This situation must be a daily occurrence and I am curious as to the approach taken by the hospitals - hope someone has the answer :)

 

Farang to the rescue is one obvious answer, but not all Thai's have that luxury.

[tonray]

I think the 3 baht scheme is still available as long as they use the hospital they are registered at in their home area.

[amvet]

Depends on where she is registered (house book).  She has to be registered where she is treated or she pays.  She will also pay for certain kinds of treatment.  My wife can be treated free at a government hospital but we go to a private hospital because it is better care with no waiting and everything is covered by her private insurance.  You are dealing with a number of things.  Work insurance (gov employees), private insurance or government or 30 baht health care.  I'm sure others know more than I can perhaps explain it better. 

Edited September 17, 2017 by amvet

[Sheryl]

All Thais have access to free health care - there are 3 schemes, one for civil servants, one for those employed in the formal private sector (with some exceptions i.e. self employed, employed in a private school or international organization) and then everyone else is covered under the Universal Care Scheme AKA "gold card" AKA "30 baht" scheme (though collection of the 30 baht is now optional and some hospitals don't bother).

 

None of this has changed, and Thai people are well aware of it.

 

Unless an emergency, care can only be obtained at the hospital one is registered at (or a higher level facility it refers you to) and for the universal scheme that is based on where you are listed in a tabian ban.

 

In an emergency care can be obtained at any government hospital. By law private hospitals are also required to provide care for free for up to 72 hours if the patient cannot safely be transferred elsewhere, but enforcement of this law is problematic.

 

If this was Samrong General Hospital in Samuk Prakan that you refer to, it is a private not government hospital.  The key questions are:

 

-  is your friend covered under Social Security (she should be since she is employed. If she is, she will have a SS card and there will also be small monthly deductions from her paycheck)?

- if so, is that the hospital where she is registered?

 

IF she is covered under SS and IF that is the hospital where she is registered, then  she would have been able to receive free treatment.

 

If she is covered under SS but registered elsewhere, she needed to have gone to the hospital where she was registered, and should in future do so. In a life-or-death emergency wherein the patient cannot be safely transferred, any hospital will be reimbursed for providing care, but enforcement of that in the case of private hospitals is problematic.

 

If she is not covered by SS then (1) her employer is breaking the law and she should insist upon enrollment and (2) until such a time as enrolled in SS, she is covered under the UCS ("30 baht") scheme but except in emergencies, only at the hospital which serves the area where she is listed in a tabian ban. Many people working in Bangkok are still listed in a tabian ban in their home province, with the result that they have to travel back there for medical care or else pay for it out of pocket (emergencies excepted). This can be redressed by changing tabian ban registration and that is worth doing is the person expects to be in Bangkok long term.

 

Should she deteriorate she should go at once to the ER of a government hospital.

[Thaifly88]

Thank you Sheryl, excellent reply, really covers every question I had about Thai medical care for locals :) 

[sinbin]

21 hours ago, Thaifly88 said:

I am trying to understand the way that medical costs for emergency treatment are charged to ordinary (as in wages) Thai nationals.

This hasn't been mentioned but treatment from the result of a traffic accident is not covered for free treatment under the '30 Baht Scheme' and must be paid for. Plus treatment for 'attempted suicide' is also not free under the said scheme. That is my understanding.

Edited September 18, 2017 by sinbin

[Thaifly88]

that seems odd, I wonder why traffic accidents are not included ?

[farang62]

I have been enrolled in the Thai S.S. Insurance system for over 22 years.

I pay my contribution every month, as I do for my employees.

I use Government hospitals, except in an emergency.

I have NEVER been charged one baht for using my S.S. benefits here in "The Kingdom".

Yes I have to wait in line and follow the same procedures that others do.

I am use to it and it doesn't bother me as much as it does the Thais.

 

I recently had major surgery at my local government hospital, Brilliant doctor and nurses, I paid only for a "Private Room" 

 

I did not pay one baht for anything other than the "private room".

Over the years here in Thailand I have never paid for treatment at any Government Hospital.

 

I have found them to be friendly, efficient and helpful considering with the resources they have available.

[tryasimight]

On 9/18/2017 at 6:42 PM, sinbin said:

This hasn't been mentioned but treatment from the result of a traffic accident is not covered for free treatment under the '30 Baht Scheme' and must be paid for. Plus treatment for 'attempted suicide' is also not free under the said scheme. That is my understanding.

The two sons in law were on a motorbike together and got knocked off. No 30 baht scheme for them. They had to pay although it was claimed back through their uncles insurance as he is in the army. Don't ask me how that bit works but it seems family members are covered somehow. Except me of course.

[sinbin]

15 hours ago, Thaifly88 said:

that seems odd, I wonder why traffic accidents are not included ?

Because the only compulsory driving insurance, Por Ror Bor, covers medical bills up to a certain amount. 

Edited September 20, 2017 by sinbin

[Sheryl]

20 minutes ago, sinbin said:

Because the only compulsory driving insurance, Por Ror Bor, covers medical bills up to a certain amount. 

Exactly. However costs in excess of this -- or all costs if the driver is unknown or uninsured - will AFAIK be covered by the SS or "30 baht" scheme.

 

 

[hgma]

Can foreign Non-Thai children and or spouses benefit from the 30 bath ruling?

[Sheryl]

35 minutes ago, hgma said:

Can foreign Non-Thai children and or spouses benefit from the 30 bath ruling?

No.

 

Of the 3 schemes that make up the national health system, only the Civil Servant SS scheme includes spouses and dependents.

[jackdd]

1 hour ago, Sheryl said:

No.

 

Of the 3 schemes that make up the national health system, only the Civil Servant SS scheme includes spouses and dependents.

Can you explain how the health insurance for civil servants works? My gf works for the army, but has no idea about it because she never had to use it yet. And how would it work for me if i would be married to her?

[tonray]

7 minutes ago, jackdd said:

Can you explain how the health insurance for civil servants works? My gf works for the army, but has no idea about it because she never had to use it yet. And how would it work for me if i would be married to her?

I like that...an expat thinking rationally about benefits for a change !

[Preacher]

3 hours ago, Sheryl said:

Exactly. However costs in excess of this -- or all costs if the driver is unknown or uninsured - will AFAIK be covered by the SS or "30 baht" scheme.

 

 

 My information to. Only the insurance for civil servants does not cover motorcycle accidents, (not sure about cars). Several civil servants I know had to pay for treatment themselves after a motorcycle accident.

[nongsangcity]

On 17/9/2560 at 9:27 PM, Thaifly88 said:

I am trying to understand the way that medical costs for emergency treatment are charged to ordinary (as in wages) Thai nationals. I have had conflicting advice on this, so I thought I would ask the TV community.  I know in days gone by that medical costs were very low due to high government subsidy levels. I think that 30 baht was all that was required from the patient some years ago. I am told this is no longer in place, and Thai's must now pay for their medical treatment. My question is how much are Thai's expected to pay in the case of emergency treatment.

 

A friend was recently diagnosed with pneumonia and was told she needed 4 days overnight hospital stay. She told them she couldn't afford it, so they gave her a bag of drugs, told her to go home and take care. She has no insurance and works full time in a store, earning around 9,500 THB per month.

 

Her bill for the drugs, and other services (X rays, Dr consultation, use of oxygen) while she was at the hospital (Samrong Hospital) for a day (but not overnight) was just over 4,500 THB.

If she deteriorates and requires admission, what is her position regarding payment that she clearly cannot afford. In such circumstances, do they just treat her and require payment over time ?  This situation must be a daily occurrence and I am curious as to the approach taken by the hospitals - hope someone has the answer :)

 

Farang to the rescue is one obvious answer, but not all Thai's have that luxury.

30b still up and running....i am on it and use it every two months for my on going blood pressure problem in my local hospital and any other problems that might arise.....not covered for any dental work though..i have been registered at my local jungle hospital for 14 yrs now....

[sandyf]

21 hours ago, tryasimight said:

The two sons in law were on a motorbike together and got knocked off. No 30 baht scheme for them. They had to pay although it was claimed back through their uncles insurance as he is in the army. Don't ask me how that bit works but it seems family members are covered somehow. Except me of course.

Surprised it was covered by an uncle, I take it you mean step sons, the children of a sibling. My brother in law was in the Thai navy and my understanding was the insurance only covered direct family members, mother, father, siblings and his own children. His father, before he died, was treated under this scheme. My wife would also be eligible if she didn't have her own scheme but unfortunately it does not extend to the spouse of a family member. We do not have any children so not quite sure on that point.

[wildewillie89]

1 hour ago, sandyf said:

Surprised it was covered by an uncle, I take it you mean step sons, the children of a sibling. My brother in law was in the Thai navy and my understanding was the insurance only covered direct family members, mother, father, siblings and his own children. His father, before he died, was treated under this scheme. My wife would also be eligible if she didn't have her own scheme but unfortunately it does not extend to the spouse of a family member. We do not have any children so not quite sure on that point.

It does only cover direct family members - husband/wife (until the official dies - including farang), kids (until 20 years old) and parents (until the official dies). Siblings are not covered. 

Father and brother in law both army. Uncles/cousins all police, teachers, nurses etc. Wife Public Health Director so the kids and I are covered. A fair chunk of my family get it, but only due to their immediate family members. For instance the sister in law doesn't get it even though everyone around her are officials as she is over 20, and hasn't passed the test herself yet. Although is about to marry a police officer. 

Not sure what happened in the original post re the uncle, maybe was some sort of private fund (which most officials have as well). But the private ones are usually more strict than the government one lol. 

Edited September 21, 2017 by wildewillie89

[tryasimight]

1 hour ago, sandyf said:

Surprised it was covered by an uncle, I take it you mean step sons, the children of a sibling. My brother in law was in the Thai navy and my understanding was the insurance only covered direct family members, mother, father, siblings and his own children. His father, before he died, was treated under this scheme. My wife would also be eligible if she didn't have her own scheme but unfortunately it does not extend to the spouse of a family member. We do not have any children so not quite sure on that point.

My mistake...yes the wifes sons....not my step sons though - they are both decent young men in their 20's married with kids of their own.

At least that is my understanding  of what happened, something may have been lost in translation I guess. Either way it didn't cost me anything!

But one thing I am pretty sure of is that the 30b scheme did not cover them.

From what I understand the scheme only covers sickness not injuries - but  I could be wrong with that as well!

 

Edited September 21, 2017 by tryasimight

[wildewillie89]

25 minutes ago, tryasimight said:

My mistake...yes the wifes sons....not my step sons though - they are both decent young men in their 20's married with kids of their own.

At least that is my understanding  of what happened, something may have been lost in translation I guess. Either way it didn't cost me anything!

But one thing I am pretty sure of is that the 30b scheme did not cover them.

From what I understand the scheme only covers sickness not injuries - but  I could be wrong with that as well!

 

I think possibly the uncle had a private fund in their names already. My father in law has some private funds in some of the kids names who aren't covered. Siblings aren't covered by official rights so it's impossible for an uncle to cover anyone other than his own kids, wife and parents. 

[Sheryl]

43 minutes ago, tryasimight said:

My mistake...yes the wifes sons....not my step sons though - they are both decent young men in their 20's married with kids of their own.

At least that is my understanding  of what happened, something may have been lost in translation I guess. Either way it didn't cost me anything!

But one thing I am pretty sure of is that the 30b scheme did not cover them.

From what I understand the scheme only covers sickness not injuries - but  I could be wrong with that as well!

 

It covers injuries. It covers all medical problems.

 

The issue with motor vehicle accidents is that the driver's insurance should pay.

[WalsallRobbo]

Is the universal health scheme available for all Thais - or just those that are working?

My wife is Thai but doesn't currently work and my daughter (born in Thailand) is only a few weeks old. I don't need the health coverage as I live and work in UK.

I am guessing she should be - by the 'gold card' or '30 baht' scheme. She lives in the Ramkhamhaeng area.

[Sheryl]

Just now, WalsallRobbo said:

Is the universal health scheme available for all Thais - or just those that are working?

My wife is Thai but doesn't currently work and my daughter (born in Thailand) is only a few weeks old. I don't need the health coverage as I live and work in UK.

I am guessing she should be - by the 'gold card' or '30 baht' scheme. She lives in the Ramkhamhaeng area.

Theer are 3 schemes that make up universal access to health care for Thais:

 

Civil Service Social Security scheme - for civil servants only. It also covers their spouses (even if farang) and is the only scheme which does that.

 

Social Security scheme (non civil sevice) - covers most people with formal employment. It is paid for through payroll deductions and can be continued after employment ends through continued payment by the insured, even if they stop working.

 

Universal scheme AKA "gold card" AKA "30 baht scheme" - covers every thai citizen who is not covered by one of the above.

 

So yes, your wife and daughter are covered. However the can only use the government hospital designated for the location where they are registered in a tabian ban (house book) or higher level facility it refers them to. EXCEPT in a real emergency where it is not possible to travel to that hospital, in which case they are covered in any government hospital and in theory even private hospitals are required to provide care for up to maximum 72 hours.In practice this is difficult to enforce and often requires a call to the national Health Security Office to intervene. 

 

If they go elsewhere than their registered hospital (except with a letter of referral or in a true life and destah emergency where impossible to reach it in time) they have to pay. 

 

Where they live and where they are listed in a tabian ban may not be the same place, especially for Bangkok residents,  so ask your wife  about that. If she is still registered somewhere upcountry and has registered your daughter likewise ask her to get it changed to where she now lives or somewhere at least in Bangkok area.  Getting listed in a tabian ban if renting can be difficult - it is possible but needs the cooperation of the house owner.

 

 

[WalsallRobbo]

Thanks very much Sheryl, you have been a great help. You have opened my eyes!

 

My wife has spent the day trying to convince me to pay 10,000 baht a month private health care for my daughter! I don't mind paying for a bit of private cover, but I was thinking closer to 10,000 baht a year rather than a month.

I have already spent £2000 on the birth.

[Sheryl]

If your wife told you 10,000 baht a month just to insure your daughter then sorry to tell you she is lying. It simply does not cost that much for a small child even for a plan that includes both IPD and OPD (which is generally unnecessary).  

 

I am quite sure your wife is well aware your daughter can get free care at government hospitals and health centers. Health centers, while limited in their range of medical services, are very useful for children as they offer vaccines, and treatment of simple childhood ailments all free or maximum 30 baht  with little waiting time and located usually close by.

 

Your wife could have delivered for free as well.  Was this a c-section? As that is more than a normal delivery would cost at most private hospitals.

 

No need for private cover except for the purpose of using private hospitals. These are much more comfortable/convenient than public hospitals but do not as a rule offer better quality of care (in fact often the reverse) , and care at government hospitals can often be rendered more comfortable by  paying extra for a private room.

 

If you do want insurance, can't get any policy worth having for only 10K a year. More like 30 -60K a year (still half of what your wife told you - or was she talking about a policy for both her and your daughter?).

 

All government hospitals are not the same though and there are some upcountry provinces known for having unusually poor ones so it is worth considering where one lives in terms of the quality of the local hospital.

 

 

 

 

[WalsallRobbo]

Thanks Sheryl. That is a great help.

The cost was a great shock to me but after further discussion it is some kind of 'stocks and shares investment thing' with AIA that also included health insurance. Details are vague but I do believe her - and I won't be choosing it!

I have done my own checking and there isn't much health insurance available for just a baby. My wife already has a policy and I don't need one either.

You are right they do cost roughly between 30,000 baht a year (inpatients only) to 67000 baht a year (in and outpatients). If I choose inpatients only then I doubt (fingers crossed) if I will spend 37000 baht a year as an outpatient for it to be worthwhile - so it looks like inpatient only at this stage.

 

The cost of £2000 for the birth was 58000 baht for a c-section at Ramkhamhaeng Hospital plus a few minor complications at birth we had to pay for and pre-op check ups. They were very good, but they should be at that price!

 

I agree with you that it all seems unnecessary to get insurance at all as if it is an emergency then the baby will be treated very well in a public hospital. It is just trying to convince my wife. She is middle class and so are all her friends and family. I speak to them and they never use public hospitals either. Why do you think that is? Perhaps it is to do with status.

 

Do you have any information on healthcare clinics? I can then try and convince my wife.

 

[Sheryl]

Your wife already knows about government health centers but middle class people don't much use them.

 

Middle class Thais DO however use government hospitals. They go to the best government hospitals, sometimes using the quasi private after hours clinics that most govt hospitals have. And when they are admitted to the hospital they get a private room which government hospitals have at extra cost.

 

Not just middle class....the elite do this as well.

 

The royal family uses Siriraj, a givernment hospital.

 

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[WalsallRobbo]

Sheryl, once again, you have been a great help. You have really filled in my gaps of knowledge and left me more assured about my baby's health.

Is there anywhere I can read about all this (in English) so I don't have to keep bothering you?

Would my daughter be automatically enrolled?

 

I like your line about the Royal Family and will use that on my wife.

[Sheryl]

I am not aware of any write ups in English other than what you can find on TV. We have a pinned thread on the Thai public health system.

As explained your daughter is eligible for free or 3o baht care at the government hospital assigned to the area where she us listed in a tabian ban. She can use other government hospitals as well but on a fee basis unless referred by the hospital she is covered under the universal scheme at. You need to find out what hospital this is.

To be free to use another government hospital of your choice (if for care available at the 30 baht hospital) you will have to pay.

If you can afford it there is a case to be made for having either health insurance or money set aside for health care so that you can go to the best hospital/doctor for the need but that does not always, or even usually, mean a private hospital.

There is a pediatric only government hosputal in Bangkok established under Royal Patronage but I do not know the fee situation there for Thai nationals registered elsewhere (under the 30 baht scheme I mean, not regular hospital registration).

A particular likelihood if using private hospitals for children is unnecessary hospitalization for common child illnesses.

At any hospital one initially has to register to get a patient number. This is necessary on 1st visit only and takes just a few minutes. Need to show Thai ID card and tabian ban. Cost 10 to 50 baht depending on hospital. After that bring the card on all subsequent visits.

One can be registered in any number of different hospitals. I'm personally registered in at least 10, government and private.

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