Medical Costs for Thai Nationals

[WalsallRobbo]

My brother-in-law has made my wife see sense and he certainly understands all the information you have given me regarding free health care. This has reassured me no end.

You say are registered with at least ten hospitals - presumably you are only entitled to free payment at one though - what would be the benefits of my baby being registered at any others than the local one?

Also, if we are on holiday in Thailand and the baby is ill (not an emergency) does that mean we have to pay for treatment at a local hospital if we cannot get back to our registered hospital?

 

I keep saying it, but thanks again Cheryl, you have been an enormous help.

[NancyL]

Here in Chiang Mai, I'm also "registered" with at least four hospitals and I'm an expat.  Reason being that you want to select the best doctor, not the best hospital. 

 

For example, we live very close to CM Ram, so when I do something stupid like cut my finger in the kitchen and know I need stitches because the bleeding won't stop, I want the convenience of walking to CM Ram because it's close and I can get in-and-out of their E/R quickly for them to give me a few stitches and process my Bangkok Bank accident insurance policy card.  Doesn't really matter who the doctor is.

 

If I think I'm having a heart attack or stroke, then Maharaj (CM University) hospital is the closest full-service E/R with 24/7 doctors, even though my cardiologist is at Bangkok Hospital.  I'd eventually want to be transferred to Bangkok Hospital, where I'm registered.  

 

I see the well regarded chiropractor and ortho doc at Rajavej Hospital from time-to-time, so I'm registered there, as well.

 

All that being "registered" means is that the hospital has my contact info in their computer and have given me a hospital number and a little ID card.  Usually means I don't have to bring my passport with me for outpatient appointments.

[WalsallRobbo]

How does it work if you are an outpatient at a government hospital and want the equivalent of a GP meeting?  

Do you just turn up on the day and it is first come first served?

Do babies get priority?

[Sheryl]

1. Being a farang I am not eligible for free care anywhere. As Nancy explained, being registered at a hospital per se just means having a patient record with your basic details on file and a patient number that links to your medical records. I have this at multiple hospitals because I have been to multiple different hospitals, at any hospital you need to do this first to be seen. There is a slight advantage to doing this in advance if you think you might use a particular hospital in future in that it saves time. Not to be confused with registration (maybe not the best word) under the 30 baht scheme, that can only be at one place and you have no choice as to where, it is determined by where you live. Well worth taking the quality of the applicable govt hospital into account if moving or buying/building a house.

 

2. For an outpatient visit you show up (as early in the morning as possible unless wanting to use the after hours clinic, in which case the queue starts around 3-3:30 PM and there will be an additional fee for this). There will be a triage desk manned by a registered nurse, who will ask the nature of the problem and direct you from there. Medical care in Thailand is pretty specialized and a baby would not be seen by a GP but rather sent to the pediatric clinic and seen by pediatrician/pediatric resident or intern on a peds rotation (in which case supervised).  GPs as such aren't very common here in any case.

 

It is first come first serve except for emergency cases.

 

3. Yes, if you go anywhere but the hospital where the baby is eligible under the 30 baht scheme and it is not an emergency you have to pay.  But costs for outpatient care at government hospital are very low.

 

If it is an emergency and you have to go to a different (government) hospital it is not unusual for them to try to demand payment - among other things the finance office has no way of knowing which cases were emergencies, they just go by your ID card and address. Any issues like this - or any other issues pertaining to the universal health scheme - call the NHSO office (call center 1330) and they will straighten it out

 

https://www.nhso.go.th/

 

[Rob 45]

On 9/18/2017 at 1:19 PM, Sheryl said:

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.

 

Does this still apply as of 2018?   Does anybody have any idea what some supplemental insurance would cost for a Thai national?  To get them some coverage for catastrophes or treatments not covered by the "free government healthcare"?

 

Does this healthcare still apply to someone who is not officially employed?  Like a stay at home wife or girlfriend?

Edited October 1, 2018 by Rob 45

[Sheryl]

Yes of course this still applies, it was just written yesterday.

All catastrophes and virtually all treatments are covered in full, very few exceptions. There is no need for supplemental insurance on that count and AFAIK there are no insurance policies designed to supplement the government system. Only altogether private insurance policies. Very few Thais get these. Their main purpose would be to enable care at private hospitals. Cost would depend on age and extent of cover.

There are 3 separeate schemes that make up the universal health cover in Thailand. One for civil sevants. One for people employed in the formal sector. And one for everyone else. So yes, housewives etc are fully coveted.

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[Rob 45]

2 hours ago, Sheryl said:

Yes of course this still applies, it was just written yesterday.

All catastrophes and virtually all treatments are covered in full, very few exceptions. There is no need for supplemental insurance on that count and AFAIK there are no insurance policies designed to supplement the government system. Only altogether private insurance policies. Very few Thais get these. Their main purpose would be to enable care at private hospitals. Cost would depend on age and extent of cover.

There are 3 separeate schemes that make up the universal health cover in Thailand. One for civil sevants. One for people employed in the formal sector. And one for everyone else. So yes, housewives etc are fully coveted.

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Yesterday? Must be something wrong either with my browser or the forum software or server clock or something.  The post I quoted says "Posted September 18, 2017", more than 1 year ago?  

 

Do you have any idea what a Thai might be talking about if they say they pay 800-900 THB per month for "social insurance"?

 

Thanks for the reply.

[Sophon]

37 minutes ago, Rob 45 said:

 

Yesterday? Must be something wrong either with my browser or the forum software or server clock or something.  The post I quoted says "Posted September 18, 2017", more than 1 year ago?  

 

Do you have any idea what a Thai might be talking about if they say they pay 800-900 THB per month for "social insurance"?

 

Thanks for the reply.

 

Nothing wrong with the dates, Sheryl just wrote more or less the same info in post no. 4 (in 2017) and in post 24 (yesterday), hence the confusion.

 

Sophon

[Rob 45]

4 minutes ago, Sophon said:

 

Nothing wrong with the dates, Sheryl just wrote more or less the same info in post no. 4 (in 2017) and in post 24 (yesterday), hence the confusion.

 

Sophon

 

Sorry I missed it.

[Sheryl]

 
Yesterday? Must be something wrong either with my browser or the forum software or server clock or something.  The post I quoted says "Posted September 18, 2017", more than 1 year ago?  
 
Do you have any idea what a Thai might be talking about if they say they pay 800-900 THB per month for "social insurance"?
 
Thanks for the reply.

The social security system for people who are employed is paid for through payroll deductions with amount based on income up to a maximum which I think is more like 450 baht than 800-900 for the general scheme. I don't know how much civil service SS scheme but doubt it would reach 800-900. I do not know what is meant at that amount.

There is no monthly payment for the "30 baht" scheme.

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[lopburi3]

16 hours ago, Sheryl said:

The social security system for people who are employed is paid for through payroll deductions with amount based on income up to a maximum which I think is more like 450 baht than 800-900 for the general scheme. I don't know how much civil service SS scheme but doubt it would reach 800-900. I do not know what is meant at that amount.

There is no monthly payment for the "30 baht" scheme.

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Believe there was a post that some 'employers' allow SS if employee pays full amount?  That might account for the higher payment if true.

 

Another reason to register at hospitals would be if you have insurance - they will then have it on file and could make emergency service faster.  

[malagateddy]

I would like to THANK Sheryl..Lopburi 3..Nancy L..and others for their excellent and very informative posts.
Re myself..I am almost 68 years young..and as far as I know quite healthy,living in the Chaiyaphum province just outside Nongbuodaeng town.
On the very few occasions that I needed to use the Nongbuodaeng District Hospital as an out patient..I found the service excellent and quite inexpensive, and all the staff very friendly and helpful..lovely smashing people.





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[Sheryl]

Believe there was a post that some 'employers' allow SS if employee pays full amount?  That might account for the higher payment if true.  

Another reason to register at hospitals would be if you have insurance - they will then have it on file and could make emergency service faster.  

 

Possibly but if so they are breaking the law. By law employer has to pay a portion and the emplyee a portion 

But yes, could happen if a small businesd and would explain a 800-900 baht amount.

 

A complaint to SS would put a stop to this abuse but of course employee might fear retaliation from employer. They should ask the SS office to keep the source of rhe complaint confidential.

 

 

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[Rob 45]

6 hours ago, Sheryl said:

Possibly but if so they are breaking the law. By law employer has to pay a portion and the emplyee a portion 

But yes, could happen if a small businesd and would explain a 800-900 baht amount.

 

A complaint to SS would put a stop to this abuse but of course employee might fear retaliation from employer. They should ask the SS office to keep the source of rhe complaint confidential.

 

 

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What could the person be paying if they are not employed but say they have a "social insurance" payment?

Edited October 2, 2018 by Rob 45

[Sheryl]

I really don't know, if the amount is 800 - 900 baht. If someone was previously employed and stopped working, they could continue their SS coverage on their own through self contributions but amount would be less than that.

 

In many villages there are village funds everyone pays into that covers things  like funeral costs but amount would not be that high.

 

And the amount is too low to be private health insurance.

 

 

Why not ask this person to for more details i.e. to whom do they pay this money?

[twig]

My Thai friend is in her 30's, and needs an operation, which is not emergency, but shouldn't be put off for more than a month or two either.

It would cost 200k THB at Bangkok Hospital. Her regional or provincial hospital supposedly wants to charge her 60K THB for it.

 

Is that plausible?

 

(She had a small business for several years, which went bankrupt a couple years ago. So, not sure what the status is with related contributions.)

[lopburi3]

4 minutes ago, twig said:

My Thai friend is in her 30's, and needs an operation, which is not emergency, but shouldn't be put off for more than a month or two either.

It would cost 200k THB at Bangkok Hospital. Her regional or provincial hospital supposedly wants to charge her 60K THB for it.

 

Is that plausible?

 

(She had a small business for several years, which went bankrupt a couple years ago. So, not sure what the status is with related contributions.)

Is that 200k a Bangkok Hospital price; or a hospital in Bangkok price?  Seems very low for Bangkok Hospital if operation price is 60k in a government facility.  Would expect closer to one million from personal experience.  Or is the second price actually a private hospital?  Thai should not have to pay for a required operation at a government hospital that serves there location.  

[TallGuyJohninBKK]

Just wanted to ask clarification re one detail about Thais and their national health insurance coverage:

 

Is the part about needing to be registered at the designated government hospital for the area where their tabien bahn is based, and needing to use that facility in order to get covered/free treatment, only pertaining to the 30 baht coverage scheme, or private employment Social Security coverage, or both?

 

Thanks!

 

Edited October 7, 2018 by TallGuyJohninBKK

[lopburi3]

Believe SS allows any contracting hospital but do not know that for a fact.  Even local government hospital 30 baht requirement patients can be sent to other hospitals on referral (often done to higher level facility). 

[blackcab]

It's definitely not the case for the SS scheme. As an example, our Bangkok based company has:

1. Staff that are listed in a tabien baan in Chiang Mai but they are registered at a hospital local to where they work in Bangkok.
2. Staff that are registered at a hospital in their local province (as they do not work in Bangkok) even though the company does not have a branch in the province they live in.

[TallGuyJohninBKK]

3 hours ago, blackcab said:

It's definitely not the case for the SS scheme. As an example, our Bangkok based company has:

1. Staff that are listed in a tabien baan in Chiang Mai but they are registered at a hospital local to where they work in Bangkok.

Thanks for the confirmation on that, that Thais covered by the Social Security medical coverage can register at an eligible hospital whether or not their tabien bahn is local for that area.

 

[twig]

On 10/7/2018 at 4:04 AM, lopburi3 said:

Is that 200k a Bangkok Hospital price; or a hospital in Bangkok price?  Seems very low for Bangkok Hospital if operation price is 60k in a government facility.  Would expect closer to one million from personal experience.  Or is the second price actually a private hospital?  Thai should not have to pay for a required operation at a government hospital that serves there location.  

Thanks for the answer.

The 200k is supposedly The Bangkok Hospital price, because that's where the problem was found during a comprehensive physical she got as a gift from a mutual friend.

So, unless the whole issue is made up, that's a solid price.

 

When queried for details, she said that the 60k that the gov hospital supposedly wants is from the regional or provincial hospital, where she's registered. When asked repeatedly about the name of the hospital, she didn't respond.

 

So, starting to get the feeling that there's more to her story... ????

 

[expat1010]

My girlfriends father (70 years)had a heart attack in early September and that is being followed up at the end of October with bypass surgery. He went to the Synphaet Hospital in BKK where he is registered and later transferred to another hospital near Don Mueng Airport. Not sure if the upcoming bypass is at the same hospital. Nonetheless so far he has paid nothing beyond the token 30baht fee which his kids paid for him.


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[lopburi3]

1 hour ago, twig said:

So, starting to get the feeling that there's more to her story... ????

Or less.  Believe you are right to question as does not make sense.  I suspect you know what is required but do not want to post on forum and understand that.  Most larger private hospitals do have communications channels for asking about costs prior to treatment if you might want to ask yourself.  But as said she should not need to pay at her government hospital in any case.  Bangkok Hospital is known as one of the most expensive facilities, so 200k is not going to pay for a lot there.  

[Sheryl]

Thanks for the confirmation on that, that Thais covered by the Social Security medical coverage can register at an eligible hospital whether or not their tabien bahn is local for that area.
 

Ss cover is limited to the hospital the person is registered at under the SS scheme (or other hospital it refers the patient to) but that has nothing to do with tabian ban listing. The tabian ban comes into play only for the 30 baht scheme.

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[twig]

On 10/13/2018 at 12:34 PM, lopburi3 said:

Or less.  Believe you are right to question as does not make sense.  I suspect you know what is required but do not want to post on forum and understand that.  Most larger private hospitals do have communications channels for asking about costs prior to treatment if you might want to ask yourself.  But as said she should not need to pay at her government hospital in any case.  Bangkok Hospital is known as one of the most expensive facilities, so 200k is not going to pay for a lot there.  

It's more clear now. Her registered hospital can do it for 30 THB, but she is concerned that she will not get good care for this problem there.

So, she wants to have it done by a renown specialist in this, at a regional government hospital, which would cost the 60k.

 

IF her local hospital referred her to him, would she still have to pay so much?

What about if the local hospital referred her to a national level hospital that specializes in such diseases?

[lopburi3]

If referred there would not be any extra charge - and again that 60k seems high to me as I was scheduled to pay that price for major 8 hour surgery at a government hospital and the Bangkok Hospital price for same operation turned out to be a bit over one million baht.  200k at Bangkok Hospital I would expect to be much less than 65k at government hospital (but that is just my feeling based on my very limited experience).  Be aware that Thai specialists often operate as a teaching team so even when under well known doctor actual procedure may only be supervised by him and referral may not get the doctor expected.

[Sheryl]

Yes, still only 30 baht if she gets a referral from the hospital where she is registered. But if it is a very simple/common procedure that they have the capacity to do, they will be unlikely to provide such a referral.

 

They would be especially unlikely to refer to national level when there is a regional hospital available.

 

60K is an unusually large sum even for private pay at a government regional hospital. A friend of mine from Cambodia, paying fully out of pocket, is having an appendectomy for a little under 20K, for example.  About the only surgeries that would run much over 20-30K would be those requiring placement of expensive devices (titanium screws/plates, stents etc).  It is hard to imagine what could cost 60K and yet only 200K at a private hospital.

 

I could advise much better if I knew what the procedure was and the names of the hospitals involved.

 

 

[oldhippy]

My wife was referred by her Chanthaburi hospital to a Bangkok government hospital for a free operation ("ablation").

Waiting list: 6 months

Price for jumping the queue: 7.000 euro (yes, in euro, not in baht)

Additional benefit: operation would be performed by a real doctor, not his students.....

We took the risk of her flying to Belgium.....