Thai national asked to pay for an operation in a government hospital

[Guderian]

My Thai lady friend had a major operation on her face around 18 months ago. When she was a child she got hit in the face and suffered a fractured eye orbit. Nobody knew about this until, as she got older, it was causing her a lot of problems that were getting more and more serious. She eventually had it diagnosed properly and the corrective surgery was carried out in Chula hospital in Bangkok.

 

It was a big operation lasting around 12 hours and involved lifting the face off the skull so they could get at the eye socket and repair it. The surgeon made a mistake and didn’t reconnect one of her tear ducts so since the operation her eye has been dry and she’s had to use artificial tears.

 

She’s been going back to Chula every three to six months since then but has only had one minor surgery to correct an asymmetry in her eyes (I couldn’t even see it!). Of course, she very much wants the operation to fix her tear duct but this has not been forthcoming.

 

She was in Chula again this week and apparently she was told that the surgery to fix the tear duct will cost her 10K Baht. I’m currently back in the UK so don’t know more than this, which she’s written to me in Thai and I’ve tried to translate it. I asked her why she now has to pay when everything so far has been free, and she just said something like, “Ask the Prime Minister”.

 

Can anybody shed light on why she’s now being asked to cough up what is, for her, quite a lot of money? The operation is scheduled for August 27^th apparently. I thought the Thai medical system was free at the point of use nowadays. Since it was a surgical error during the original procedure that left the tear duct useless I don’t see why she (read: me) should have to pay anything. I know it’s not a vast sum, but I’m wondering why there’s any need to pay at all?

 

Thanks for any info or insights.

[Guderian]

Just an afterthought, she's renewed her registration cards at Chonburi and Chula hospitals, I remember her showing me them a while back, so it's not because she's fallen out of the Thai system.

[Maestro]

If the hospital is unable to explain it to her she should call the government hotline 1111 to ask for information. She has to make this call, not tell you to make these enquiries (ie "ask the Prime Minister")

[Rally123]

If your lady friend has moved to a new abode she is obliged to register at the nearest hospital to her registration in the blue book. By moving she probably has negated the right to use the previous hospitals. It's normal for Thais to be charged for treatment if they do not use the hospital to which they are registered. If she has moved then all she needs to do is start the whole thing over again and get a referral letter from her hospital she's now registered at. That's how I see it.

[simoh1490]

Co-pay is becoming more common in many government hospitals in Thailand, my Thai wife experienced similar three years ago at the Provincial Hospital in Chiang Mai following a gallbladder removal op.

[Sheryl]

The government system is free only for care at the hospital that services the area where the person is listed in a  tabian ban (if under the "30 baht" or "universal scheme) or, in the case of people with jobs covered under Social Security, the hospital they are registered for under Social Security....or, in either instance,  a higher level facility that the primary hospital  refers her to. 

 

 The original surgery was highly specialized and presumably she got a letter of referral from whatever hospital covers her (under either 30 baht scheme or SS, whichever she is in)  to Chula. She will need the same for the second operation and as it is nto quite as specialized it is possible they would not refer to Chula but somewhere else, or even be able to do it at her primary hospital whatever that is.

 

To make any sense out of this you need to know:

 

Is she under Social Security or the "gold card" AKA "30 baht" scheme?

 

If under SS, what is her SS hospital? Has it given her a referral to Chula for this tear duct surgery?

 

If under gold card/30 baht" where is she listed in a tabian ban? What hospital covers that district? Has she gotten a letter for referral from it?

[chickenslegs]

1 hour ago, Guderian said:

 ... I asked her why she now has to pay when everything so far has been free, and she just said something like, “Ask the Prime Minister”...

Sounds like something said out of frustration. I expect this has been a stressful time for her.

 

You said that she has waited a long time for this op and she very much wants/needs it. Maybe the 10,000 baht isn't an "compulsory" fee but will help cut through the red tape, or get her to the front of the queue, or a choice of surgeon.

 

Just my 2d worth.

[Guderian]

2 hours ago, Sheryl said:

The government system is free only for care at the hospital that services the area where the person is listed in a  tabian ban (if under the "30 baht" or "universal scheme) or, in the case of people with jobs covered under Social Security, the hospital they are registered for under Social Security....or, in either instance,  a higher level facility that the primary hospital  refers her to. 

 

 The original surgery was highly specialized and presumably she got a letter of referral from whatever hospital covers her (under either 30 baht scheme or SS, whichever she is in)  to Chula. She will need the same for the second operation and as it is nto quite as specialized it is possible they would not refer to Chula but somewhere else, or even be able to do it at her primary hospital whatever that is.

 

To make any sense out of this you need to know:

 

Is she under Social Security or the "gold card" AKA "30 baht" scheme?

 

If under SS, what is her SS hospital? Has it given her a referral to Chula for this tear duct surgery?

 

If under gold card/30 baht" where is she listed in a tabian ban? What hospital covers that district? Has she gotten a letter for referral from it?

 

She's on the 30 Baht scheme. She's registered in Pattaya but the hospitals there couldn't deal with the original problem so she had to be referred to the Chonburi provincial hospital for further diagnosis. To be able to use that hospital she had to go through another registration process and get a second card (still under the 30 Baht system I assume?). Everybody knew that she would have to go to Chula for the operation but it seems it was only the provincial hospital that could refer her there. So she didn't receive any treatment in Chonburi, just the referral to see a doctor in Chula and to use their facilities she had to register again and get another card. As I said in post#2, she's recently re-registered in all the places so as far as she's aware should be able to continue getting free treatment for her condition. However, it's all in Thai and I don't really understand the system so I can't be any more specific I'm afraid. The follow-up operation to fix the tear duct in August is in Chula, but she said something about "needing to find a big doctor". How can they make an appointment for her if she doesn't even have a surgeon lined up yet, or did I misunderstand what she was saying?

[Guderian]

3 hours ago, simoh1490 said:

Co-pay is becoming more common in many government hospitals in Thailand, my Thai wife experienced similar three years ago at the Provincial Hospital in Chiang Mai following a gallbladder removal op.

I must be honest and admit that I've never heard of co-pay in Thailand. I get the impression it's a mystery to my lady friend too. But it might explain what's going on.

[Guderian]

1 hour ago, chickenslegs said:

Sounds like something said out of frustration. I expect this has been a stressful time for her.

 

You said that she has waited a long time for this op and she very much wants/needs it. Maybe the 10,000 baht isn't an "compulsory" fee but will help cut through the red tape, or get her to the front of the queue, or a choice of surgeon.

 

Just my 2d worth.

Possible, I guess. She said something twice about needing to 'find a big doctor'. I don't see, though, how they've already booked an appointment for the surgery in August if she doesn't even have a surgeon lined-up yet?

[simoh1490]

6 hours ago, Guderian said:

I must be honest and admit that I've never heard of co-pay in Thailand. I get the impression it's a mystery to my lady friend too. But it might explain what's going on.

In the case of my partner, she needed to have her gallbladder removed and was referred to the District Hospital in Chiang Mai, we paid an additional 1,000 baht for a room upgrade which was optional but then at the time of discharge we were presented with a bill for 14,000 baht to pay for items not covered under the health scheme. We paid the bill because it was excellent value, we'd earlier been discussing having the op. privately which would have cost 100k or thereabouts.

[Rally123]

1 hour ago, simoh1490 said:

In the case of my partner, she needed to have her gallbladder removed and was referred to the District Hospital in Chiang Mai, we paid an additional 1,000 baht for a room upgrade which was optional but then at the time of discharge we were presented with a bill for 14,000 baht to pay for items not covered under the health scheme. We paid the bill because it was excellent value, we'd earlier been discussing having the op. privately which would have cost 100k or thereabouts.

1,000 Baht is about normal in a government hospital upgrade from a public ward to a private room. But 14,000 Baht in extras on top? I wouldn't mind knowing what those extras were?

[simoh1490]

14 minutes ago, Rally123 said:

1,000 Baht is about normal in a government hospital upgrade from a public ward to a private room. But 14,000 Baht in extras on top? I wouldn't mind knowing what those extras were?

I was given a quick verbal translation at the time but didn't pay much attention, I was just relieved to be getting away so cheaply, it was also about three years ago now so it's not exactly fresh. But as I recall the amount covered items that the health scheme didn't cover, I'll see if my wife still has the paperwork and let you know. The op was a Laparascopic (minimally invasive) removal of the gall bladder.

[Sheryl]

 
She's on the 30 Baht scheme. She's registered in Pattaya but the hospitals there couldn't deal with the original problem so she had to be referred to the Chonburi provincial hospital for further diagnosis. To be able to use that hospital she had to go through another registration process and get a second card (still under the 30 Baht system I assume?). Everybody knew that she would have to go to Chula for the operation but it seems it was only the provincial hospital that could refer her there. So she didn't receive any treatment in Chonburi, just the referral to see a doctor in Chula and to use their facilities she had to register again and get another card. As I said in post#2, she's recently re-registered in all the places so as far as she's aware should be able to continue getting free treatment for her condition. However, it's all in Thai and I don't really understand the system so I can't be any more specific I'm afraid. The follow-up operation to fix the tear duct in August is in Chula, but she said something about "needing to find a big doctor". How can they make an appointment for her if she doesn't even have a surgeon lined up yet, or did I misunderstand what she was saying?

She might neef to get a new referral from the Pattaya hospital to Chonburi provincial hospital and (if necessary, might not be) a new letter of referral from Chonburi to Chula. Each referral is for one procedure or condition only, it is not permanent. So possibly this is the idsue.

However 10k is surely less than the actual cost of the surgery so might also be that there is something specific involved that is not covrred though I have trouble imagining what it would be, usually that occurs if there is special supplues or disposable equipment required. Or, as other poster suggested, it might be something paid to expedite the timing.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Guderian]

6 hours ago, Sheryl said:

She might neef to get a new referral from the Pattaya hospital to Chonburi provincial hospital and (if necessary, might not be) a new letter of referral from Chonburi to Chula. Each referral is for one procedure or condition only, it is not permanent. So possibly this is the idsue.

However 10k is surely less than the actual cost of the surgery so might also be that there is something specific involved that is not covrred though I have trouble imagining what it would be, usually that occurs if there is special supplues or disposable equipment required. Or, as other poster suggested, it might be something paid to expedite the timing.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Thanks, it's nothing terribly obvious then. I'm back in Thailand on Tuesday so maybe I can figure it out better talking to her than I can from using Google Translate. If she was outside the necessary chain of referrals then I shouldn't have thought they'd have booked her a slot for the surgery would they? Maybe she's upgraded herself to a private room for the op and the 10K Baht is the cost, who knows?

[chas39]

Not directly Thai related - but concerning operations to reconnect the tearduct properly. Many years ago I had a couple of operations, done by the UK NHS to tighten/stitch my eyelids to improve the drainage of " tears" from my eyes. 

That was fine for many years. About 3 years ago my eyelids started to droop a bit. Old age? It's not life threatening, but tears tended to roll down my cheeks if it was windy, and particularly when near fans in Thailand. It is irritating, but more importantly it's tempting to rub your eyes. This is a danger for me as I've had two cornea grafts and I don't want to do any damage. 

When I asked my eye consultant if I could get this fixed again the answer ( under the free NHS) was " er - maybe - the operation is restricted now and will have to go before the Committee for consideration". So I think it may now be regarded as cosmetic/less of a priority when the money could be spent on say, cornea grafts. Could this be a factor in the Thai Hospital looking for payment? 

Anyway, t'Comittee agreed my operation is necessarily. I'm just waiting for the date. 

3 years after I first raised it. But grateful for the NHS anyway, and I understand them watching the budget. 

I hope your wife's operation goes well. 

[lopburi3]

22 hours ago, Guderian said:

Thanks, it's nothing terribly obvious then. I'm back in Thailand on Tuesday so maybe I can figure it out better talking to her than I can from using Google Translate.

Might make a real difference in person.  Thai/English is not a strong point for Google translate (and that is about as kind as I can put it - but I say this with no language knowledge other than trying to use on web pages and almost always getting totally false or suspect results).  I suspect even basic spoken English would be an improvement on Google translations.

[Guderian]

On 6/15/2018 at 12:00 PM, chas39 said:

Not directly Thai related - but concerning operations to reconnect the tearduct properly. Many years ago I had a couple of operations, done by the UK NHS to tighten/stitch my eyelids to improve the drainage of " tears" from my eyes. 

That was fine for many years. About 3 years ago my eyelids started to droop a bit. Old age? It's not life threatening, but tears tended to roll down my cheeks if it was windy, and particularly when near fans in Thailand. It is irritating, but more importantly it's tempting to rub your eyes. This is a danger for me as I've had two cornea grafts and I don't want to do any damage. 

When I asked my eye consultant if I could get this fixed again the answer ( under the free NHS) was " er - maybe - the operation is restricted now and will have to go before the Committee for consideration". So I think it may now be regarded as cosmetic/less of a priority when the money could be spent on say, cornea grafts. Could this be a factor in the Thai Hospital looking for payment? 

Anyway, t'Comittee agreed my operation is necessarily. I'm just waiting for the date. 

3 years after I first raised it. But grateful for the NHS anyway, and I understand them watching the budget. 

I hope your wife's operation goes well. 

Funnily enough my older brother back here in the UK has the same problem with tears running down his cheeks when he's out in the wind. His GP was sympathetic but said the condition would have to get quite a bit worse before the NHS would consider giving him an operation. Well, if you can't get cataracts fixed until you're practically blind these days I don't suppose they're going to care too much about a few tears.

 

Re. my lady friend in Thailand, I suspect the lack of tears for over 18 months now has damaged her eye as she complains about her vision, but whether it will come back OK when they fix the tear duct I have no idea. Since the problem was caused by them botching the surgery in the first place I'd be most disappointed if they regard it as low priority and so feel they can charge for it.

[Guderian]

3 hours ago, lopburi3 said:

Might make a real difference in person.  Thai/English is not a strong point for Google translate (and that is about as kind as I can put it - but I say this with no language knowledge other than trying to use on web pages and almost always getting totally false or suspect results).  I suspect even basic spoken English would be an improvement on Google translations.

Yeah, I've rechristened it Google Gibberish when trying to translate Thai. The Thai-2-English website is better but much slower and you largely have to figure out the meaning yourself from the individual words it translates.

[Sheryl]

7 minutes ago, Guderian said:

 I'd be most disappointed if they regard it as low priority and so feel they can charge for it.

How much of a medical priority it is considered will not have any bearing on what if anything is charged. It is either covered under the 30 baht scheme or it's not.

[Sheryl]

Just now, Sheryl said:

How much of a medical priority it is considered will not have any bearing on what if anything is charged. It is either covered under the 30 baht scheme or it's not. (it will affect how quickly it is scheduled, though)

 

[Guderian]

1 hour ago, Sheryl said:

How much of a medical priority it is considered will not have any bearing on what if anything is charged. It is either covered under the 30 baht scheme or it's not. (it will affect how quickly it is scheduled, though)

I guess you mean if it's under the 30 baht scheme it won't get done as quickly as if she's paying for it? Seems fair enough, much the same as the NHS vs. BUPA here, but as far as I'm aware everything's being done under the 30 Baht scheme so I still don't understand why she's being asked for 10K Baht.

 

I've thought on occasion of simply paying for the tear duct operation myself as it's been so unpleasant for her, but I assumed that the doctors at Chula would not be amused by her having a private operation and might refuse any other necessary follow-up treatment. Her eye orbit and nose were rebuilt using a piece of one of her ribs, and the plan eventually is to chisel her nose back into a better shape. I'm not sure what else may be needed along the way so I thought it best not to interfere. (She might well have refused if I'd made the offer anyway.)

[Sheryl]

Yes, private pay would be quicker than under 30 baht scheme. But I doubt it would cost only 10k baht for full private cost.

This sounds more like a partial pay. Perhaps there is some special equipment or device or drug entailed that the scheme doesn't cover. I think you have to wait till you get back to figure this out.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Guderian]

Now that I’m back in Thailand I thought I would give an update on matters, though to be honest I’m not much wiser.

 

The 10K Baht being demanded is apparently to pay for the new tear duct itself, not the surgery or a nice room or anything like that, but for the special bit of piping they’ll install that will carry the tears from the glands to the eyes. It seems a bit odd to me, what next, asking an organ transplant recipient to pay for a new kidney or heart?

 

My lady friend is adamant that it’s the Nayok’s fault (i.e. the Prime Minister), medical treatment is no longer free she thinks. Once the tear duct is sorted she’ll need to have nose surgery to reshape it and she expects to have to pay for that too.

 

I tried explaining to her that the tear duct problem was caused by a mistake during the big operation she had, which is what she originally told me, so the hospital should sort it out for free, but she doesn’t seem so sure now. She seems to think she had a tear duct problem before the operation and maybe that’s why they are demanding money. Thai logic, but that’s all I can make of what she’s saying. I knew her for around seven years before the operation and she never mentioned any problem with a dry eye, nor was there anything unsightly, unlike after the big operation, so I don’t know quite where all this mea culpa bit is coming from.

 

She’s consoling herself in that her aunt in Laem Chabang recently had to have major surgery also on her skull, I think she had a motorbike accident or something like that, and ended up paying over 150K Baht for it. At least my lady friend got the big 12 hour op for free, as I’ve been told that surgery would have cost an arm and a leg.

 

Apologies, I can’t be any more specific as I still don’t really understand what’s going on, but it does seem that (in her case at least) there has been a change in policy regarding payment for surgery in government hospitals.

[Sheryl]

From the sound of it they will be implanting a type of prosthetic device. These indeed are usually not covered, hospitals have to buy them directly from the manufacturer (foreign) and patients have to cover the actual cost.

Organ transplants are not analagous since hospitals do not have to purchade organs.

Nothing to do with medical care no longer being free. As you note the surgery, nursing care, room, meds etc are all being provided free of charge. It is this one item of expesive imported equipment that is not.

Are you sure the duct problem is due to surgical error as opposed to simply being a known complication of the first procedure? Not at all the same thing.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Guderian]

On 6/27/2018 at 3:54 PM, Sheryl said:

From the sound of it they will be implanting a type of prosthetic device. These indeed are usually not covered, hospitals have to buy them directly from the manufacturer (foreign) and patients have to cover the actual cost.

Organ transplants are not analagous since hospitals do not have to purchade organs.

Nothing to do with medical care no longer being free. As you note the surgery, nursing care, room, meds etc are all being provided free of charge. It is this one item of expesive imported equipment that is not.

Are you sure the duct problem is due to surgical error as opposed to simply being a known complication of the first procedure? Not at all the same thing.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

As I tried to explain I wasn't aware of the lady ever having had any pre-existing problems with her tear duct before the operation and she never needed any artificial tears before so when she came out of Chula with one eye looking like an oyster and having to use the Alcon tears ten times a day I assumed it was a surgical error. Now she seems to be saying she had some problems before, so I give up. At least it sounds like it's all kosher and she's not being ripped off, I was just wondering where the 10K came from all of a sudden. She still blames everything on the Nayok though. ?