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Posted

I started an in-patient private medical policy almost a year ago which is now coming up for renewal.  Since then I married a Thai lady who teaches in a government school which apparently allows me free(ish?) medical treatment anywhere in Thailand in a government hospital.  Does anyone see any point in continuing the private policy?  If relevant, I am here on a retirement visa extension, I rarely get sick or need treatment, we live in Bkk and the relationship and her job are both stable.

Regards,

Olmy.

Posted (edited)

Have a look at some public hospital wards before you make a decision, as well as the queues for admission. I have seen only Buriram hospital, for instance, terrifying... Every time I see my doctors at Bumrungrad I feel the 250 USD I pay monthly are really well spent. Been paying since 1991, and will pay until I die. Forgot to say that my former employer coughs up another 450 a month..

Edited by KiChakayan
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Posted

How this Insurance works, when the wife would die? Is the OP still covered afterwards?

 

One thing to consider, now you have a Insurance with maybe no exclusions. If you have to start it again in a few years. Maybe there is an option to put the Insurance plan to rest. So it can be reactivated. I not sure this is possible but maybe worth a try.

  • Like 1
Posted
49 minutes ago, HampiK said:

How this Insurance works, when the wife would die? Is the OP still covered afterwards?

 

One thing to consider, now you have a Insurance with maybe no exclusions. If you have to start it again in a few years. Maybe there is an option to put the Insurance plan to rest. So it can be reactivated. I not sure this is possible but maybe worth a try.

 

No, he will lose cover if she dies before him.

 

There is no way to put a temporary halt to a policy, as soon as you stop paying premiums it is cancelled.

 

It is true that he could end up regretting not being insured if his wife dies before him and he still wants to stay in Thailand. On the other hand, she might night, or he might decide nto to stay in LOS if she does.

 

 

 

 

Posted
2 hours ago, Sheryl said:

 

There is no way to put a temporary halt to a policy, as soon as you stop paying premiums it is cancelled.

 

Many European policies do have this option, especially if they are in the price range the OP mentioned

Posted
23 hours ago, Olmy said:

I rarely get sick or need treatment, we live in Bkk and the relationship and her job are both stable.

From my personal experience in one Thai Public Hospital, private is the only way to go.

 

Once you reach a certain age, I think 60, it becomes difficult to get insurance, however there are insurers out there that once your in, will keep insuring you, naturally your premium goes up as everything else does.

 

At the end of the day you really have to ask yourself this, how much do I value my life, and how much trust can I put on a doctor in a public hospital here in Thailand Vs a doctor in a private hospital, also public hospital que's are usually lengthy, i.e. my experience has been 1 hour 30 to see a doctor Vs 10-20 minutes in a private hospital.

 

My cover is for emergency and elective surgery cover only as I figure I can afford to pay for the usual outpatient costs, 2,3,4,5,000 baht depending if X-rays and medicines are required, however I have also told the doctor on repeats that I will get the repeats myself as I have a friend who has a pharmacy, they don't question me and the savings can be quite substantial, no point in paying an extra 900 baht for the same thing if you follow me.

 

Perhaps you should shop around, my policy also covers me for 4 adjoining countries and up to 90 days emergency cover to my home country. I found other policies would add too many things in that I wouldn't require, including countries that I wouldn't visit and charge more, up to 40,000 baht per annum more, to add the insurer I am with accepted my pre-existing condition for 1,320 per month on top of the policy when two other insurers wouldn't take on my pre-existing condition.

 

Would hold onto your policy or change to save a few $ if your getting value, but wouldn't cancel private cover because I reckon you would get better treatment and have better chances of survival in a private hospital in Thailand, this is just my opinion.

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Posted

Consider very carefully before you cancel it.

If she lost her job you could be in hot water & to reinstate at your age the policy price will be double

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Posted

Olmy being the spouse of a government school teacher, you are covered with her insurance.

Please dont think you can just walk into any government hospital for treatment, you have to be registered first at the hospital.

I am covered on my wifes insurance, and i am registered at 2 hospitals, local hospital and a large city hospital.

Posted
On 3/9/2019 at 12:56 PM, Sheryl said:

If she is a civil servant (as opposed to a contract hire) then she is covered under the Civil Service Social Security scheme which does cover spouses.

 

In that case it is not necessary for you to have private insurance unless you want the option of choosing your doctor/ using private hospitals (and want it badly enough to be worth the cost of the insurance premium). Since you are retired, you're of an age where premiums are considerable.

I don’t know it depends on him and his situation but his wife’s insurance he said only covers him at government hospitals and I’ve seen one government hospital and I would not take a stray dog to that particular government hospital.  My cat literally got better medical care at an emergency veterinarian than they give people at the government hospital I saw.  The emergency veterinarian hospital was literally cleaner and even had better X-ray and stuff like ultrasound equipment.  If he can afford it I’d recommend that he keep his private insurance policy if at all possible.  I’m retired military so I’m luck to be fully covered at private hospitals but I still pay for most of my medical stuff out of pocket unless it’s something like a major procedure just because I don’t like dealing with all the paperwork they require back in the States at TRICARE.  In fact my wife and I are both over due for a colonoscopy so I’m definitely going to have them cover that because those can get expensive depending on the doctor.  

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Posted (edited)

You can't say all government hospitals are bad or all private hospitals are good but overall private hospitals in Thailand will tend to have more up to date medicine, shorter waits, newer equipment, cleaner facilities, more English speaking staff, and more experienced doctors.

 

If you take a first-rate insurance policy and put the expensive premiums into a conservative investment.

 

Then over time you are fully covered and even in your 80s plus you are safe = no cancellations.

 

Note small private hospitals typically are not good for emergency care.

 

 

Edited by TravelerEastWest
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Posted
1 hour ago, Sheryl said:

 

I would strongly disagree with this, in fact quite the opposite though of course it does depend very much on which level of public hospital is involved. 

 

The convenience and comfort factor is very true, waits at government hospitals are very, very long  (whole day not unusual) and can be under very uncomfortable conditions.  And unless you are able to get a private room ("hong piset"), inpatient conditions can also be extremely unpleasant.

 

But the quality of medical care is usually very good, some low level (i.e. community hospital) facilities excepted.

 

The most egregious malpractice I have seen in my years on this board have been in private hospitals. Upcountry private hospitals especially but it does happen in Bkk as well.

 

Government hospitals have  treatment algorothms and protocols that reflect good medical practice. All staff are required to follow these and they are enforced.  So even if you do get unlucky and are treated by one of the less stellar members of the medical staff there are controls in place that usually limit the damage they can do. And, of course, there is no incentive at all to over-treat, do unnecessary tests, make up fake diagnoses etc in a government hospital.

 

In Thai private hospitals, the doctors have pretty much carte blanche to do as they like. If you have researched your choice of doctor carefully and chosen well, this is fine, in fact may even be to your benefit and save time.  But if not, there is nothing in place to guarantee you are treated in accordance with normal medical standards. And there is a definite incentive to over-treat and over-test. Doctors vary greatly in whether they are willing to alter their practice accordingly and the best ones - who are at the top of their game, getting more patients than they can begin to handle and have far more interest in maintaining their medical reputations than in how much they make from patient X - will not be swayed. But those not of that caliber  may be. And in some cases they will go to pretty extreme and unethical lengths. accordingly.

 

In Thailand especially, clean modern facilities and shiny new equipment do not necessarily (or even usually) equate to better medical care. Lay people are unduly swayed by these as it is what they can readily see, but believe me, some very, very good medical care is delivered in antiquated, run-down public hospital buildings and  appalling malpractice sometimes occurs in private hospitals that look like 5 star hotels.

I pretty much agree,  especially with the last paragraph. 

Beware: government hospital have a very minimalistic approach (as opposed to over-treatment in many private hospitals) which sometimes borders on malpractice. 

 

OP stated he lives in Bangkok. So I would keep my private insurance as there are excellent private hospitals in Bangkok.  

 

Upcountry, it would depend on the location. Most places upcountry don't have better care in the private hospitals than in the government hospitals.

Pattaya being an obvious exception.

 

 

 

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Posted

All I can say it is that I was referred to Siriraj after my local, very swish, private hospital ran out of options. And thanks to the doctor that did that, she obviously took the Hippocratic oath seriously. 

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Posted
2 hours ago, Sheryl said:

 

I would strongly disagree with this, in fact quite the opposite though of course it does depend very much on which level of public hospital is involved. 

 

The convenience and comfort factor is very true, waits at government hospitals are very, very long  (whole day not unusual) and can be under very uncomfortable conditions.  And unless you are able to get a private room ("hong piset"), inpatient conditions can also be extremely unpleasant.

 

But the quality of medical care is usually very good, some low level (i.e. community hospital) facilities excepted.

 

The most egregious malpractice I have seen in my years on this board have been in private hospitals. Upcountry private hospitals especially but it does happen in Bkk as well.

 

Government hospitals have  treatment algorothms and protocols that reflect good medical practice. All staff are required to follow these and they are enforced.  So even if you do get unlucky and are treated by one of the less stellar members of the medical staff there are controls in place that usually limit the damage they can do. And, of course, there is no incentive at all to over-treat, do unnecessary tests, make up fake diagnoses etc in a government hospital.

 

In Thai private hospitals, the doctors have pretty much carte blanche to do as they like. If you have researched your choice of doctor carefully and chosen well, this is fine, in fact may even be to your benefit and save time.  But if not, there is nothing in place to guarantee you are treated in accordance with normal medical standards. And there is a definite incentive to over-treat and over-test. Doctors vary greatly in whether they are willing to alter their practice accordingly and the best ones - who are at the top of their game, getting more patients than they can begin to handle and have far more interest in maintaining their medical reputations than in how much they make from patient X - will not be swayed. But those not of that caliber  may be. And in some cases they will go to pretty extreme and unethical lengths. accordingly.

 

In Thailand especially, clean modern facilities and shiny new equipment do not necessarily (or even usually) equate to better medical care. Lay people are unduly swayed by these as it is what they can readily see, but believe me, some very, very good medical care is delivered in antiquated, run-down public hospital buildings and  appalling malpractice sometimes occurs in private hospitals that look like 5 star hotels.

The issue with government hospitals is not only the quality of care but also the type of treatment that is, or isn't, available. For my prostate problems (BPH, Prostatitis, + small low grade cancer) I am followed by a very pleasant local Urologist, and I go to Bumrungrad 2 or 3 times year. When I got diagnosed for cancer, my Doctor in Buriram said that the only local treatment options, were Orchiectomy or hormone therapy. I am now on Active Surveillance with yearly MRIs. No way I would have gotten that without a private insurance. BTW, sadly, Orchiectomy is the most popular treatment for prostate cancer in Thailand. 

I have also another interesting condition condition, which is Barret's esophagus. Would I get regular (every 3 years) endoscopies to monitor the onset of Dysplasia in a provincial hospital? I doubt it. Would endoscopic resection or RFA be performed if dysplasia was found, in my Buriram hospital? Very unlikely, they don't have the resource for such subtleties, it would Esophagectomy and/or die.

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Posted (edited)

My wife needed emergency Icu treatment for 3 weeks and a government hospital saved her life because I pay for her social security payments. The room had ants in it and her room was shared with a terminally Ill patient who I wish was still with us although the hospital saved my wife’s life and we sent flowers and gift baskets to the ward staff when she recovered. I thought I was going to lose her and they saved her life. I saw the bill that would have been 180,000 baht but my wife was covered by social care, were very grateful although of course I’ve paid much more to the Thai system. It’s more than very fair and they save lives.

 

On the other hand I needed treatment recently and I went to a private hospital they charge a small fortune and my overpriced health insurance doesn’t cover outpatient so I wish I had social care.

 

if you can wait a few hours in a queue it’s preferable to me than relying on private insurance that costs the earth and might not pay out when you need it. I don’t have that option unfortunately.

 

Edited by NightSky
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Posted

I don't think anyone really has the exact answer for you?  Insurance here is rolling the dice!  and so with your relationship with Thai wife.

I like you are on a Retirement Extension I've been buying insurance for 12 years for whatever reason I'm set on the number 1 million baht coverage all these years never have I made a claim. I've bounced around from all the major insurance company here to try to get the best bang for my baht.

The only hospital I have used for my wife, son is Bangkok/Pattaya, but that doesn't mean I haven't visited others particularly the government ones because I'm planning ahead for the worse and what is an acceptable level of care for the wife and even myself since if something major comes up once diagnosed confirmed my million baht isn't going to go far so I want to stretch the coverage.

I think what is important to me is the country he comes from and what is his budget and what has he purchased the last year the coverage amount? He being in Bangkok I consider him lucky many more options and being in Pattaya are considering government hospital to visit so Sheryl, if you see this post and got really sick what where would you head without hesitation?  As noted, he should get his wife medical booklet and make a visit to some of these hospitals has he spoken to his wife what hospital she has used or heard that are good.

If money isn't much of an object I would self-fund but it takes a lot of discipline. For insurance to cover insurance if a decision can't be made now I would downsize to the lower amount of coverage take the difference in cost and sock it away in a medical account. This is why I'm going to start doing this myself while I'm still healthy.  As I noted I've bounced around from a number of companies as you age particularly 60 and up companies start to put you in age brackets, the bad in general many in those older brackets make a lot of claims whether you do or not being in the group must share the cost of increase which goes up 3-5,000 from a year on the average. If you make a claim basically around or exceed your premium, believe me, they will find a way to get it back whether they can cancel you or not and to me that is the catch?  They might no cancel your policy but they will raise the premium to a point they don't have to cancel you will do it yourself unless you have deep pockets if that is the case should self-fund?

My recent policy with AXA, 1 million got in just before 65, said no checkup etc. since I've made no claims with other companies was accepted with flying colors for 29,000 baht, I left ACS, covered me $500,000 USD but the premium was sky high I was thinking the way it was going up soon it would hit the moon? So I downsize and took the savings of 45-50,000 baht and socked it away. 

Last year after my renewal AXA canceled the Expat policy the agent said we are actually covered by Pacific Cross who will honor the premium of 32,000 baht the agent explained they will cover you until 90 years old but what he failed to conveyed was coming up their premium chart for 65-70 is 52,000 baht, not 32,000?  So it got me thinking sure they might not cancel me but will make it tough to continue because as you get older more claims even if one doesn't put in a claim now it is a matter of time? unless I'm related to god?

So if I live for another 20 years my mom is 100 years old what is the premium going to be 100,000 for the same 1 million and what will 1 million get me then, an emergency visit? So I'm seriously considering in downsize to the lower and cheapest policy of 700,000 put the difference away and take care of myself and hope for the best?

 

Posted
1 hour ago, KiChakayan said:

The issue with government hospitals is not only the quality of care but also the type of treatment that is, or isn't, available. For my prostate problems (BPH, Prostatitis, + small low grade cancer) I am followed by a very pleasant local Urologist, and I go to Bumrungrad 2 or 3 times year. When I got diagnosed for cancer, my Doctor in Buriram said that the only local treatment options, were Orchiectomy or hormone therapy. I am now on Active Surveillance with yearly MRIs. No way I would have gotten that without a private insurance. BTW, sadly, Orchiectomy is the most popular treatment for prostate cancer in Thailand. 

I have also another interesting condition condition, which is Barret's esophagus. Would I get regular (every 3 years) endoscopies to monitor the onset of Dysplasia in a provincial hospital? I doubt it. Would endoscopic resection or RFA be performed if dysplasia was found, in my Buriram hospital? Very unlikely, they don't have the resource for such subtleties, it would Esophagectomy and/or die.

Orchiectomy is NOT the most common prostate cancer treatment in Thailand and is reserved for Stage IV cases. It would certainly never be done for prostate caner in situ. Plenty of TURPs done in government hospitals. But, like other specialized surgeries, requires a regional or national level facility. Which Thai patients can and do get referred to, and as a foreigner you (since you have to pay anyhow) you can go directly to.

 

Do not confuse what is available in a local hospital with what is available altogether through the public system. It has many tiers.  There is pretty much nothing available in private hospitals that is not also available at the top tier government  hospitals (e.g. Siriraj, Chulalongkorn) and indeed, these often precede the private hospitals in introducing new treatments and technologies.

 

You could indeed get what you need for monitoring and management of Barretts esophagus in a government hospital, but it would need to be one of the university hospitals.

 

 

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Posted
45 minutes ago, Sheryl said:

Orchiectomy is NOT the most common prostate cancer treatment in Thailand and is reserved for Stage IV cases. It would certainly never be done for prostate caner in situ. Plenty of TURPs done in government hospitals. But, like other specialized surgeries, requires a regional or national level facility. Which Thai patients can and do get referred to, and as a foreigner you (since you have to pay anyhow) you can go directly to.

 

Do not confuse what is available in a local hospital with what is available altogether through the public system. It has many tiers.  There is pretty much nothing available in private hospitals that is not also available at the top tier government  hospitals (e.g. Siriraj, Chulalongkorn) and indeed, these often precede the private hospitals in introducing new treatments and technologies.

 

You could indeed get what you need for monitoring and management of Barretts esophagus in a government hospital, but it would need to be one of the university hospitals.

 

 

Sheryl, TURP isn't a treatment for prostate cancer. And, the topic of this thread is having a private insurance or not. So, since I got one, I am glad I could eventually go to the government facility of my choice. But I'd do that only if I was suffering from withdrawal symptoms because my immigration office is making things too easy. And yes, Siriraj enjoys a great reputation, an when it comes to the crunch I'll definitely consider the switch to Siriraj private. But for now Bumrungrad is just too close to Nana Plaza.

  • Like 1
Posted (edited)
5 hours ago, Sheryl said:

 

You could indeed get what you need for monitoring and management ... in a government hospital, but it would need to be one of the university hospitals.

 

But the government hospital may not be where the patient is. It matters in an emergency. 

Upcountry, there are examples where life saving equipment is only available in the private sector (e.g. Bangkok Hospital had the first ever cath lab north of Khonkaen. If you had a heart attack in Udon or Nongkhai this made a big difference.  Bangkok Hospital also had the first MRI on Phuket).

On the other side,  quite often government hospitals are better equipped than the private sector (the only MRI in Surat Thani is in the government hospital. Hematology for the southern tourist provinces is in a government hospital).

So, as I said before: whether private insurance is worth it upcountry depends on your location. 

 

BTW only the private sector has the option of patient transfers by helicopter. But not every insurance will pay for this. 

Psychiatry does hardly exist in the private sector outside of Bangkok and Pattaya 

Edited by uhuh
Posted
16 hours ago, Sheryl said:

 

I would strongly disagree with this, in fact quite the opposite though of course it does depend very much on which level of public hospital is involved. 

 

The convenience and comfort factor is very true, waits at government hospitals are very, very long  (whole day not unusual) and can be under very uncomfortable conditions.  And unless you are able to get a private room ("hong piset"), inpatient conditions can also be extremely unpleasant.

 

But the quality of medical care is usually very good, some low level (i.e. community hospital) facilities excepted.

 

The most egregious malpractice I have seen in my years on this board have been in private hospitals. Upcountry private hospitals especially but it does happen in Bkk as well.

 

Government hospitals have  treatment algorothms and protocols that reflect good medical practice. All staff are required to follow these and they are enforced.  So even if you do get unlucky and are treated by one of the less stellar members of the medical staff there are controls in place that usually limit the damage they can do. And, of course, there is no incentive at all to over-treat, do unnecessary tests, make up fake diagnoses etc in a government hospital.

 

In Thai private hospitals, the doctors have pretty much carte blanche to do as they like. If you have researched your choice of doctor carefully and chosen well, this is fine, in fact may even be to your benefit and save time.  But if not, there is nothing in place to guarantee you are treated in accordance with normal medical standards. And there is a definite incentive to over-treat and over-test. Doctors vary greatly in whether they are willing to alter their practice accordingly and the best ones - who are at the top of their game, getting more patients than they can begin to handle and have far more interest in maintaining their medical reputations than in how much they make from patient X - will not be swayed. But those not of that caliber  may be. And in some cases they will go to pretty extreme and unethical lengths. accordingly.

 

In Thailand especially, clean modern facilities and shiny new equipment do not necessarily (or even usually) equate to better medical care. Lay people are unduly swayed by these as it is what they can readily see, but believe me, some very, very good medical care is delivered in antiquated, run-down public hospital buildings and  appalling malpractice sometimes occurs in private hospitals that look like 5 star hotels.

Thanks for that Sheryl, very informative as usual, and appreciated, all taken on board.

 

I will admit, I did go under the knife (day procedure) at Khon Kaen public hospital (University), a two hour drive from home, to remove a Basal Carcinoma on my face, and it was done by an Associate Professor (Plastic Surgeon) while showing his 4 students how it was done and I have no complaints, although as you say, the wait can be for hours, fortunately for me on the day of surgery, one of the nurses after 2 hours put one and one together and said, hey this guy's procedure won't take log and put me in the top of the que, about 8 others waiting ahead of me for big operations, after my procedure there is almost no visible scar, with a dermatologist and my GP back in my home country both stating that he did an excellent job.

 

I have had a bad experience in another public hospital where my diagnoses of a chest infection and narrowing of my windpipe was put down as the flu, this flu was lingering for 8 weeks and I was having trouble breathing (badly), one Dr more into his mobile texting than really paying attention to my symptoms, no physical inspection, the other in emergency ward on another day, gave me oxygen which helped and sent me to this lung doctor, that was enough to put me off, because a 10 minute wait in a private hospital to see a Dr and then a chest specialist diagnosed my condition as a chest infection and allergy which inflamed my windpipe narrowing air getting in and out, we later worked it out as an old mould stain on the ceiling I was sitting under, the roof leak was fixed but never cleaned the mould that built up over time.

 

Not an expert on the hospital systems, but sure the privates have to extract the $'s, but I feel the public hospital I was misdiagnosed at, could have been eventually lead to my death, if I am not being overdramatic. 

 

At the end of the day, I hope I don't have to visit any hospitals here, prefer back home, but then again, having private cover does give me some sense of security, and I can only hope if I do end up in either hospital system I get out better than when I went in, although private is my preference, glory and all.    

 

 

Posted
17 hours ago, natway09 said:

Consider very carefully before you cancel it.

If she lost her job you could be in hot water & to reinstate at your age the policy price will be double

If an insurance policy is cancelled it may not be able to be reinstated. My insurance became unavailable if I wasn't insured before 65 ( very good Thai insurance ). I either kept renewing it or went without.

Posted

As a spouse of a government employee you are covered by Civil Service Social Security scheme until you Die or Divorce. 

Many Thai Civil Servants choose to pay extra at Sriphat Medical Centre instead of waiting for a long time in Chiang Mai Hospital which is serviced by the same doctors.

Personally, i Would never have any major operation in Thai hospital 

 Your choice Your health 

  • Confused 1
Posted
2 hours ago, 4MyEgo said:

"I did go under the knife (day procedure) at Khon Kaen public hospital (University),..."

Khon Kaen Hospital and the university hospital (Srinagarind) are not the same place.

  • Thanks 1

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