Followup on hernia operation

[cmarshall]

So, I just had laparoscopic inguinal hernia repair.  I decided to have it done at Chulalongkorn Hospital's after hours clinic, with the expectation that it would cost somewhat more than at the daytime clinic, but with less waiting.   The operation went as expected without any problems so far.

 

What is kind of interesting is the payment system.  I made every effort to identify all the costs up front, but apparently pricing for health care services in Thailand are as opaque as in the US.  When I asked the surgeon what it would cost he said THB 130,000.  Immediately afterward in the scheduling discussion, the nurse quoted me THB 164,000 to 174,000 not counting the room for overnight stay for which she would not have a quote until the day of the operation since it depended on availability.  Some rooms go for THB 30,000 per night and if that turned out to be all that was available we would be stuck with that unless we rescheduled which I wouldn't have done.

 

So, when we called on op day for the room quote she said THB 4500, which was fine.

 

Stayed one night and could move around with minimal discomfort the next day, so staying a second night was not necessary.  The bill I was handed was THB 131,000 all in.  There was also a pre-op checkup a few days prior which cost THB 1900, a Covid PCR test the day before at THB 1300, and the initial consultation at THB 1000.  Turns out the room she quoted for THB 4500 came in at only THB 3500.  

 

An internet search of the US cost of laparoscopic inguinal hernia repair showed a range of $3900 to $12,500 with an average of $7,750.

 

I especially enjoyed the experience of getting Thai medical care along with Thai people and would recommend it.  I did note that when applying for my patient card at Chula they did not accept my US passport card, but insisted on seeing my US passport book which they checked for a valid visa.  On subsequent visits when they requested my passport I always gave them my US passport card, which they did accept.

 

One curious observation.  Thai staff apparently do not know how to measure blood pressure correctly.  Neither can the fully automatic BP machines in use there.  You can find out how it should be done in this lecture by a specialist who references the research.  It is worth pointing out that in the US many people including doctors who take BP readings are not using best practices either.  I fired one doctor in New York for asking me questions while he was taking my BP.  

 

 

Edited January 23, 2022 by cmarshall

[lopburi3]

38 minutes ago, cmarshall said:

Some rooms go for THB 30,000 per night and if that turned out to be all that was available we would be stuck with that unless we rescheduled which I wouldn't have done.

That does not sound right - rooms are a pay for option - if no room you go to open ward AFAIK.  Did you insist on private room perhaps?  As for the price it seems very close to what you were quoted (doctor 130, actual 131) - normally nurse will provide a high estimate including everything in most hospitals in my experience as they do not want you to come back and say it cost more than you were told.  

[Pravda]

So basically you paid almost the same US price in a third rate hospital

[connda]

I had a standard mesh surgery done at Maharaj Hospital CM for 18,000 THB including two nights in a private room. 

[Chris.B]

10 minutes ago, connda said:

I had a standard mesh surgery done at Maharaj Hospital CM for 18,000 THB including two nights in a private room. 

That is good to know if you don't want to pay for Laparoscopic surgery. How long did it take to heal up?

 

Unfortunately, I need this procedure and have been advised to go for Laparoscopic.

 

[TantrikLvr]

After researching for cost of Laparoscopic Hernia operation, found that Sukhumvit hospital, St. Louis, Medpark and Bumrumgrad (the last 2 offer a competitive 'promotion') all estimate the cost at 200,000, including room, but not the pre opp costs, estimated at 10 - 20k more.  

[Lacessit]

IMO the only really accurate way to measure BP is with a sphygmomanometer. The machines are only as good their last calibration, or not even that.

I can remember going to RAM Hospital in Chiang Mai for some dental work. On my first visit, I was checked with one of the portable machines, 170/100. I knew from my own recently calibrated machine I was about 110/60.

When I looked at the back of the RAM machine, the most recent calibration sticker was 5 years old.

[timendres]

20 minutes ago, Chris.B said:

That is good to know if you don't want to pay for Laparoscopic surgery. How long did it take to heal up?

 

Unfortunately, I need this procedure and have been advised to go for Laparoscopic.

15 years ago, I needed a hernia operation in the US. The doctor recommended that I not do laparoscopic. I asked why. He said that the laparoscopic is more difficult for the doctor, has higher failure rates, and does not last as long. I opted for the traditional mesh, and it has lasted these 15 years without a problem. That said, I did have a dull pain in the area for many months, and it concerned me. Only then did I do some research and discovered that hernia operations have a relatively high incidence of chronic pain. My point being that, for an operation that is "sold" as simple and common, I would definitely pay a little more for a doctor that is very good. Had that pain never ceased (as it never does for many), I cannot imagine living with it permanently.

[lopburi3]

12 minutes ago, Lacessit said:

IMO the only really accurate way to measure BP is with a sphygmomanometer. The machines are only as good their last calibration, or not even that.

I can remember going to RAM Hospital in Chiang Mai for some dental work. On my first visit, I was checked with one of the portable machines, 170/100. I knew from my own recently calibrated machine I was about 110/60.

When I looked at the back of the RAM machine, the most recent calibration sticker was 5 years old.

Actually have found Omron meters very accurate and experience the 170/100 in hospital when at home 110/70 many times on both meters and sphygmomanometer.  We can have very large increase as we go into the white coat world (even shopping centers for me - which made me believe home meter must be wrong many times over the years).  

Edited January 23, 2022 by lopburi3

[Sheryl]

2 hours ago, Pravda said:

So basically you paid almost the same US price in a third rate hospital

I would hardly call Chula -- a major teachning hospital -  a "third rate" hospital!

 

 

[cmarshall]

13 hours ago, Pravda said:

So basically you paid almost the same US price in a third rate hospital

Chula has the reputation of having the best doctors in Thailand.  My surgeon certainly inspired my confidence.  

[cmarshall]

12 hours ago, lopburi3 said:

Actually have found Omron meters very accurate and experience the 170/100 in hospital when at home 110/70 many times on both meters and sphygmomanometer.  We can have very large increase as we go into the white coat world (even shopping centers for me - which made me believe home meter must be wrong many times over the years).  

Same here.  I have been using an Omron for years.  As the doctor in the video I posted explained home measurements are usually lower than in the doctor's office.  White coat explains part of it, but another part is that office measurements are often not taken correctly which results is higher readouts and corresponding over treatment.

[cmarshall]

13 hours ago, Chris.B said:

That is good to know if you don't want to pay for Laparoscopic surgery. How long did it take to heal up?

 

Unfortunately, I need this procedure and have been advised to go for Laparoscopic.

 

So far, I would recommend laparoscopic.  The healing progresses by the hour.  I would ask the prospective surgeon how many such operations he has done in the past year.  The only advantage I see for open surgery over laparoscopic is that only a local anesthetic is needed.  In all other respects laparoscopic seems to be superior.  

[gargamon]

Any surgeon that pushes open surgery over a laproscopic procedure is likely not very skilled at laproscopic. He/she will of course say that it's better to do open surgery as he doesn't want you to go elsewhere. 

 

Laproscopic surgery is very common. Avoid surgeons that are so out of date that they don't want to or can't do it.

[bkk6060]

So, you don't have insurance in the U.S.?  

Anyway, it is an out patient procedure in western countries sounds like you got oversold.  Glad you are doing OK.

Edited January 23, 2022 by bkk6060

[Pravda]

15 hours ago, Sheryl said:

I would hardly call Chula -- a major teachning hospital -  a "third rate" hospital!

 

 

I am talking about after service and warranty. What happens in a Thai hospital if things go wrong? Is there such thing as personal responsibility and liability in Thailand?

[cmarshall]

3 hours ago, bkk6060 said:

So, you don't have insurance in the U.S.?  

Anyway, it is an out patient procedure in western countries sounds like you got oversold.  Glad you are doing OK.

How do you figure that?  I got inpatient care, with correspondingly greater risk management, at a price that matched the lowest in the US, which would be for outpatient treatment.  Sounds like a bargain to me.   

 

So, you would fly back to the US for such treatment?  Why on earth would anyone do that?  Why would anyone maintain health insurance in the US while living in Thailand, beyond the minimum Medicare parts A & B?

Edited January 24, 2022 by cmarshall

[cmarshall]

1 hour ago, Pravda said:

I am talking about after service and warranty. What happens in a Thai hospital if things go wrong? Is there such thing as personal responsibility and liability in Thailand?

Where did you get the idea that medical treatment in the USA, for example, comes with a warranty?

[Pravda]

10 minutes ago, cmarshall said:

Where did you get the idea that medical treatment in the USA, for example, comes with a warranty?

You can certainly sue if something goes wrong. 

 

If there is a mistake the problem it will be fixed.

 

What happens in Thailand if a surgery goes pear shaped?

 

 

Edited January 24, 2022 by Pravda

[cmarshall]

10 minutes ago, Pravda said:

You can certainly sue if something goes wrong. 

 

If there is a mistake the problem it will be fixed.

 

What happens in Thailand if a surgery goes pear shaped?

 

So you believe, but what you really get is defensive medicine designed not to provide you the best care, but to protect the doctor from your lawsuit, which means more than merely excessive testing.   I have personally experienced the disadvantages of that system when my New York doctor made it pretty clear that he wanted me to take a medicine that had already caused me serious, painful side effects, because the standard treatments protected him from some possible future lawsuit by my widow.   

 

I feel that I got the best standard of treatment from the best doctors at a bargain price which is a better assurance than the opportunity to bring a lawsuit.

 

Just as an aside, the fact that my wife could stay with me in the room was an immense benefit that would not have been available to me in the USA.

[RandiRona]

51 minutes ago, cmarshall said:

Where did you get the idea that medical treatment in the USA, for example, comes with a warranty?

You can sue them if something goes wrong for one , you will be charged for defamation here if you try here.

[cmarshall]

1 minute ago, RandiRona said:

You can sue them if something goes wrong for one , you will be charged for defamation here if you try here.

While you have been lulling yourself to sleep at night with the appealing prospect of one day bringing a medical malpractice suit, the doctors have been investing their more than adequate incomes in tort reform with the result that 

 

The results showed that 55% of all medical malpractice claims involved litigation.  Of the cases that resulted in litigation, 54% were dismissed by the court in favor of the medical provider.  Of the cases that were not dismissed by the court, between 33 and 50% were settled before they reached a trial verdict.  Only 4.5% of medical malpractice claims reached a trial verdict.  What’s more, of the few cases that did reach a verdict, right at 80% resulted in favor of the medical care specialist.

 

https://www.collinsattorneys.com/medical-malpractice-attorney-albuquerque/common-medical-malpractice-claims/medical-malpractice-claims-litigation-and-trial-numbers/

 

 

[RandiRona]

7 minutes ago, cmarshall said:

While you have been lulling yourself to sleep at night with the appealing prospect of one day bringing a medical malpractice suit, the doctors have been investing their more than adequate incomes in tort reform with the result that 

 

The results showed that 55% of all medical malpractice claims involved litigation.  Of the cases that resulted in litigation, 54% were dismissed by the court in favor of the medical provider.  Of the cases that were not dismissed by the court, between 33 and 50% were settled before they reached a trial verdict.  Only 4.5% of medical malpractice claims reached a trial verdict.  What’s more, of the few cases that did reach a verdict, right at 80% resulted in favor of the medical care specialist.

 

https://www.collinsattorneys.com/medical-malpractice-attorney-albuquerque/common-medical-malpractice-claims/medical-malpractice-claims-litigation-and-trial-numbers/

 

 

You have a right whether that right brings you results or not, that could be a point of argument, but here you will be packed in body bag and shipped back with cardiac arrest with their non calibrated instruments showing 'factual' data. I am happy it worked for you and you are doing well. For anything which is not an emergency, I would go back and do it I  states if possible. Peace of mind if that make sense.

[lopburi3]

12 minutes ago, RandiRona said:

You have a right whether that right brings you results or not, that could be a point of argument, but here you will be packed in body bag and shipped back with cardiac arrest with their non calibrated instruments showing 'factual' data. I am happy it worked for you and you are doing well. For anything which is not an emergency, I would go back and do it I  states if possible. Peace of mind if that make sense.

Actually Bangkok has been a highly regarded international medical destination for decades - you may have access to the newest cutting edge, at a price, in USA but there is nothing second rate about the many first class doctors available in Thailand, many of whom have trained and worked in medical centers all over the world.  

[RandiRona]

1 minute ago, lopburi3 said:

Actually Bangkok has been a highly regarded international medical destination for decades - you may have access to the newest cutting edge, at a price, in USA but there is nothing second rate about the many first class doctors available in Thailand, many of whom have trained and worked in medical centers all over the world.  

I am not disagreeing,  I am just talking about your rights when things go south. If you can afford in States(Insurace/Medicare/Medicaid) and if it's not an emergency , why leave that option?

[Sheryl]

5 hours ago, bkk6060 said:

 

Anyway, it is an out patient procedure in western countries sounds like you got oversold.  Glad you are doing OK.

It is common in Thailand to keep people overnight for what would be day procedures in the US and this has minimal effect on costs since room costs are low.

[lopburi3]

1 minute ago, RandiRona said:

I am not disagreeing,  I am just talking about your rights when things go south. If you can afford in States(Insurace/Medicare/Medicaid) and if it's not an emergency , why leave that option?

What good is a one in a million right to sue when already dead/maimed?   In Thailand you have immediate access to first class doctors at a reasonable cost and with family around you.  But guess I am not of the lawyer/sue/not have to work generation that so many lawyers seem to be turning us into.  

[RandiRona]

4 minutes ago, lopburi3 said:

What good is a one in a million right to sue when already dead/maimed?   In Thailand you have immediate access to first class doctors at a reasonable cost and with family around you.  But guess I am not of the lawyer/sue/not have to work generation that so many lawyers seem to be turning us into.  

Again , I am not questioning Doctor's knowledge and capability here but if you go through OP's first post, he saw that BP instrument was not calibrated and it was calibrated 8 years ago. Now if the same instrument shows someone BP higher than what it is during procedure and if Doctors give something to reduce that , that patient can die. In US or may be in other western countries, you can question that, here you will be in jail if you try to defame any procedure or hospital or doctor. 

People can die here in hospital or in US but in US , your family can seek justice, here not so much!

[Pravda]

14 minutes ago, lopburi3 said:

What good is a one in a million right to sue when already dead/maimed?   In Thailand you have immediate access to first class doctors at a reasonable cost and with family around you.  But guess I am not of the lawyer/sue/not have to work generation that so many lawyers seem to be turning us into.  

Forget suing.

 

How about a general screwup, misdiagnosis? Surely a hospital in US will do the right thing and fix the problem.... Free of charge, of course.

 

 

[lopburi3]

Actually no doctor is going to act on one BP reading or same unit for medication here (and have extensive experience myself as often more than 50 points higher).  As for uncalibrated that it has not been sent to Timbucktu for official calibration does not mean it has not been checked.  Nor does it not mean you go to jail for pointing out - in most cases medical staff are very responsive and do not threaten patients.  And from reports I have seen over the years most hospitals/doctors will go out of their way to fix any errors just as anywhere in the world.