Typical cost of hospice/palliative

[ole1291]

While browsing the benefit table for the different options for private health insurance in Thailand, I noticed a hospice/palliative care column.

This, it turns out, is the amount the insurance will pay for all the comfort/pain treatment you will be given once your condition is declared non treatable (with usually a 6 months max life expectancy).

 

As an example, April Thailand's extensive plan will offer ฿ 1,637,500 in such a case. 

The problem is I have no idea what the typical cost for such matters run at in Thailand, but I guess a multi month stay in a private hospital could run in the millions.

I realize this is something hard to estimate, depending on the condition, life expectancy etc... but a ballpark figure would help, perhaps someone who works in the insurance business here would have seen sample cases he can share with us?

 

I think it's important for people to realize that once an illness is declared untreatable, the insurance will only cover medical expenses up to the amount specified under palliative care (which is usually way  below the policy overall coverage, sometimes even zero). A little underhanded and could be a bad surprise for someone who thought he was covered.

 

That leads me to my second question which is how good is palliative care in Thai public hospitals (insurance would be for my Thai wife)? 

My feeling, at least in the country hospitals, not good. Huge wards, indifferent/rude nurses etc...

[Sheryl]

Palliative care is a very weak area in Thai health care. There are almost no hospices as such and no real hospice care. That includes at private hospitals.

 

About the only place that comes close is McKean Hospital in Chiang Mai.

 

That line item in insurance policies is for care in a hospice facility which (with possible exception of McKean) is not applicable here, since there are none. Insurance will not exclude care in a hospital because the prognosis is terminal (which they also likely won't know). Their coverage will depend on what thep urpose of the hospitalization is, which leads to the next point - it is hard  to imagine a scenario in which one would want to spend a month in a Thai hospital - private or otherwise - if in the terminal phase of an illness. Most people would much rather be at home, with hired-in carers if needed.

 

Government hospitals will give pain killers, and there are some with palliative care units (e.g. Khon Kaen University hospital). The big difficulty comes when  the patient is no longer able to swallow oral meds, as they will not provide morphine drips and the like outside the hospital. Typically this is within days of death and many people at that point go into the hospital.

 

 

[ole1291]

20 hours ago, Sheryl said:

Palliative care is a very weak area in Thai health care. There are almost no hospices as such and no real hospice care. That includes at private hospitals.

 

About the only place that comes close is McKean Hospital in Chiang Mai.

 

That line item in insurance policies is for care in a hospice facility which (with possible exception of McKean) is not applicable here, since there are none. Insurance will not exclude care in a hospital because the prognosis is terminal (which they also likely won't know). Their coverage will depend on what thep urpose of the hospitalization is, which leads to the next point - it is hard  to imagine a scenario in which one would want to spend a month in a Thai hospital - private or otherwise - if in the terminal phase of an illness. Most people would much rather be at home, with hired-in carers if needed.

 

Government hospitals will give pain killers, and there are some with palliative care units (e.g. Khon Kaen University hospital). The big difficulty comes when  the patient is no longer able to swallow oral meds, as they will not provide morphine drips and the like outside the hospital. Typically this is within days of death and many people at that point go into the hospital.

 

 

Thank you Sheryl for this informative reply.

 

Previously, while corresponding with AAinsure, this is what they told me about the applicability of palliative care:

 

With regards to hospice care generally, is it so that once an illness is declared terminal, hospital stay will only be covered by the amount stipulated under "palliative care" or be paid by the insured own pocket? 

Whether or not a condition is qualified as palliative is evaluated based on medical reports and international medical definitions as regards to palliative care/treatment. Should it however come to a stage where the condition is labelled as palliative care, coverage is indeed limited to palliative cover of the policy.

 

It does seem to indicate that insurances would terminate normal coverage in case an illness is terminal.

I guess the crux is whether the hospital notifies the insurance... but one would assume the insurer would be eager to find out.

 

[Sheryl]

2 hours ago, ole1291 said:

Thank you Sheryl for this informative reply.

 

Previously, while corresponding with AAinsure, this is what they told me about the applicability of palliative care:

 

With regards to hospice care generally, is it so that once an illness is declared terminal, hospital stay will only be covered by the amount stipulated under "palliative care" or be paid by the insured own pocket? 

Whether or not a condition is qualified as palliative is evaluated based on medical reports and international medical definitions as regards to palliative care/treatment. Should it however come to a stage where the condition is labelled as palliative care, coverage is indeed limited to palliative cover of the policy.

 

It does seem to indicate that insurances would terminate normal coverage in case an illness is terminal.

 

No, not at all. Ir means that if the care in question is labelled or described as palliative, it will be covered under the amount indicated for palliative care.

 

A person could, for example, have an ultimately terminal condition but still chose to undergo treatments to proling life (e.g chemotherapy, radiation). That eould nor fsll undef "palliative care" because the aim is nit palliation but prolomging life.

 

Palliative care means comfort measures only and it is logical for that to have lower level of reimbursement.

 

The issue is the type of care involved not the patient's prognosis.

 

 

[ole1291]

3 hours ago, Sheryl said:

No, not at all. Ir means that if the care in question is labelled or described as palliative, it will be covered under the amount indicated for palliative care.

 

A person could, for example, have an ultimately terminal condition but still chose to undergo treatments to proling life (e.g chemotherapy, radiation). That eould nor fsll undef "palliative care" because the aim is nit palliation but prolomging life.

 

Palliative care means comfort measures only and it is logical for that to have lower level of reimbursement.

 

The issue is the type of care involved not the patient's prognosis.

 

 

 

I see.

 

I've known numerous people however whom either weren't offered any life prolonging treatments or turned them down, with months remaining to live. They still required extensive medical attention to (somewhat) control their symptoms and reduce the pain. Towards the end, they had to be hospitalized, the last few months.

In such a case, it is my understanding the insurance wouldn't cover those expenses (pain medication, home nursing, ultimate hospital stays).

 

I understand this varies and I've also known other people who were switched to palliative care only a few days from death. The whole point of an insurance however, is to avoid those kind of gambles.

 

 

[Sheryl]

It is extremely rare for someone to be hospitalized in an acute care hospital for months for palliative care. In fact pretty much unknown nowadays. And not an appropriate use of an acute care hospital bed.

 

In the west there are hospices for this purpose. In Thailand it is usually done at home though a nursing home might also be an option. 

 

Costs are a tiny fraction of an acute care hospital. 

 

 

[ole1291]

16 hours ago, Sheryl said:

It is extremely rare for someone to be hospitalized in an acute care hospital for months for palliative care. In fact pretty much unknown nowadays. And not an appropriate use of an acute care hospital bed.

 

In the west there are hospices for this purpose. In Thailand it is usually done at home though a nursing home might also be an option. 

 

Costs are a tiny fraction of an acute care hospital. 

 

 

Then it is indeed different.

Thanks for clarifying those points. Very helpful.