Another Disappointing Encounter with the Thai Medical Establishment

[Mike Lister]

1 minute ago, BangkokHank said:

I am a resident here. Just not a "permanent" resident.

 

Who said that I think that the people at the clinic don't know that they charge foreigners more? The receptionist told ME that they practice dual pricing, so of course they are aware of it.

 

You also say to go with the flow and accept the things I cannot change. So first I have to see if I can change it. And if I can't, only then will I accept it - however reluctantly. But if nobody complains, then they certainly won't change.

Have at it, let us know how it works out for you.

[mikeymike100]

3 minutes ago, Mike Lister said:

Oh I'm well on track, you still don't seem to understand that using a private hospital is a choice, the cheaper option is to use the government hospital which you seem to wish to ignore in favour of the marble fountains in the foyer and the 42 inch flat screen. If that more expensive option, that you freely chose, has several pricing options, hey, you made that choice.

You are not on track!

I agree using a private hospital is a choice for everyone, I also agree Government hospitals are cheaper, but that is NOT what the thread is about and certainly not what my post was about!

To be clear I am saying at Private Hospitals , foreigners get charged more than Thais and I think it is unfair In a nutshell that's itt

[BritManToo]

29 minutes ago, Mike Lister said:

Why is it unfair, or do you mean you don't like it? You didn't contribute to the Social Security Fund and you aren't a member of the 30 baht scheme, why should you or anyone else receive benefit for something that you haven't contributed to or helped finance? If you were in the UK you would be the first to scream most likely if you read that foreign tourists were visiting, just to use the NHS for free, there is little difference.

I would be more than happy to pay the UK price of 700gbp for unlimited use of the Thai health service.

[Mike Lister]

1 minute ago, mikeymike100 said:

You are not on track!

I agree using a private hospital is a choice for everyone, I also agree Government hospitals are cheaper, but that is NOT what the thread is about and certainly not what my post was about!

To be clear I am saying at Private Hospitals , foreigners get charged more than Thais and I think it is unfair In a nutshell that's itt

Foreigners are charged more at SOME private hospitals but not all, the option to charge more exists but is not something that is enforced or written into law. It  is an option that exists which is at the discretion of the hospital as to how much they charge patients. I can think of two examples in the North where private and semi private (university based hospital) charge everyone the same price, one for inexpensive cataract surgery, the other across the board.

[Mike Lister]

Just now, BritManToo said:

I would be more than happy to pay the UK price of 700gbp for unlimited use of the Thai health service.

Me too, but that wasn't what I wrote. 

[Celsius]

26 minutes ago, Mike Lister said:

Yur a sad man Celsius.

 

I on the other hand think you are a person of good morals and a well intentioned individual.

 

However, your reply did not make much semse. As others have mentioned, this was a private clinic.

[BritManToo]

Just now, Mike Lister said:

Me too, but that wasn't what I wrote. 

I'm more concerned by the Thai private hospitals extorting unwary foreign tourists. In fact if I was a travel insurance company, I would exclude all treatment in Thai private hospitals from my policies just to teach the greedy bar stewards a lesson.

[Mike Lister]

1 minute ago, BritManToo said:

I'm more concerned by the Thai private hospitals extorting unwary foreign tourists. In fact if I was a travel insurance company, I would exclude all treatment in Thai private hospitals from my policies just to teach the greedy bar stewards a lesson.

Like you, I read these stories also but I have to wonder about some of them. Either the patient was in a seriously bad way when they were admitted or perhaps there is another angle, journalistic license perhaps!

[Sheryl]

15 minutes ago, Mike Lister said:

Oh I'm well on track, you still don't seem to understand that using a private hospital is a choice, the cheaper option is to use the government hospital which you seem to wish to ignore in favour of the marble fountains in the foyer and the 42 inch flat screen. If that more expensive option, that you freely chose, has several pricing options, hey, you made that choice.

 

I agree that using private facilities is a choice. And that government facilities are far, far less expensive (excluding opportunity costs and, for some people, travel costs). 

 

But I doubt any expats opt for private because of "marble fountains in the foyer and the 42 inch flat screen" ! (And there are private hospitals without anything like this e.g. the various no-frills non-profits). It is unfair to imply this. 

 

Those who opt for private facilities usually do so because  of things like (in no particular order):

 

- Ability to choose the doctor and availability of doctor credentials online

- Ability to make online appointment in advance

- English speaking

- Speed of service (which can be a difference of days, if needing to see a specialist)

- Convenience (e.g. less red tape, ease of navigating the place)

- Less crowding

- air con waiting areas with plenty of places to sit (in some government hospitals it is standing room only, non -a/c, packed like sardines and waiting for hours...)

- direct payment arrangements with insurers

-if being admitted: much better nurse-patient ratio; possible to stay without a friend/relative always  accompanying; more comfortable patient rooms

 

Now whether these factors are worth the cost, rather depends on the individual and their financial circumstances.  Also on whether one has a lot of time to spend getting medical care  -- for some people, time is in shorter supply than money, or effectively is money.

 

Lastly, the medical quality of both government and private options -- and the range of specialists available in each -- varies enormously depending on  where  one lives. 

 

I almost always use private, mainly because to I live 3 hours each way from Bangkok and the added cost in travel and hotels to use the large government hospitals more than outweighs the savings for most outpatient care (one whole trip just to make the appointment, at least one more another for the visit etc etc), and I have insurance for inpatient which will reimburse private, but not government, hospitals directly .  However if I lived in Bangkok, I would be much more inclined to use the after hours clinic at Chula and other major government hospitals for outpatient care because at that point the savings is meaningful. 

 

But I have used more local government facilities for some uncomplicated things, especially ones where I could go straight to the emergency room  e.g. like animal bites etc.

 

[Andre0720]

On 12/19/2023 at 10:44 AM, BangkokHank said:

A shopping mall near my home in a Bangkok suburb is currently undergoing a complete renovation. While walking around the mall a couple of weeks ago observing the work in progress, I spotted what I thought was a brilliant addition to the mall: A very large, modern looking health clinic. This is such a practical idea, because there are many health-related things that do not require the use of a hospital, such as blood tests, etc.

 

Yesterday I went back to the mall to check if the clinic was open, and it was. So I asked them what it would cost to have a fasting insulin test. The man working at the reception responded with, "We only recently opened, so we don't have our foreigner prices yet." Ha. Not a good start. I countered with, "So you have different prices for foreigners and Thais." He said yes. So I asked, "And the prices for foreigners is lower, right?" I was actually not so surprised when he answered that no, actually foreigners have to pay a little more. When I asked him why, he just mumbled something about "hospital policy". 

 

The actual prices were as follows: Price of the test (for foreigners): 420 baht. Plus a 250 baht hospital fee. Price for Thais: 350 baht (plus the hospital fee). Conclusion: The main benefit for me of having this conveniently located clinic just minutes away from my home is that now I don't have to go as far as I used to to get overcharged for medical care. I wonder why they feel the need to charge foreigners more for things? And I just hope that the other shops in the mall, like the supermarket, don't get any ideas from them.

Perhaps they think that foreigners have the privilege here to use medical facilities in Thailand, and forcing Thai people to queue behind them.

TIT....

[Celsius]

Yep. I always go for the best available option. I went to Medpark as well as Chula.

[Mike Lister]

10 minutes ago, Sheryl said:

 

I agree that using private facilities is a choice. And that government facilities are far, far less expensive (excluding opportunity costs and, for some people, travel costs). 

 

But I doubt any expats opt for private because of "marble fountains in the foyer and the 42 inch flat screen" ! (And there are private hospitals without anything like this e.g. the various no-frills non-profits). It is unfair to imply this. 

 

Those who opt for private facilities usually do so because  of things like (in no particular order):

 

- Ability to choose the doctor and availability of doctor credentials online

- Ability to make online appointment in advance

- English speaking

- Speed of service (which can be a difference of days, if needing to see a specialist)

- Convenience (e.g. less red tape, ease of navigating the place)

- Less crowding

- air con waiting areas with plenty of places to sit (in some government hospitals it is standing room only, non -a/c, packed like sardines and waiting for hours...)

- direct payment arrangements with insurers

-if being admitted: much better nurse-patient ratio; possible to stay without a friend/relative always  accompanying; more comfortable patient rooms

 

Now whether these factors are worth the cost, rather depends on the individual and their financial circumstances.  Also on whether one has a lot of time to spend getting medical care  -- for some people, time is in shorter supply than money, or effectively is money.

 

Lastly, the medical quality of both government and private options -- and the range of specialists available in each -- varies enormously depending on  where  one lives. 

 

I almost always use private, mainly because to I live 3 hours each way from Bangkok and the added cost in travel and hotels to use the large government hospitals more than outweighs the savings for most outpatient care (one whole trip just to make the appointment, at least one more another for the visit etc etc), and I have insurance for inpatient which will reimburse private, but not government, hospitals directly .  However if I lived in Bangkok, I would be much more inclined to use the after hours clinic at Chula and other major government hospitals for outpatient care because at that point the savings is meaningful. 

 

But I have used more local government facilities for some uncomplicated things, especially ones where I could go straight to the emergency room  e.g. like animal bites etc.

 

A fair and complete representation.

 

I think there is another set of reasons why foreigners don't use government hospitals, the main one being fear of having to navigate a foreign environment and secondly the appearance which typically doesn't match up to their expectations of what a hospital should look like. The reference to marble fountains in the foyer was of course tongue in cheek bit is also the business school reference for companies to be wary of!

 

I stepped on a nail last year and badly injured my foot so I went to the local government hospital. It's a fairly new building but it was chaotic and I was shown into the ER. Inside were around fifteen or twenty table/beds, each one occupied by ER patients in different stages of distress. There was patches and splatters of blood in various places on the floor and the sheets on the beds didn't appear to have been changed, some patients were whimpering from pain and several babies and children were screaming.. A single female doctor managed the whole thing, she appeared to be under 30. Despite the appearance, the process was efficient and effective but I don't know  how many Western tourists or newbies would have  tolerated the place, I think many would have run for the security of Bangkok Hospital, in a flash. Personally, I found the whole thing interesting and a great learning experience.

 

For me personally, having lived here for many years and having a reasonable handle on such things, my biggest reservation about using a government hospital is their use of student doctors which I think is the biggest risk that needs to be managed.

Edited December 21, 2023 by Mike Lister

[BritManToo]

21 minutes ago, Mike Lister said:

think there is another set of reasons why foreigners don't use government hospitals, the main one being fear of having to navigate a foreign environment and secondly the appearance which typically doesn't match up to their expectations of what a

Disagree,

The reason foreign tourists go to private hospitals is because that's where the ambulance takes them.

[Mike Lister]

1 minute ago, BritManToo said:

Disagree,

The reason foreign tourists go to private hospitals is because that's where the ambulance takes them.

Only a minority of patients to who visit hospitals are ambulatory, I've been dozens of times and never once been in an ambulance.

[BritManToo]

1 minute ago, Mike Lister said:

Only a minority of patients to who visit hospitals are ambulatory, I've been dozens of times and never once been in an ambulance.

But you're not a foreign tourist, you live here and have your own transport.

Edited December 21, 2023 by BritManToo

[jaideedave]

On 12/19/2023 at 12:47 PM, edwardflory said:

Most foreign people do not know that you can use a Thai Military Hospital. Many of the doctors were trained in US or UK, thus speak good English.

 

You have to register and get a hospital ID card ( free )- passport needed until registered, then use Hospital ID card at the hospital.  

 

Military hospitals are slightly more expensive than civilian government hospitals, WAY WAY WAY LESS expensive than private hospitals, you pay the same cost as Thai civilians using the hospital.

I use Queen Sirikit Naval hospital in Sattahip. I've had surgery there.Unfortunately I pay more as a resident foreigner by about 50% I believe.Its posted on the wall.There are 3 tiers of fees.

The Dr I see semi annually told me to get my meds at Fascino because as a foreigner I pay more.

At the end of the day its just a gov't hospital at a ton cheaper than private.My 5 minute Drs visit takes until noon after arriving at 8am.But they must wait for lab blood test results. I now don't go anywhere else. Do youself a big favour and avoid going into a ward.It was a horrible experience and I could hardly wait to get a private room of which there are very few.

 

 

 

[Mike Lister]

Just now, BritManToo said:

But you're not a foreign tourist!

I don't think my immigration status has anything to do with my visits to hospitals, people visit hospitals because they have a medical need, regardless of what their visa stamp says.

[Nonthaburi Boy]

On 12/19/2023 at 5:52 PM, Mike Lister said:

The government approved and published tiered pricing in hospitals about five years ago, there are four bands but they are not always used in all hospitals. it is at the discretion of each hospital.

 

The lowest band is a Thai national

The second an ASEAN resident

The third is a visitor from another country

The highest is a foreigner who lives here.

 

https://www.pacificprime.co.th/blog/dual-pricing-at-thai-public-hospitals-and-the-implications-on-foreigners/

 

Thanks for that link. I hadn’t realised that I might pay more on a non-taxpayer basis, so I’ll be more careful to ask about that in future and make sure. However, your summary doesn’t seem to match the article. According to the article a foreigner who works here pays considerably less than a tourist, and a foreigner who lives here does not pay more than a tourist. Is there another source for the tiers you quote? (Acknowledge that you say it is at the discretion of each hospital and also that the tiers referred to in the article may specifically be those for insurers - likely affecting your premiums too).

[spidermike007]

12 hours ago, Sluglord said:

 

Well, that's pretty much the definition of xenophobia.

 

I disagree. Xenophonia is when landlords will not rent to you. It is when you cannot get a long term visa. It is when restaurants refuse to seat you. It is when you are getting constant nasty looks on the street. I experienced that in Vietnam. Especially in the north, on my first visit 23 years ago. The youth were fine. It was the older folks. Cannot say I blame them. But it was not fun.

 

I do not get any of that here. Yes, we are treated as outsiders. So what? Means nothing to me.

[Mike Lister]

1 minute ago, Nonthaburi Boy said:

 

Thanks for that link. I hadn’t realised that I might pay more on a non-taxpayer basis, so I’ll be more careful to ask about that in future and make sure. However, your summary doesn’t seem to match the article. According to the article a foreigner who works here pays considerably less than a tourist, and a foreigner who lives here does not pay more than a tourist. Is there another source for the tiers you quote? (Acknowledge that you say it is at the discretion of each hospital and also that the tiers referred to in the article may specifically be those for insurers - likely affecting your premiums too).

I must admit I didn't read the article in full, I just searched for a link to support my statement and listed what I thought was the correct sequence in my post. I believe that foreigners who have work permits are classed in a similar group to other ASEAN residents. I am highly confident that resident expats (excluding work permit holders) are the highest group because I recall the angst amongst posters when the news was first released. I'll search further for more definitive confirmation.

[Sheryl]

1 hour ago, Mike Lister said:

 

 

For me personally, having lived here for many years and having a reasonable handle on such things, my biggest reservation about using a government hospital is their use of student doctors which I think is the biggest risk that needs to be managed.

 

Absolutely. Needed to be especially wary during the first months of the academic year (May - July) as at that point many of the "doctors" were still in medical school just a few months back and have almost nil experience. 

 

I have a family member who underwent complex spinal surgery at a government university hospital. Turns out the senior doctor in charge did not even enter the OR, the interns and residents were left totally on their own (I later found out he was altogether out of town). The result was excessive blood loss (needing multiple transfusions afterwards) and a hematoma pressing on the spinal cord which nearly paralyzed her for life. Further,  the staff lied about her condition and kept telling the senior doc by phone (and writing in the chart) that everything was fine when in fact she was numb from the waist down and could not stand up. I had to stage a virtual sit-in at the nurses' station two days in a row to finally get the senior doctor to come in (he hopped a plane in Chiang Mai once he knew the actual condition of the patient) following which he operated himself, luckily in time to avoid permanent paralysis.

 

There is a work-around for this issue, which is to utilize the "after hours" clinics that most government hospitals have. There, for anywhere from 250 - 500 baht extra, you can directly see a senior doctor.  

 

 

[jaideedave]

On 12/20/2023 at 9:44 AM, fondue zoo said:

 

They tried this on with me every visit to an ophthalmologist, white coat syndrome had my blood gushing out of every orifice according to their test(s). They got me to lie down for 20 minutes it somehow went higher. The looks on their faces, how can you still be conscious?  can you see through the red mist?  I got out of bed and did 3 star jumps (no lie), nope I'm good.  I was feeling extra saucy that day. They then insisted on a wheelchair, which I took because it looked like fun, knowing that every little thing was going to be on my bill.

 

I then actually paid attention to how they applied the cuff, and as someone who has been on the administering side an age ago realised that some staff do not get much training. 

Not all cuff sizes are the same, even if adjustable. Turns out they had mixed up the kids cuffs with those used for adults resulting in see-saw results. 

 

 

side note:  my lady ophthalmologist was a smoke show, hot dam, Dr Butternut.

 

They try that crap on me also. My bp is always high at the hospital. Years ago I needed a work related dental exam for a job application.I went to Pattaya Memorial, My bp was high as normal and they wouldn't let me see the dentist unless I saw a Dr first.I grabbed my papers and left. Went to a local clinic and done in 15 minutes.

Like you sometimes I overhear the nurses talking in whispers about if I'm going to make it out of the hospital without heart surgery. Laughable  really

[Sheryl]

4 hours ago, BritManToo said:

Disagree,

The reason foreign tourists go to private hospitals is because that's where the ambulance takes them.

 

In emergencies yes, often the case

 

But I think it is true that the appearance of government hospitals as well as the crowds and forms, signs etc usually  being in Thai  only is off-putting for most actual tourists. And very hard for them to navigate the red tape etc. (again, tourists -- expats are a whole other story). 

[Sheryl]

3 hours ago, Nonthaburi Boy said:

 

Thanks for that link. I hadn’t realised that I might pay more on a non-taxpayer basis, so I’ll be more careful to ask about that in future and make sure. However, your summary doesn’t seem to match the article. According to the article a foreigner who works here pays considerably less than a tourist, and a foreigner who lives here does not pay more than a tourist. Is there another source for the tiers you quote? (Acknowledge that you say it is at the discretion of each hospital and also that the tiers referred to in the article may specifically be those for insurers - likely affecting your premiums too).

Pay no attention to this link, it bears little to no relation to what government hospitals actually charge. 

 

In most cases the base charge (shown as charge for Thais) alone is much lower  than in the government hospitals have been charging for years. The pricing in the MoH booklet is utterly unrealistic and has been widely ignored accordingly.  The only relevant point -- for those who might assume otherwise -- is that government does officially endorse the idea of charging foreigners more for health care.

 

And only some hospitals bother to create different pricing tiers, for many hospitals it is simply not worth the trouble. You will encounter it mainly in areas where there is a large expat population. (Bangkok, Pattaya, CM etc).

 

In fact some (a few) small  upcountry government hospitals won't charge you at all because they so seldom treat anyone not covered by either the universal system of SS that they have not set up procedures to collect fees. 

 

[Mike Lister]

5 hours ago, BritManToo said:

But you're not a foreign tourist, you live here and have your own transport.

Having own transport or not is neither here nor there in this matter!

[jaideedave]

2 hours ago, Sheryl said:

 

In emergencies yes, often the case

 

But I think it is true that the appearance of government hospitals as well as the crowds and forms, signs etc usually  being in Thai  only is off-putting for most actual tourists. And very hard for them to navigate the red tape etc. (again, tourists -- expats are a whole other story). 

You are correct.A foreign tourist won't have a good result going to a gov't hospital in most cases.I only go yo Queen Sirikit hospital in Sattahip with my wife or at least a Thai speaker.You will be lost otherwise.I've been using them for a few years now.