What Do Isaan People Do For Health Insurance?

[Svenn]

Many Isaan people make only 3,000 baht a month, yet that figure seems to be the minumum for insurance at least for what I've found on thaivisa. My gf just has like 30,000 saved in the bank for health, she says they just live with insecurity. So when the doctor says grandma needs some fancy heart surgery, they just tell her 'time do die'?!

My gf and I are in mid-twenties, but I still don't like the idea of not having her insured more completely, are there cheaper alternatives? I mean, what would 1000 baht a month get you?

[citizen33]

Many Isaan people make only 3,000 baht a month, yet that figure seems to be the minumum for insurance at least for what I've found on thaivisa. My gf just has like 30,000 saved in the bank for health, she says they just live with insecurity. So when the doctor says grandma needs some fancy heart surgery, they just tell her 'time do die'?!

My gf and I are in mid-twenties, but I still don't like the idea of not having her insured more completely, are there cheaper alternatives? I mean, what would 1000 baht a month get you?

The main options for ordinary Isaan people are in the public health care system. The two schemes covering the biggest groups are (a) the free universal coverage gold card (previously known as the 30 baht progamme) and (b ) the social security scheme - normally based on employment-related contributions but which can be carried on for members who move out of work (at about 450 baht per month). As far as I can see few Isaan people have private health insurance (a few universities and companies now have this). Quite a lot of people in the UC scheme pay out-of-pocket for some treatments (i.e. go to private clinics) because they have doubts about the quality of free care. However, in theory both these public schemes would cover heart surgery, if a referral is made. There is a good recent thread on the SSS in the Insurance section.

Edited September 13, 2008 by citizen33

[Heng]

Pretty good summary above. A sad addendum would be that many do just accept death, and many resort to non-scientific medicine: herbal medicine, religion related 'treatments,' etc.

[rockyysdt]

(b ) the social security scheme - normally based on employment-related contributions but which can be carried on for members who move out of work (at about 450 baht per month).

Can you get onto this one if you never had employment related contributions?

[Svenn]

Many Isaan people make only 3,000 baht a month, yet that figure seems to be the minumum for insurance at least for what I've found on thaivisa. My gf just has like 30,000 saved in the bank for health, she says they just live with insecurity. So when the doctor says grandma needs some fancy heart surgery, they just tell her 'time do die'?!

My gf and I are in mid-twenties, but I still don't like the idea of not having her insured more completely, are there cheaper alternatives? I mean, what would 1000 baht a month get you?

The main options for ordinary Isaan people are in the public health care system. The two schemes covering the biggest groups are (a) the free universal coverage gold card (previously known as the 30 baht progamme) and (b ) the social security scheme - normally based on employment-related contributions but which can be carried on for members who move out of work (at about 450 baht per month). As far as I can see few Isaan people have private health insurance (a few universities and companies now have this). Quite a lot of people in the UC scheme pay out-of-pocket for some treatments (i.e. go to private clinics) because they have doubts about the quality of free care. However, in theory both these public schemes would cover heart surgery, if a referral is made. There is a good recent thread on the SSS in the Insurance section.

Thanks for the sum. I'm not finding any info on the 'gold card' scheme, and the sss one is apparantly only if she was employed at specific places? I'm looking for a plan just for someone coming in off the street. 450 baht is a good figure.

[ballbreaker]

You could contact BUPA Thailand or search for other such providers on the internet or insurance forum this web site and then contact for quote on coverage you desire. I pay around 23k baht per year for 500k baht coverage per illness for my age group (I'm 59). It only covers in-patient care which is what I chose for coverage. Someone younger will pay less.

Edited September 14, 2008 by ballbreaker

[citizen33]

The gold card scheme is administered by the National Health Security Office (In Thai for short saw-baw-saw-chaw - SBSC).

http://www.nhso.go.th/NHSOFront/FrontWebIndexAction.do

(Thai only I'm afraid- but your GF could read this).

She needs to present for registration with her house registration document, and can then obtain a card. This can only be done in the area where you live (i.e. you cannot register in Bangkok with a Khorat house registration). I am out of date about where you register. In the past registration took place in in the Health Insurance Division of the Provincial Health Office but now there are 13 regional offices of the NHSO (4 in Isaan at Khorat, Khon Kaen, Ubon and Sakon Nakhon). I don't know if nowadays intending members have to go there, to the provincial health office or the local hospital. There may be something under the individual regional offices' websites.

http://www.nhso.go.th/NHSOFront/SelectView...000000000000044

I think that unfortunately you must work at some point to join the SSS. While working you pay 5% of your income (up to 750 baht per month maximum) and it drops to less than 450 baht for people out of employment.

Edited September 14, 2008 by citizen33

[ballbreaker]

The gold card is issued by the Tambol or Amphor office, not sure which, where you live and are on house paper.

I have one comment about the gold card and in general the slow process of government health care. Regardless of health problem you have to deal with local Tambol or Amphor doctors before getting referred to province hospital. If your lucky and the local doctors are good then diagnosis will be done locally and you will not need referral.

In my wifes case she spent a month going back and forth to local hospital and getting different pills without doing much more than a blood test. The last time they once again gave her more pills to try and come back in two weeks. I said screw this and took her to a private hospital (St. Marys) in Korat. It took about 2 hours and they found the cause of her problems and it would require surgery. The surgery was scheduled that same week at St. Marys but all followup treatment was done at the government hospital (Maharat) in Korat because surgeon also worked at Maharat and said it would be covered by gold card.

While receiving followup treatment at Maharat the wife found out it would have taken 3 months before the surgery could have been done at Maharat. All this would have been covered by the gold card but it doesn't seem to carry much priority. Another example: she needed CT scan done but it would require her returning to Maharat everyday until she could be fitted into schedule and most likely would take a month but if she checked into the hospital it at our expense it would be scheduled in a few days time instead. CT scan was covered by gold card and we paid for private room to jump the que.

In my wifes case it would have been extremely expensive for the followup care in a private hospital but the gold card picked cost up totally in government hospital. I would say have both gold card and private insurance and then judge when to use.

[jay-uk]

Gold card scheme should be renamed "tin card scheme" as it is worth little more than this. It is the poorest of health care cover and cannot be rellied on by Thais for anything major which may occur. My wife's uncle had a brain tumor which was operable by all accounts and unfortunately as he only had the so called gold card doctors kept moving him from gov: hospital to hospital several times over without any surgeons or consultants taking time to see him. Excuse after excuse that no surgeons were available to operate led to him returning home eventually for a few months and dying in his village with only family to care for him until his passing. No one had the money to pay for private treatment and it was a sad loss which shows the need for cover if at all possible through someone like BUPA for us farangs but rarely afforded by rural Thais. Even if you get BUPA cover there is a cut-off when I last checked over 70 years of age with escalating premiums so beyond 70+ most could not afford cover even if they are foreigners or Thai. Its a sorry existance for anyone who gets seriously ill if you have no money.

Edited September 14, 2008 by jay-uk

[prakhonchai nick]

The gold card is usually issued by the hospital nearest to where you live. Only need to take the House registration Book.

Service at Government Hospitals is generally poor, with overworked and many under-qualified doctors. The better doctors also run local clinics, so they generally work from 7am to 8pm 7 days a week. Not surprising they frequently mis-diagnose.

But I suppose for the Thai people it is better than nothing, even if they are only prescribed paracetamol for a heart condition!

Farangs can use the government hospitals, but they must pay (usually cheap however) OK in the main for accidents rather than sickness.

[Tim207]

Many Isaan people make only 3,000 baht a month, yet that figure seems to be the minumum for insurance at least for what I've found on thaivisa. My gf just has like 30,000 saved in the bank for health, she says they just live with insecurity. So when the doctor says grandma needs some fancy heart surgery, they just tell her 'time do die'?!

My gf and I are in mid-twenties, but I still don't like the idea of not having her insured more completely, are there cheaper alternatives? I mean, what would 1000 baht a month get you?

Well Sven, I took the time to dig around and find a link that I had saved from someone else's post some time back. I posted it here, but that post has since disapeared. I guess it was objectionable for some reason. It sure would be nice if whoever found it objectionable could have the curtesy to let me know why it was removed so that I will not waste my time in the future making posts that will be deleted.

[citizen33]

The gold card is usually issued by the hospital nearest to where you live. Only need to take the House registration Book.

Service at Government Hospitals is generally poor, with overworked and many under-qualified doctors. The better doctors also run local clinics, so they generally work from 7am to 8pm 7 days a week. Not surprising they frequently mis-diagnose.

But I suppose for the Thai people it is better than nothing, even if they are only prescribed paracetamol for a heart condition!

Farangs can use the government hospitals, but they must pay (usually cheap however) OK in the main for accidents rather than sickness.

I don't disagree with the earlier comments about variable quality, but people need to appreciate the difference between a community hospital (i.e. district/amphur) and a provincial or regional public hospital. The regional hospitals are at Khon Kaen, Ubon and Khorat. A community hospital has very basic facilities and anybody with a serious problem is looking to get referred on to tertiary services. The difficulty is that in the past referrals have sometimes been delayed because of perverse incentives to keep money in the community hospitals. If you are an expat and paying privately, and do not want to go to Bangkok, one of the regional public hospitals is actually your best option. As I keep saying, the University hospital in Khon Kaen is thought by most who know to be the best in Isaan. The private hospitals in Isaan are of variable quality and do not have the same technical facilities as say the University hospital, although they often do have good specialists (working part time away from their appointment in a public hospital). I sense that many of our North American friends in particular labour under the mistaken belief that private is always best.

Edited September 16, 2008 by citizen33

[Issangeorge]

"I sense that many of our North American friends in particular labour under the mistaken belief that private is always best." I think you mean American friends and perhaps Mexican, in Canada we have very few private hospitals and those we have usually specialize in one thing, such as hernia operations. Although there are some Canadians from the extreme right who think private is best. Issangeorge.

[citizen33]

"I sense that many of our North American friends in particular labour under the mistaken belief that private is always best." I think you mean American friends and perhaps Mexican, in Canada we have very few private hospitals and those we have usually specialize in one thing, such as hernia operations. Although there are some Canadians from the extreme right who think private is best. Issangeorge.

Yes, you are right. Canada is virtually unique in prohibiting private health insurance for (core) medically necessary services, at least before the Chaoulli case in Quebec clouded the issue, and Canadians - perhaps outside Alberta - are less enthusiastic about private health care. The only nitpick I have is that most hospitals are independent (so that technically health care is publicly financed but privately provided) - even if not-for-profit - which is different from the Thai system or a system like the UK. But, you are right that Canadians should be excluded from my criticism.

Edited September 16, 2008 by citizen33

[gpdjohn]

I sense that many of our North American friends in particular labour under the mistaken belief that private is always best.

There is no such thing as public health care in the US. ( maybe only on a indian reservation ) Everything is private and extremely expensive, even the county hospitals will charge you if they know you can pay.

Most Americans have no idea what PHC is, and have normally only heard about it through friends /family who live in the EU or Canada, but it is a big selling item always in elections.