Thai Hospital Which Doesn't Force Their Medicines

[junkofdavid2]

It appears that as a going practice here in Thailand, after you consult with a doctor in a hospital, the doctor doesn't let you see his prescription and hands it over to a hospital aid...

...who then whisks it to the hospital pharmacy where you then pay the bill complete with the oftentimes expensive medicines which you are therefore "forced" to buy from the hospital instead of from your favorite pharmacy who gives you a discount outside and/or the generic version. I tried to ask if I could just pay the hospital bill and get the prescription; well, they didn't say "no" but you can say there was some "resistance" and my Thai wasn't good enough to argue... so I finally just paid the full 3,000.

(Doctor's consultation and lab test... only 450... cheap! Medicines from hospital... 2,500+!!!). Note that this was from a supposedly "non-profit" Catholic hospital as it says on their website (Saint Louis).

Is there any hospital/doctor here who doesn't do this??

[joskydive]

No! They have a quota to fill for the medicines and get a % of the sale but you can refuse the medication and go and get it from your favourite pharmacy. I think it's part of their contract with the hospital!

At one time I went to Pattaya Memorial for something and everything was cheap until the Pharmacy bill came and that was just for Paracetomal. They wanted the charge 3,000 baht for it. Needless to say, I declined!!!!

[Heng]

Yes, you can decline, but you should tell your doctor from the get go, instead of making a big deal at the pharmacist's counter.

I've always just told them that my dad and uncle are both pharmacists, I'd rather give my business to them, and that's that. If you have a regular doctor, you only have to tell them once anyway. Well worth it.

[junkofdavid2]

How do you refuse the medication and buy outside... if you don't see the prescription at all until you've paid for both the bill together with the medicines???

[joskydive]

You can always ask what the medication is and write it down yourself or ask them to.

[junkofdavid2]

Will try that next time...

[Nowhereman60]

I go to Bumrungard and always tell my doctor I will buy my own medicine. Bumrungard charges like 50% more for the same medicine I get at my pharmacy. I also use TRICARE (retired army USA) and I always use a doctor who was trained and worked in the USA, this way I can have him write a prescription and I pay $3 for 90 day supply which I mail to TRICARE to fill and mail to me.

[skipvice]

I go to Bumrungard and always tell my doctor I will buy my own medicine. Bumrungard charges like 50% more for the same medicine I get at my pharmacy. I also use TRICARE (retired army USA) and I always use a doctor who was trained and worked in the USA, this way I can have him write a prescription and I pay $3 for 90 day supply which I mail to TRICARE to fill and mail to me.

I did not think tri-care will mail prescriptions to thailand, at least that is what they told me. so have you done it ? and how long does it take to get them in the mail?

Pharmacy Benefit

• Over the counter (OTC) medicine

purchases are not a covered benefit.

• You may be required to pay for

prescriptions from a pharmacy or provider,

and file for reimbursement through TRICARE.

• TMOP is authorized overseas, but requires

FPO/APO box & US licensed provider

are you using a post office box at justmag ?

Edited September 28, 2009 by skipvice

[Sheryl]

While all private hospitals make a significant profit through their pharmacies and thus prefer that patients get their medications there, hospitals differ considerably in how aggressive they are in trying to make that occur. And individual doctors differ in how they respond to the efforts of hospital administration in that regard.

The worst offender in my experience is Bumrungrad. I have had doctors there tell me frankly that there is a policy against writing out take-home prescriptions for patients and that they can get "in trouble" for doing so. Some deal with this by prescribing a very small quantity through the in-hospital pharmacy and quietly tell the patient to buy the rest outside (especially for a long term and costly drug). By contrast I find the doctors in Samitivej often take the initiative in recommending to patients that they get a drug on their own outside as a way to save money.

Regardless, no hospital has the right, legally or in terms of Thai Medical Council policy, to require you to buy your meds there nor does any doctor have the right not to tell you what medication s/he is prescribing.

There is more at stake here than money. You need to know what the plan of treatment is and the rationale for it and have a chance to ask questions -- e.g. side effects and contraindications of each medication and, this being Thailand where unnecessary "poly prescripton" (prescribing as many different drugs a spossible) is the norm, whether the drug is really necessary. If more than 1 thing is prescribed for the same condition there is an excellent chance that at least some are not necessary. For example, vitamins, paracetemol, and other things providing only symptomatic relief (for symptoms you may not even have or which might not be botheriong you that much) are often added on top of an antiobiotic. ANd, antibiotics are over-prescribed. This is not always or only done for reasons of revenue; there is a widespread misperception among the Thai public that many medications equals better care and many doctors assume this is what patients want and expect. Indeed, I have had hospital staff become deeply embarassed and upset to have to tell me that "only one medicine!" had been ordered since in their view this was a sign of poor treatment which the patient was expected to resent.

OP, you need to be much more assertive with youtr doctors (politely, of course, but firmly). you can make that process a lot easier on yourslef if you do some reserach first and try to select doctors who have been trained or practiced in the West as they will have been more exposed to this type of patient behavior.

Bottom line -- if the doctor will not explain your treatment to you fully, change doctors.

P.S. There are some medications which are restricted and cannot be bought in an outside pharmacy, so one of the questions you ask about the medications being recommended is whether they can be bought at a regular pharmacy.

[junkofdavid2]

So that they don't "lose face" if I say it's cheaper outside, I'll just say my girlfriend's a pharmacist and I can get the medicines for free...

[jfchandler]

Junk, I had the same thing happen at St. Louis recently, about 500 baht for the visit and consult, and then close to 2500 baht for a single prescribed medicine...in quantity...

I didn't know what the price for the med would be at this hospital pharmacy, but I wanted to know, so I waited until I went to the cashier when I finally saw the bill, and the portion related to the medicine (which was higher than the price I already knew I could get at my local pharmacy). At that point, I told the cashier... medicine mai ow.... So she re-did the bill to exclude the medicine, and I paid it. In a good point, no grief from them about excluding the medicine or redoing the bill for me.

One thing that always surprises me, though... When I go to "check out" after an outpatient medical visit, the BKK hospitals seem to always expect me to pay the bill without providing me with a detailed, itemized billing statement showing what services/items were provided (including any prescribed medicines) and at what cost. I always have to ask for that (and I do get it). But I rarely recall ever being given that voluntarily prior to paying my bill.

[Milo]

For most/minor ailments the Pharmacist can diagnose/treat you. I've never once visited hospital in the 7yrs I've been here, our local guy treated my duodenal ulcers that the NHS was insisting on a biopsy for back in the UK. When 70% of stomach ulcers are now proven to be curable with antibiotics why go to all the bother & expense? My thought was pop the pills, if they didn't work THEN go for the laser treatment! We all know about over/misuse of antibiotics but to take them once a year could hardly fall into this category?

My uncle was a pharmacist and used to go nuts about Doctors' constant and consistent mistreatment of ailments. Why go to the hospital for a minor illness? Alternatively if you know it's something serious pay your money first time around for peace of mind & obtain repeat prescriptions from your pharmacist at a reasonable rate.

In my opinion any single visit to the hospital (unless you've been involved in an RTA) must be minor by definition. The Thais crack me up, going to hospital for a cold and proudly brandishing seven different medications on returning! Can you explain to them it'll be gone in a week anyway?? At least the missus has learned, down a few hot toddies (whisky, lemon, honey, cloves, cinnamon stick, hot water), wrap up warm, sweat it out overnight and you'll feel right as ninepence in the morning. If not, repeat treatment until too maow to care!!

[lopburi3]

For 'detail' bill it is an extra step as most customers do not need or want it. At Vejthani they enter requirement into computer program so if you always need it you will always get it (unless perhaps if the cashier is asleep) and the language you wish it to be in.

As for medication prices - they are higher at private hospitals - and can be a lot higher. But most doctors will freely provide advise to buy elsewhere if they believe it is worthwhile and quality will be the same. But in some cases it may be worth buying there; especially up country. It is likely to be real, fresh and properly stored. All three are sometimes suspect in outside stores - especially away from central distribution sources.

[Sheryl]

For most/minor ailments the Pharmacist can diagnose/treat you.

Two points:

1. While grade one Thai pharmacists are well trained, they are not who is behind the counter in your average local pharmacy. Indeed the people who are behind the counter are often so uninformed as to be unable to recognize drugs by generic name. In many provincial towns there will not be more than one outlet with a "real" pharmacist regularly on duty. be sure to take the time to identify such places and avoid taking advice from the average pharmacy sales person.

2. (Real) pharmacists are trained to know the conditions that medicatiosn treat, how they work, contraindications, side effects, interactions. They are usually much more knowledgable than doctors with regard to these last 3. They are not, however, trained in diagnosis. If you are reasonably sure what is wriong with yoy, can certainly ask them what the usual treatments are. But do not expect them to be able to diagnose what it is that ails you. They are nto trained for this.

[scorecard]

Junk, I had the same thing happen at St. Louis recently, about 500 baht for the visit and consult, and then close to 2500 baht for a single prescribed medicine...in quantity...

I didn't know what the price for the med would be at this hospital pharmacy, but I wanted to know, so I waited until I went to the cashier when I finally saw the bill, and the portion related to the medicine (which was higher than the price I already knew I could get at my local pharmacy). At that point, I told the cashier... medicine mai ow.... So she re-did the bill to exclude the medicine, and I paid it. In a good point, no grief from them about excluding the medicine or redoing the bill for me.

One thing that always surprises me, though... When I go to "check out" after an outpatient medical visit, the BKK hospitals seem to always expect me to pay the bill without providing me with a detailed, itemized billing statement showing what services/items were provided (including any prescribed medicines) and at what cost. I always have to ask for that (and I do get it). But I rarely recall ever being given that voluntarily prior to paying my bill.

I concur about the hospital in Convent Road. I stopped going there after they botched an operation on my hnad.

However I went through several 'incidents' whereby I had to simply refuse to pay until they showed me a bill with full details, not just a spoken total amount.

A couple of times the cashier called the supervisor who abruptly told me 'that's not our precedure here'. I just said, "no bill, no payment". and sat down in the waiting area. Didn't take long for the detailed bill to be delivered to the waiting area.

t down and stood my ground and saidSeveral times the cahsirs

[Finlaco]

This is Thailand and things are done Thai way

I find that a smile and repeating myself (usually three times) will ensure that the Doctor gives me the prescription.

I understand that the Doctor has a sales quota to fill, and when i make it obvious (politely) that i am willing to sit in his office for the next 30 minutes repeating my polite request for the prescription, the Doctor will hand it over. Its a game. Played politely, you will always win.

I suggest you don't waste time explaining why you want the prescription cos he already knows why.

Just do it politely, and in effect, let him chose whether to give you the prescription now, on in 30 minutes times.

I know its not nice. I prefer non hassles, but this is Thailand.

[SurfRider]

I arrived one day at a very well known up-scale Than hospital with a Staph infection on my foot at leg.

The Doc wanted to admit me to the hospital for five days and administer two strong antibiotic drips per day.

I told him that was unacceptable and asked for the alternative.

It's a long sordid tale, so I'll skip to the bottom line.

He prescribed three weeks of a very strong Cipro antibiotic which I could buy at Fascino for less than 1/3 of the price of the imported product that the hospital pharmacy offered.

I asked him if there was any problem with buying the meds outside -- he just stared at me -- I asked again and his response was "That's not good for the hospital"

Again to the bottom line -- By managing the situation myself, the total cost was around 5000 Baht.

After running the numbers on what the Doc had originally suggested, it was clear that I would have spent between 50,000 and 70,000 Baht if I had "gone with the flow", so to speak . . .

.

[jfchandler]

Scorecard, do you mean St. Louis Hospital, or BNH Hospital???

St. Louis is on Sathorn Road. BNH is on Soi Convent...

I concur about the hospital in Convent Road. I stopped going there after they botched an operation on my hnad.

[SurfRider]

"a "real" pharmacist regularly on duty. be sure to take the time to identify such places and avoid taking advice from the average pharmacy sales person."

That's an interesting point!

I've often wondered how you tell the difference between a "REAL" Pharmacist and the drone clerk wearing a name-plate that says "PHARMACIST"? . . .

Any suggestions?

.

[hazz]

The problem is does the hospital/doctor see you as a revenue stream or as a patent.

Clearly its dangerous to use a hospital/doctor that see's you as a revenue stream and their attitude to you about buying your medicine independently is very revealing. if they are intent to bleed you of money in out patients, just imagine what will happen when they have you in one of their beds.

Personally I make it clear when I go into a hospital that I will be buying my own drugs and not using their pharmacy. To the doctor I explain that where I come from we don't like to mix medicines and like to know what each is for. So far I have not had any problems. Plus a good pharmacist will have a better understanding of how to medicate a diagnosed condition than a non-specialist doctor.

Should anything medically serious happen to me I cannot think of a hospital in bangkok where there is a high change of me meeting a competent doctor, rather than a medically qualified salesman, this bothers me.

[Tywais]

I've often wondered how you tell the difference between a "REAL" Pharmacist and the drone clerk wearing a name-plate that says "PHARMACIST"? . . .

Any suggestions?

.

Perhaps Google a prescription drug then ask the "Pharmacist" if it has any side effects. If they don't know or don't know how to look it up, probably not a licensed one.

My recent experience: I've been seeing a cardiologist regarding hypertension and cholesterol issues and just did a stress test. As he was jotting down notes for the meds I need to continue on he hinted on getting them outside. To be clear that I heard right, I asked if I can get them at an outside pharmacy and he said no problems.

However a new med added was Aspent, which is medical grade Aspirin and he asked me to get that at the hospital pharmacy. Considering the cost was only a couple hundred baht for that I had no problems with that. That suggests that hospital management does have some requirements of the doctors to obtain meds at the hospital pharmacy.

Another thing, he just wrote what I needed on a piece of paper rather then a prescription with no signature. Asked him will a pharmacy give me this without a formal prescription - he gave a big smile and said "this is Thailand, no problem".

Bottom line, some doctors are sympathetic to patients and costs regardless of hospital policy.

[CWMcMurray]

I had not thought about this issue in the past... just walk over to the cashier and pay the bill.

I will most definately be requesting prescriptions to buy medications outside the hospital from now on.

[nidhogg]

I had not thought about this issue in the past... just walk over to the cashier and pay the bill.

I will most definately be requesting prescriptions to buy medications outside the hospital from now on.

Its worth remembering that counterfit drugs are not unheard of in Thailand, and that there are a number of questions about the efficacy of generic drugs made in Thailand (and in other less developed countries that get imported into Thailand).

caveat emptor.

[SurfRider]

"Its worth remembering that counterfit drugs are not unheard of in Thailand, and that there are a number of questions about the efficacy of generic drugs"

There was a study done on those issues a couple of years ago. Sorry I can't locate the link right now, but it found that those occurrences were very low.

What WAS discovered is that the meds are not always stored properly and, due to the heat and humidity in Siam, some of the small so-called "pharmacies" occasionally had stock that was questionable.

There is a pharmaceutical manufacturer in Bangkok named Berlin. They have been in business since 1932 and manufacture quality meds that meet the international standards of the well known imported names. I have asked many doctors about Berlin and received only positive comments and approval of their meds.

http://www.berlinpharm.com/index.htm

Fascino is also a quality reputable pharmacy chain with many branches.

If you stay with FASCINO for quality and BERLIN for low cost meds-- IMHO, you'll be safe and satisfied.

http://www.thaivisa.com/forum/Fascino-Phar...Nua-t92305.html

.

[Sheryl]

"Its worth remembering that counterfit drugs are not unheard of in Thailand, and that there are a number of questions about the efficacy of generic drugs"

There was a study done on those issues a couple of years ago. Sorry I can't locate the link right now, but it found that those occurrences were very low.

What WAS discovered is that the meds are not always stored properly and, due to the heat and humidity in Siam, some of the small so-called "pharmacies" occasionally had stock that was questionable.

That's correct. The quality of drugs produced in Thailand is comparatively good.

I personally have no hesitation about buying Thai generic equivalents.

But the storage aspect needs to be considered, especially in upcountry pharmacies. Thiws probably will apply equally to imported brand name drugs. Buy only from a large air-conditioned pharmacy that does a high volume of business, and personally check the expiration dates.

reason for the "high volume of business" criteria is that they will then likely get their drugs direct from manufacturer or distributror whereas smaller shops might use another middle man in which case, even if their premises are air conditioned, that of the place that supplied them might not be.

The only fakes I have heard of are preparations not legal to sell over the counter (e.g. Viagra) which some pharmacies openly sell, these are apparently often fake. (Maybe that's the loophole that let's the shops openly sell these restricted drugs?).

Fake anti-malarials have been a problem along the Thai-Cambodian border, mopstly the Cambodian side, but not thought to originate from Thailand.

For sure you will not run into counterfeit generic products as there is no profit to be made from that. Counterfeiters go for brand name drugs whose prices they can undercut and still make a large profit.

[Sheryl]

"a "real" pharmacist regularly on duty. be sure to take the time to identify such places and avoid taking advice from the average pharmacy sales person."

That's an interesting point!

I've often wondered how you tell the difference between a "REAL" Pharmacist and the drone clerk wearing a name-plate that says "PHARMACIST"? . . .

Any suggestions?

.

In my experience the ones wearing white coats and name tags with the title Pharmacist are indeed pharmacists, which is not to say that there couldn't be imposters out there. I just haven't encountered it. it's the folks in no white coat, or white coat without name tag or title or title other than Pharmacist (note that "pharmacy assistant" is entirely different!) who are clueless.

But if in doubt, ask for whatever it is you need by generic name. Barring really common things like antibiotics, the non-pharmacists won't have a clue. A real pharmacist will recognize virtually any drug by its generic name.

Another good one (assuming they speak English) is to ask what the contraindications. Only the "real" pharamcists will even un derstand the question.

[hhgz]

"t appears that as a going practice here in Thailand, after you consult with a doctor in a hospital, the doctor doesn't let you see his prescription and hands it over to a hospital aid who then whisks it to the hospital pharmacy...you are therefore "forced" to buy from the hospital...Is there any hospital/doctor here who doesn't do this??"

Of course, but you need to do something very extraordinary: YOU need to open your mouth and say something, rather than sit there like a bump on a bar stool. YOU need to take responsibility for your health care. After the prescription is written, YOU immediately (not the next day, after you already bought the medication form the hospital pharmacy) tell the doctor that YOU want to fill the prescription yourself. It is really that simple. But, as I mentioned earlier, it is up to YOU.

[twschw]

Bumrungrad has never made me get my expensive and hard to come by meds there. In fact the doctor was the one who suggested getting them else where and where to find them. Just lucky to pick this doctor I guess.

[SurfRider]

"after you consult with a doctor in a hospital, the doctor doesn't let you see his prescription and hands it over to a hospital aid who then whisks it to the hospital pharmacy"

At the hospital that I go to, the Doc simply punches the scrip into the computer and the meds are waiting for you when you go to the cashier to settle up.

In one case, I had told the Doc that I would buy the meds outside and I personally wrote down the specs so I would have the proper names and dosage.

He apparently ordered the meds via his computer anyway and the cashier attempted to charge me for them. I told her that I hadn't ordered the meds and refused to pay for them -- she took them off the bill.

.

.

[nidhogg]

"Its worth remembering that counterfit drugs are not unheard of in Thailand, and that there are a number of questions about the efficacy of generic drugs"

There was a study done on those issues a couple of years ago. Sorry I can't locate the link right now, but it found that those occurrences were very low.

What WAS discovered is that the meds are not always stored properly and, due to the heat and humidity in Siam, some of the small so-called "pharmacies" occasionally had stock that was questionable.

That's correct. The quality of drugs produced in Thailand is comparatively good.

A simple search on GPO-Vir will show you that that statement is questionable at best.