Thinktank Says Thai Hospitals Overcharge For Medicine

[silk]

Why don't more foreigners who live here permanently use public hospitals? They are not as luxurious as the private ones, but the medical standard is mostly good and the prices of medicines often lower than in the pharmacies. The private ones, although better equipped, will often give you the treatment that is the most profitable to them, not necessarily what is the most useful for the patient.

I think the article is not about private hospitals, they do not get re-imboursed by the thai social system, they get their fees from the patient or from the insurance of the patient (any country if properly covered - thais with private insurance included)

To me it seems that the article is about government hospitals, providing treatment and medication, who are charging more than the the actual costs, which they provide to the government social insurance to be paid back. If this is the case, it is understandable that it has to be investigated and actions have to be taken to reduce these costs for the good of this country.

[moskito]

Expensive medicine AND lazy doctors! Paid yesterday evening in a Pharmacy 15.-BAHT for the same medicine they gave me in Phuket International three weeks ago for 1300.-Baht.

not much better Phuket Bangkok, one pay for just a handshake 1500.-Baht. They once gave me a cream for 960,-Baht wich u can find in a normal Pharmacy for much less than 100.-Baht.

When it comes to doctors in Thailand I get the Horror. Hope you never really nead one. They are maybe good in Operations and Plastic Surgery but I never met some selfcalled doc here which is educated like a Singaporean or European Doc. You just get the feeling they are HiSo

[robertson468]

<br>LOL, i am not sure if the article is about gov hospitals or private.<br>Bangkok Hospital charges 300% more for the medicine then any other pharmacy<br>Pattaya Memorial charges 200% then an expensive pharmacy<br><br>This is why when you go see doctor with sore throat you come out with 10 different tablets and your doctors fee is 600 but your medicine is 1500 baht.<br>

<br><br>On Koh Samui we have Bangkok Hospital, Bandon Hospital, Thai International Hospital and the Government Hospital.  Bangkok is by far the most expensive, but does provide a 5* service, although having said that, one can pay for a very reasonable private ward in the Government Hospital.  In fact the Bangkok Hospital in Phuket is less expensive than the Bangkok Hospital on Koh Samui, but one might rationalise that by saying there is a higher patient ration at Phuket.  It would be interesting to know how this compares to other Countries in Asia?  Anyone have any stats?<br>

[SoftWater]

[what is up with the crap editor? Admin please sort it out]

I've had a lot of experience of hospitals and clinics both in Bangkok and outside - mostly because I have two toddlers, but also on a few occassions for myself and of course my wife during both pregnancies. My father-in-law also had a triple-heart by pass at the hospital at Victory monument (forgot the name).

Some of what has been said above rings true. Of course, the hospital pharmacy is more expensive, for reasons 'geriatrickid' nicely elucidated early in this thread and the fact that they generally use brand name drugs rather than generics.However, I have many times had doctors who told me not to get the drugs from the hospital, and simply wrote down the name for me to get myself because it is cheaper elsewhere. This has happened to me at BNH in Bangkok, St.Louis and Chulalongkorn hospital. The only hospital where I feel I was systematically ripped off and would never go to again is the so-called 'internationally-acclaimed' Bamrungrad.

Similarly, I have had nurses tell me not to see Dr X, see Dr Y instead because the 'doctor's charges' are not the same for each doctor (generally, you will pay more for those called Ajarn... rather than jus plaiin 'Dr' I believe).

Every 'clinic' I've ever been too has been a waste of time, with doctors apparently knowing little more than myself, and in every case never prescribing a treatment that solved the problem. They will usually prescribe or sell you generic drugs, but I know from experience with my kids that 5 times out of ten these will either be wrongly prescribed or ineffective. The only good clinic I've ever been to was one in which the doctor was moonlighting from chulalongkorn hospital. If I'd gone to see here there it would have cost me a third of the price (but you'd have to wait five times as long, it is true). Generally, my advice is stay out of clinics unless all you're after is a medical certificate.

My father-in-laws triple by-pass was also instructive. This was the deal: he could go on a 6-month waiting list on the 30-baht medical care scheme, or they could slot himin 'after hours' (=after 4pm) if we paid 70,000 baht. For that price, you're paying for the theatre, the surgeon, the nurses and all the equipment and drugs. We had to find twenty people to donate blood to replace the blood in the hospitals blood bank because they couldn't authorise the blood use unless it was met with a substitution (I kid you not, that is what they told us). I'd point out, in case anyone is getting the wrong side of the story that 70,000 baht (was then) merely a 1000 pounds sterling - for a triple heart bypass - that is incredible value for money (if you've got it). And while the hospital wards were something out of a Dickensian nightmare, the operation was a complete success and I doubt you'd find better value anywhere.

The moral of this longer than intended post is: the hospitals are generally the best place to get good treatment and good drugs. If you can afford it, I wouldn't worry about the fact that Somchai is selling knock-off identical pharmaceuticals down the soi for a tenth of the price. If you can't afford it, then you might want to shop around. If you're in BKK, go to Chulalongkorn hospital for just about any medical problem and you will get good treatment and good prices. You might have to wait a bit, and the admin staff are the rudest dragons from hel_l, but the doctors are great. If you don't like waiting, go to either BNH or St. Louis, tho' the latter is cheaper, the doctors competence does vary somewhat.

Edited July 16, 2010 by SoftWater

[featography]

<BR>Bangkok Hospital Phuket was going to charge me about twice the price of my local pharmacy for the same drug, outpatient. I got a bit angry with the doctor there as well. I guess Thais never question a doctor. She was a bit taken aback by my questioning her. And then got a bit rude to me, which doesn't fly with an American that is taught to ask questions of their doctor and be informed. At that point I told her to give me all the test results, paid the bill and never went back there.<BR>

<BR><BR><BR>My beliefs exactly. True too, Thai never question doctors. Doctors have the hight education, deal 90% with the sub educated populace, have that class distinction above them, and dont like  being questioned, or disputed. My wife has gone from horrified to embarrassed over the years, when I ask the questions of the doctors, as you and I have been taught to do in US. Shocked and disbeliving when I tell her our doctors advise us to ask for 2nd and or 3rd opinions. They dont want to make a mistake, and want another doctor to validate their prognosis. Together, you, I and hopefuly other farang will do our little part to change the Thai attitude. Argue or fight with us as they will, make no mistake about it, they ARE listening and learning the western way, and discreetly changing. Hang in there Bro.

[SoftWater]

<BR>Bangkok Hospital Phuket was going to charge me about twice the price of my local pharmacy for the same drug, outpatient. I got a bit angry with the doctor there as well. I guess Thais never question a doctor. She was a bit taken aback by my questioning her. And then got a bit rude to me, which doesn't fly with an American that is taught to ask questions of their doctor and be informed. At that point I told her to give me all the test results, paid the bill and never went back there.<BR>

<BR><BR><BR>My beliefs exactly. True too, Thai never question doctors. Doctors have the hight education, deal 90% with the sub educated populace, have that class distinction above them, and dont like  being questioned, or disputed. My wife has gone from horrified to embarrassed over the years, when I ask the questions of the doctors, as you and I have been taught to do in US. Shocked and disbeliving when I tell her our doctors advise us to ask for 2nd and or 3rd opinions. They dont want to make a mistake, and want another doctor to validate their prognosis. Together, you, I and hopefuly other farang will do our little part to change the Thai attitude. Argue or fight with us as they will, make no mistake about it, they ARE listening and learning the western way, and discreetly changing. Hang in there Bro.

As an addendum to my last post, I'd add that the doctors in the hospitals I mentioned above generally do explain their diagnosis and have no problems with questions. My kids' doctor at St. Louis is great; she will explain everything in both English for me and Thai for my wife. She is also very good at the 'offering treatment options' strategy (tho' personally I hate this kind of doctor-patient model, which I see as a way of doctors avoiding responsibility - I pay the doctor to tell me what's best, not ask me what I want to do. Maybe that's a difference between Brit and American culture here?).

Edited July 16, 2010 by SoftWater

[jfchandler]

Since we're having a bit of a broader medical care discussion now, here's another tip to consider:

In many cases, individual doctors don't just work at one hospital... Typically, they may work at 2 or 3 or more -- with different days and hours at each different hospital around Bangkok.

In many cases, they may have a "full time" job at a government hospital, and then work additional shifts at private ones. Or they may have a main gig at one private, and then work other days/shifts at other privates.

What does that mean to you the customer?

It means the same doctor you might see at Bumrungrad for a 1000 or 1200 baht physician's fee may be holding office hours on a different day at St. Louis for a 500 or 600 baht physician's fee... and then calculate the difference in all the related costs accordingly. The hospital names may change doctor to doctor, but the idea remains the same.

I've had that exact thing happen with a couple of doctors I've seen here over the past few years.

One guy, a dermatologist, used to have his main gig at pretty pricey BNH, but then he left to join a new private dermatology hospital (which I assume is at least as expensive, if not moreso), but he kept his one day per week assignment at St. Louis.... The fee at St Louis was about half the price to see the same doctor at BNH...

Likewise, I had another doctor I was seeing at one point at St. Louis... and for that particular issue, St. Louis didn't stock a particular kind of medicine in its pharmacy. But, it turned out, the same doctor also had a one-day a week schedule at Bumrungrad, so I went to see him there just in case I ended up needing the medicine there...though fortunately I didn't.

Most of the private hospitals have lists of their doctors online on their web sites. So if you have a particular doctor you like at one of the pricier hospitals, you might ask him/her if they have assignments at any other hospitals, or just look at a few other local hospitals web sites to see if that doc shows up on their staff lists. You might be surprised.

[Likenitstill]

Bangkok Hospital Phuket was going to charge me about twice the price of my local pharmacy for the same drug, outpatient. I got a bit angry with the doctor there as well. I guess Thais never question a doctor. She was a bit taken aback by my questioning her. And then got a bit rude to me, which doesn't fly with an American that is taught to ask questions of their doctor and be informed. At that point I told her to give me all the test results, paid the bill and never went back there.

This may be a bit off the actual subject but when my wife and I were in the hospital during the period when she was giving bith etc. they were pushing all kinds of unecessary routines on us which we absolutely refused. Little did the doctor know that I have over 12 years in healthcare and many of those working in Emergency so when asking him sone questions about something he literally answered me with "its because your stupid". Both my wife and I told him that that remark was very unproffessional and not called for and left. When I brought the issue up with the hospitals admin board they met with me and said if I did not like the way they did things i could leave. I never went back and never refered another person there.

Someone previously mentioned we should be able to trust the doctors and hospitals? Yes ideally we should it is very sad that I cannot even raise my child to trust the police or the emergency system here period, that goes for your neibours as well.

[SoftWater]

Bangkok Hospital Phuket was going to charge me about twice the price of my local pharmacy for the same drug, outpatient. I got a bit angry with the doctor there as well. I guess Thais never question a doctor. She was a bit taken aback by my questioning her. And then got a bit rude to me, which doesn't fly with an American that is taught to ask questions of their doctor and be informed. At that point I told her to give me all the test results, paid the bill and never went back there.

This may be a bit off the actual subject but when my wife and I were in the hospital during the period when she was giving bith etc. they were pushing all kinds of unecessary routines on us which we absolutely refused. Little did the doctor know that I have over 12 years in healthcare and many of those working in Emergency so when asking him sone questions about something he literally answered me with "its because your stupid". Both my wife and I told him that that remark was very unproffessional and not called for and left. When I brought the issue up with the hospitals admin board they met with me and said if I did not like the way they did things i could leave. I never went back and never refered another person there.

Someone previously mentioned we should be able to trust the doctors and hospitals? Yes ideally we should it is very sad that I cannot even raise my child to trust the police or the emergency system here period, that goes for your neibours as well.

Your post reminded me of a very simple fact from my own experience. Tho' I'll admit it could be an over-genaralisation, the fact is every CRAP doctor I've seen in Thailand has been male, that ranges from a gynacologist at Bamrungrad, a respiratory doctor at St. Louis, a so-called 'back specialist' also at St. Louis, an 'ear specialist' at somewhere out across the Chao Phraya I can't remember (I think the hospital was called 'The ENT specialist hospital') and several male pediatricians.

On the other hand, I found a great back specialist at Chula (female), a great female gynacologist at St. Louis, two great pediatricians at St. Louis (both female), and a great pediatrician at BNH (female). All the crap doctors I've seen at clinics - including two who both prescribed my wife drugs she was allergic to - were men.

[kuffki]

Why don't more foreigners who live here permanently use public hospitals? They are not as luxurious as the private ones, but the medical standard is mostly good and the prices of medicines often lower than in the pharmacies. The private ones, although better equipped, will often give you the treatment that is the most profitable to them, not necessarily what is the most useful for the patient.

Have you been to a public hospital?

Most if not all doctors there do not speak any English.

English is a compulsory subject at university.

So if the doctor was not able to learn even little of such a simple language, are you sure he/she was able to learn something as complex as medicine?

Personally i am not willing to bet my life on it.

Also i have had a shoulder surgery in private hospital and have a mate who had the same one in public. I paid 5 times more then he did.

However i have 2 tiny scars on my shoulder that are not even visible unless i show you, He on the other hand has a scar bigger then his shoulder-looks more like a butcher went to work.

At the end of the day you get what you pay. BUT price of medicine should NOT be different irrespective if its private or public hospital

[SoftWater]

Some of the public hospitals are good - Chula being the obvious example. Lertsin (เลิดสิน) also has a good rep', tho I haven't been there myself. The one I mentioned at Victory that my father-in-law had his operation in was also public (tho' I might agree kuffki that they are not exactly worrying about aesthetics when they dig the knife in).

Edited July 16, 2010 by SoftWater

[paulchiangmai]

Boots charges 600% profit on many medicines. EG Miricid Bt135 a packet of 10 versus Bt25 from the wholesale chemist.

Fascino about 50% over wholesale chemist.

It should be obligatory for all medicines to be labeled with a controlled price,

I presume you mean Miracid? Strange you pay 135 Baht for ten as I pay 84 Baht for 14.

[Jimi007]

Bangkok Hospital Phuket was going to charge me about twice the price of my local pharmacy for the same drug, outpatient. I got a bit angry with the doctor there as well. I guess Thais never question a doctor. She was a bit taken aback by my questioning her. And then got a bit rude to me, which doesn't fly with an American that is taught to ask questions of their doctor and be informed. At that point I told her to give me all the test results, paid the bill and never went back there.

My beliefs exactly. True too, Thai never question doctors. Doctors have the hight education, deal 90% with the sub educated populace, have that class distinction above them, and dont like  being questioned, or disputed. My wife has gone from horrified to embarrassed over the years, when I ask the questions of the doctors, as you and I have been taught to do in US. Shocked and disbeliving when I tell her our doctors advise us to ask for 2nd and or 3rd opinions. They dont want to make a mistake, and want another doctor to validate their prognosis. Together, you, I and hopefuly other farang will do our little part to change the Thai attitude. Argue or fight with us as they will, make no mistake about it, they ARE listening and learning the western way, and discreetly changing. Hang in there Bro.

As an addendum to my last post, I'd add that the doctors in the hospitals I mentioned above generally do explain their diagnosis and have no problems with questions. My kids' doctor at St. Louis is great; she will explain everything in both English for me and Thai for my wife. She is also very good at the 'offering treatment options' strategy (tho' personally I hate this kind of doctor-patient model, which I see as a way of doctors avoiding responsibility - I pay the doctor to tell me what's best, not ask me what I want to do. Maybe that's a difference between Brit and American culture here?).

Yes there is a difference in "culture" and attitude. We pay for our insurance, actually my employers do, it's not "socialized medicine." We are taught that a doctor is just like any other person in the world, we all make mistakes. Actually I can't speak for all America's and won't even attempt to do so. But I think university educated people in general, usually have a desire to learn and become knowledgeable about the world around them and ask questions to learn more. At least that was what I was taught, but my mother was an educator. If you don't ask questions, how do you learn? I guess the hard way, as my mother would say. My American doctor talks to me as an equal, almost like a concerned friend and gives me options as no one is the same. We are individuals with different needs. What works for one person may not work for another. If my doctor, who has two specialties; internal medicine and infectious diseases, doesn't know, he refers me to a specialist. And then there is a consultation and a treatment. Very civilized...

Edited July 16, 2010 by Jimi007

[SoftWater]

Yes there is a difference in "culture" and attitude. We pay for our insurance, actually my employers do, it's not "socialized medicine." We are taught that a doctor is just like any other person in the world, we all make mistakes. Actually I can't speak for all America's and won't even attempt to do so. But I think university educated people in general, usually have a desire to learn and become knowledgeable about the world around them and ask questions to learn more. At least that was what I was taught, but my mother was an educator. If you don't ask questions, how do you learn? I guess the hard way, as my mother would say. My American doctor talks to me as an equal, almost like a concerned friend and gives me options as no one is the same. We are individuals with different needs. What works for one person may not work for another. If my doctor, who has two specialties; internal medicine and infectious diseases, doesn't know, he refers me to a specialist. And then there is a consultation and a treatment. Very civilized...

Maybe I missed something, but I don't see where you get the idea that I'm i. not university educated or ii. not asking questions of my doctor or iii. a product of some imaginary difference that private medical care and a welfare system makes to people's intellect...but anyway, the point about 'doctor's offering choices' is, from my point of view, an abdication of responsibility. Doctors are specialists in their area, and as such they should be recommending the best course of action based on their expertise.

I don't know what choice can 'work for me' that may not 'work for someone else' if there is no medically relevant distinction between our cases. Are you talking about whether to pay by Visa or Mastercard?

I'll give you an example of what I mean: one doctor gave us the option of admitting our child to the hospital or treating her at home. That seemed to me ridiculous and unprofessional. Which is best for my child? Does she NEED to be in a hospital or not? If the answer is yes, then get her admitted. If the answer is no, then why are you even suggesting it and causing us to worry and doubt about whether we are doing the right thing if we take her home? Imagine the guilt - you 'choose' to take your kid home and she gets real sick or dies - oh, why didn't we choose to admit her? That is the doctor's job to determine. If I wanted to make those decisions myself based on expert knowledge I'd have to train as a physician myself, wouldn't I?

If the doctor is unsure - and you're right, they do make mistakes as is human - then they should seek or recommend a second opinion from a professional, not a layman (i.e., the patient).

Edited July 16, 2010 by SoftWater

[surangw]

I'm always dismayed at how thai doctors seem to over prescribe medication, go in with a runny nose and come out with 5 packets of different pills

[Jimi007]

Yes there is a difference in "culture" and attitude. We pay for our insurance, actually my employers do, it's not "socialized medicine." We are taught that a doctor is just like any other person in the world, we all make mistakes. Actually I can't speak for all America's and won't even attempt to do so. But I think university educated people in general, usually have a desire to learn and become knowledgeable about the world around them and ask questions to learn more. At least that was what I was taught, but my mother was an educator. If you don't ask questions, how do you learn? I guess the hard way, as my mother would say. My American doctor talks to me as an equal, almost like a concerned friend and gives me options as no one is the same. We are individuals with different needs. What works for one person may not work for another. If my doctor, who has two specialties; internal medicine and infectious diseases, doesn't know, he refers me to a specialist. And then there is a consultation and a treatment. Very civilized...

Maybe I missed something, but I don't see where you get the idea that I'm i. not university educated or ii. not asking questions of my doctor or iii. a product of some imaginary difference that private medical care and a welfare system makes to people's intellect...but anyway, the point about 'doctor's offering choices' is, from my point of view, an abdication of responsibility. Doctors are specialists in their area, and as such they should be recommending the best course of action based on their expertise.

I don't know what choice can 'work for me' that may not 'work for someone else' if there is no medically relevant distinction between our cases. Are you talking about whether to pay by Visa or Mastercard?

I'll give you an example of what I mean: one doctor gave us the option of admitting our child to the hospital or treating her at home. That seemed to me ridiculous and unprofessional. Which is best for my child? Does she NEED to be in a hospital or not? If the answer is yes, then get her admitted. If the answer is no, then why are you even suggesting it and causing us to worry and doubt about whether we are doing the right thing if we take her home? Imagine the guilt - you 'choose' to take your kid home and she gets real sick or dies - oh, why didn't we choose to admit her? That is the doctor's job to determine. If I wanted to make those decisions myself based on expert knowledge I'd have to train as a physician myself, wouldn't I?

If the doctor is unsure - and you're right, they do make mistakes as is human - then they should seek or recommend a professional second opinion, not a layman's (i.e., the patient's).

I'm sorry if you take my response to your post as a personal affront. I did not mean in anyway to disrespect you. I was trying to explain the difference in "culture" and or attitude between people I know, in the US and the UK. For instance I have a bad knee. I went to my doctor and he said to me; you have three choices: Get it X rayed and that won't show us anything much. Get a MRI and some surgeon will want to cut it open or take some anti inflammatory drugs and go home to Thailand and rest it. I'm not talking life and death decisions here. As to where you first quoted me in this thread, I was talking about a dermatologist, with a high so attitude. I see a very good dermatologist every year that doesn't have an attitude, but he's old and wise... Have you ever had a Thai doctor tell you to seek a second opinion? But this is way off topic as I also stated in an earlier post. This topic was about Thai hospitals over charging for medicine. The OP article stated, that the "think tank" came to the conclusion; they are...

Edited July 16, 2010 by Jimi007

[marios]

Bangkok Hospital Phuket was going to charge me about twice the price of my local pharmacy for the same drug, outpatient. I got a bit angry with the doctor there as well. I guess Thais never question a doctor. She was a bit taken aback by my questioning her. And then got a bit rude to me, which doesn't fly with an American that is taught to ask questions of their doctor and be informed. At that point I told her to give me all the test results, paid the bill and never went back there.

This is the problem. Thai doctors cannot be doubted. How can you make an asian person lose face? You can certainly do it in a one -off visit, you cannot do it if you see the same doctor on a regular basis, I think.

In 2004 I spent 2 weeks as an in-patient at Bumrungrad. The cost of medicines was high, but the cost of the room was really cheap. It was a huge room with breakfast bar and a sofa with 2 armchairs,full UBC etc. I think it was 2500 per day. I am not sure but it was certainly more than half of what I would had paid in my own country. I had a crippling case of sciatica which let me bedridden for 2 weeks. They treated me fine. There was an endless availability of nurses. I have feelings of gratitude to those nurses and physiotherapists who treated me in such a cheerful and smiling manner. A nurse was 2 minutes away from my ringing the bell.

All in all my thoughts on this hospital, in 2004, were very positive. They overcharged the medicines? Someone has to pay for the privilege of having a nurse rushing to your bedside when you press the button.

[astral]

It is a sellers market, the "actual cost" does not come into the equation.

I travel to India quite regularly and buy my medication there

at a fraction of the price at home.

Fake, I here you say, not so. Genuine International brand names

are now manufacturing there, Aventis and the like.

The same is true with other medical services.

Last year I had a PET scan here in the middle east, cost $800

a few weeks later I had a second scan in London, cost 1500 pounds, that is 3x as much.

I was lucky my insurance paid.

[SoftWater]

I'm sorry if you take my response to your post as a personal affront. I did not mean in anyway to disrespect you. I was trying to explain the difference in "culture" and or attitude between people I know, in the US and the UK. For instance I have a bad knee. I went to my doctor and he said to me; you have three choices: Get it X rayed and that won't show us anything much. Get a MRI and some surgeon will want to cut it open or take some anti inflammatory drugs and go home to Thailand and rest it. I'm not talking life and death decisions here. As to where you first quoted me in this thread, I was talking about a dermatologist, with a high so attitude. I see a very good dermatologist every year that doesn't have an attitude, but he's old and wise... Have you ever had a Thai doctor tell you to seek a second opinion? But this is way off topic as I also stated in an earlier post. This topic was about Thai hospitals over charging for medicine. The OP article stated, that the "think tank" came to the conclusion; they are...

No worries .

As an aside, I have sort of had a Thai doctor tell me to seek a second opinion - the crap back specialist at St. Louis I mentioned in an earlier post, said to me at the end of my third consulation (when he'd run out of muscle relaxants to offer me) "Well, if you come back again next week maybe you can see someone else. You know, you don't have to see me, anyone can take your case." There was a tone of desperaton in his voice. Needless to say, I didn't bother going back to him or his clinic.

[jfchandler]

Unfortunately, medicine is as much an art as it is a science. It's not like a doctor is adding 2 and 2 together, and knows every time the answer is going to be 4. Thus, usually, there's a fair amount of room for hunches, intuition, and even alternate routes of treatment.

Sometimes here in Thailand, doctors are quick to make their pronouncement... But unfortunately, they often may not have in their mind all the pertinent background or knowledge that you as a family member may have... such as allergies to medicine, or symptoms you've seen at home, or small things... You may have told them, or it may be in the medical record, but that certainly doesn't mean they always are conscious or thoughtful enough to consider those things. Sometimes, doctors react too much from just rote repetition, as OK, you have symptom A, so I'm going to respond with Treatment A... Period. In other words, they miss things or fail to appropriately consider them.

I used to accept doctors directions pretty much without questioning, figuring, as many do, they're the experts... But... they're seeing me for maybe 10 minutes. And I'm knowing my body and life for my entire life, and I live with whatever may be bothering me every minute and every day. So after much experience with doctors both here and in the U.S. making a lot of bad and sometimes just ill-informed judgments, I have learned to listen but to check everything independently myself, and certainly to seek 2nd and 3rd opinions for anything significant.

I remember one episode here in Thailand, at a pretty prominent hospital, where a doctor prescribed some medicine for me... And when I asked the name during our appointment, the name rang a bell, and I recalled reading in the news some health warning about that drug. But I was at the hospital as an outpatient then, so I accepted the prescription and took it home.. Went to the computer, searched the drug, and sure enough, it had been recalled by the U.S. Food and Drug Admin. a few months earlier amid much publicity because of serious side effects in patients. So I didn't take the medicine, went back to the hospital later, explained the issue to the doctor, and got him to prescribe a different medicine. While I was there, I also asked the pharmacy director about the same issue, and everyone just said..don't worry, the original medicine is fine. They seemed to not know anything about the recall in the U.S.

I'm fine to listen to the doctors, and give their opinion and recommendations due weight.... But ultimately, it's my health and my body... So I'm going to be a cautious, informed patient... And if I have a reason, I won't hesitate to politely challenge or even refuse a doctor's guidance, as I did with the medicine that had been recalled in the U.S.

I'll give you an example of what I mean: one doctor gave us the option of admitting our child to the hospital or treating her at home. That seemed to me ridiculous and unprofessional. Which is best for my child? Does she NEED to be in a hospital or not? If the answer is yes, then get her admitted. If the answer is no, then why are you even suggesting it and causing us to worry and doubt about whether we are doing the right thing if we take her home? Imagine the guilt - you 'choose' to take your kid home and she gets real sick or dies - oh, why didn't we choose to admit her? That is the doctor's job to determine. If I wanted to make those decisions myself based on expert knowledge I'd have to train as a physician myself, wouldn't I?

If the doctor is unsure - and you're right, they do make mistakes as is human - then they should seek or recommend a second opinion from a professional, not a layman (i.e., the patient).

[rayw]

Well two things I think should always be state run in ALL countries and that is Hospitals and Doctors, and children's education and private not allowed to coexist to bleed the state run systems of all the best doctors and teachers just for the already over privileged rich who can afford to pay over the top prices. It is wrong to use sick people and children's education to make money. WRONG WRONG WRONG. Even pharmaceuticals should be nationalised or heavily state controlled in ALL countries. Then we stop seeing this disgusting abuse of people just to make bloody money the new god of the 21st century (and last century too yes I know). Capitalism has its place in society to produce all the nice consumer goods we love but NOT for our sick people and children's education, it is so so wrong and grossly immoral, that is where Socialism wins hands down and has its place too. Until we get this vital nationalisation then expect to see more scams and rip offs of those that really should never be ripped off whether rich or poor.

[silk]

Since we're having a bit of a broader medical care discussion now, here's another tip to consider:

In many cases, individual doctors don't just work at one hospital... Typically, they may work at 2 or 3 or more -- with different days and hours at each different hospital around Bangkok.

In many cases, they may have a "full time" job at a government hospital, and then work additional shifts at private ones. Or they may have a main gig at one private, and then work other days/shifts at other privates.

What does that mean to you the customer?

It means the same doctor you might see at Bumrungrad for a 1000 or 1200 baht physician's fee may be holding office hours on a different day at St. Louis for a 500 or 600 baht physician's fee... and then calculate the difference in all the related costs accordingly. The hospital names may change doctor to doctor, but the idea remains the same.

I've had that exact thing happen with a couple of doctors I've seen here over the past few years.

One guy, a dermatologist, used to have his main gig at pretty pricey BNH, but then he left to join a new private dermatology hospital (which I assume is at least as expensive, if not moreso), but he kept his one day per week assignment at St. Louis.... The fee at St Louis was about half the price to see the same doctor at BNH...

Likewise, I had another doctor I was seeing at one point at St. Louis... and for that particular issue, St. Louis didn't stock a particular kind of medicine in its pharmacy. But, it turned out, the same doctor also had a one-day a week schedule at Bumrungrad, so I went to see him there just in case I ended up needing the medicine there...though fortunately I didn't.

Most of the private hospitals have lists of their doctors online on their web sites. So if you have a particular doctor you like at one of the pricier hospitals, you might ask him/her if they have assignments at any other hospitals, or just look at a few other local hospitals web sites to see if that doc shows up on their staff lists. You might be surprised.

very true! I now many thai people covered by government social scheme. They go to a private hospital, check their preferred doctor's schedule when they are on duty in a government hospital to see him/her there.

[techboy]

It's a blatant scam by the hospitals. They are exploiting sick people. It's so obvious that there was no need for a "Thinktank" to be revealing this.

Hospitals, as respected institutions of society on which many people's lives are dependent on every day, should be upholding ethical practices.

I felt so disgusted when I compared the prices of medicine that I had bought in a hospital with prices in Boots pharmacy. From then whenever I visit a doctor in a hospital I tell the doctor that I will buy the medicine outside.

Yes, hospital meds are generally more expensive but if you go to their pharmacies they will frequently inform you that you can purchase the product for a better price at an outside source. Do the in-patients pay more than the hospital pharmacy price? If not they are still doing well. The system in Thailand allows you to purchase drugs at an incredibly cheap price and you can buy them over the counter rather than getting sucked into a racket in which you must pay for a consultation with a doctor and then pay the pharmacist to fill the prescription. Sure I understand that some items such as new broad spectrum antibiotics should be controlled to avoid the the bug population from adapting but most of the time your are just getting ripped-off in other countries. Try Singapore if you want to understand what I am talking about. You cannot even get Norgesic there without dropping 100 bucks before you finish jumping through hoops- The stuff is even over the counter in the States for Pete's sake. By the way I feel sorry for anyone that thinks they are being savvy going to Boots for a good deal.

[techboy]

It's a blatant scam by the hospitals. They are exploiting sick people. It's so obvious that there was no need for a "Thinktank" to be revealing this.

Hospitals, as respected institutions of society on which many people's lives are dependent on every day, should be upholding ethical practices.

I felt so disgusted when I compared the prices of medicine that I had bought in a hospital with prices in Boots pharmacy. From then whenever I visit a doctor in a hospital I tell the doctor that I will buy the medicine outside.

Yes, hospital meds are generally more expensive but if you go to their pharmacies they will frequently inform you that you can purchase the product for a better price at an outside source. Do the in-patients pay more than the hospital pharmacy price? If not they are still doing well. The system in Thailand allows you to purchase drugs at an incredibly cheap price and you can buy them over the counter rather than getting sucked into a racket in which you must pay for a consultation with a doctor and then pay the pharmacist to fill the prescription. Sure I understand that some items such as new broad spectrum antibiotics should be controlled to avoid the the bug population from adapting but most of the time your are just getting ripped-off in other countries. Try Singapore if you want to understand what I am talking about. You cannot even get Norgesic there without dropping 100 bucks before you finish jumping through hoops- The stuff is even over the counter in the States for Pete's sake. By the way I feel sorry for anyone that thinks they are being savvy going to Boots for a good deal.

[astral]

their pharmacies they will frequently inform you that you can purchase the product for a better price at an outside source

That is news to me.................

I used to ask my ENT consultant what I needed and buy outside,

but was never told by the hospital (Samitivej)

[jomtienbob]

I was just hospitalized (emergency) for the first time in decades and it was in Pattaya Memorial that I ended up but mainly because I know of and have heard of so many horror stories from BKKPTYa. But I was very happy with the Doctor, but most of the rest of their 'operation' was geared to maximize profits regardless of any leaning towards the Hippocratic oath. When it came time for my bill they were quite brutal about it all but as an outpatient I was even more appalled at their exorbitant approach. I had to ensure that I checked their bill before I paid the money every time because the first 3 were wrong by 2-300%. They got somewhat peeved at me after a while but I just explained to them I had no confidence in their accuracy in their billing so I did actually save myself quite a bit.

Gee you would think that a Hospital like that making all that money would have fairly good hygiene etc. Well I'm no expert but I went in for surgery and they said I'd wake up in ICU, which shocked me somewhat because the very first thing I woke up to was the overhead fluorescent lights and there were 4-5 bugs of different flying and crawling derivatives on the 2 lights. Latter I was told that this was not ICU it was merely the particular recovery ward where they put people after serious surgery. Ahh well that explains it perfectly! Gee why didn't they just put me in the carpark I wonder? Or better still, down on the beach? mmm perhaps those drips with all those expensive drugs going into me might have been a bit more problematic to keep getting filled out there.

Anyhow I got out of the whole scenario for about 33% more that I probably would have paid in Australia (or so I am now informed) and they used 20 year old techniques and perhaps technology, but NO! they did INDEED fill me with the latest and greatest and most expensive drugs on the market today!! for all that expense I now have a 8 inch surgical wound where modern medicine would have had 1cm, and the list goes on. All I can say is that at least I did save myself some money by not going to BKKPTYa. That apparently would have cost me at least double what I had paid! My GF's sister works there, we checked!

[Honolulu]

I recently paid for an ovary removal for my GF at Phuket International Hospital. A very standard operation at any hospital. At the beginning they told me it would cost 70,000 Bhat. After, they tried to charge me 130,000 Bht. I easily complained them down to 100,000 Bht. They were trying to rip me off, and they knew it. After I paid and we were leaving, I asked them to call me a taxi. They wanted me to pay 1000 bht for a 300 bht taxi ride. Total ripoff. This is the way they do things over here.<div><br><div> Always get the price up front and be aware in Thailand. Hospitals in Thailand are worse than beer bars. </div></div>

[bangon04]

The only reason I pay the price for prescription drugs in hospitals is because I an not so sure id the drug I am buying at the outside phamarcy is the real thing. I suppose that is the case also in the hospitals. I would like to be sure due to my condition that I am being supplied with the correct drugs and not a copy from a Third World country.

What pharmacy can you trust in Thailand?? Boots?

You seem to imply that Thailand is not a third world country.........

and are you sure that the hospital would never dream of buying in cheap drugs to make a higher profit? Do you completely trust the self regulating authorities in Thailand to be completely scrupulous? I admire your faith....

[anotheruser]

They definitely overcharge. I went to the hospital for a boil on my ear and the treatment was reasonably priced. I took a number to wait in line for the medicine and they charged me like 3,000 THB for paracetimol and antibiotics. The fee for the procedure was around 500 THB. This was at the Christian hospital on silom road not far from Pat Pong.

[maccaroni man]

I am almost in shock that in the year 2010 it takes a think tank to discover that meds from a hospital (not just thailand) are more exp then from a private business. Oh Me, Oh MY, the shock, the shame, the horror; are you kidding me??? this has been a common practice since the begining of private hospitals. As for complaining to the dr. about such things and expecting them to be able to do something? Dr's have nothing to do with pricing in hospitals outside of their own service, they are independent contractors,or employees not policy makers. Another post objected to the dr giving them an option? lets say a child has a fever and needs to be observed and sponged throughout the night to control the fever, this is something that can be done at home but it can also be done by a nurse in hospital which cost more? the dr offers the option to help save money and is now considered a quack? dont get me wrong i am no fan of hospitals or dr's, i do what ever i can to avoid visiting either, and from my exp, the typical dr visit comprises of them telling me what i already know but at least in thailand a dr fee is 500 baht compared to 50 or 100 dollars in the states. hospital stays in thailand are a song compared to the prices in the US. imho anyone who complains about cost of private hospital health care in thailand is in serious need of a reality check concerning private business practices and or is coming from a place where the redistribution of wealth is paying for their responsibility of health care. Medical tourisim is on the rise in thailand and asia, the low cost is a major reason for this.