Thinktank Says Thai Hospitals Overcharge For Medicine

[moetownblues]

Not just a thai thing. Normal practice world wide. Medication is still a fraction of the price compared to western countries like Australia where the community is being screwed over.

[Deeral]

<br>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.<br><br><br>What pharmacy can you trust in Thailand?? Boots?<br>

<br><br>

What makes you think the hospitals are any different?????

On what basis do you make this assumption?

Edited July 16, 2010 by Deeral

[Deeral]

THailand is NOT a third world country.

Thailand is wealthy and it's healthcare is a lottery.

" their 'operation' was geared to maximize profits regardless of any leaning towards the Hippocratic oath." - this is the key to understanding Thailand's healthcare system.

Edited July 16, 2010 by Deeral

[truthfulfox]

the best hospital I visited in thailand and would never complain about it's services!!! is the airport , departures gate.

[moskito]

Not just a thai thing. Normal practice world wide. Medication is still a fraction of the price compared to western countries like Australia where the community is being screwed over.

Sorry but its not! Its may be common in Australia or USA and for sure Thailand these times. In Germany and most western European countrys Doctors have to swear the Hippocratic oath to help people in need. In Thailand they just let u die if u cant afford to pay them. First Credit Card or Cash, after First Aid, same in Phuket Bangkok or Phuket International Hospital

The Private Hospitals in Thailand are build after the USAmerican RipOff system not more not less. And do not forget, A LIFE MEANS NOTHING IN ASIA

[meelousee]

If you have ever been in the hospital you know this story all to well, overcharge and overcharge. The limitation is location. The Military hospital in Chang Rai Charges 153B per tablet and Military hospital in Bangkok charges 250B per tablet (I wont tell you which drug)and the Bangkok Hospital in Pattaya charges 395B per tablet, all three sell the same drug same company same package and so on. There is no difference except price.

Also, there are 1000's of drugs that are only available in the Hospital no matter if you are in- patient or out. The only place to get them is at the hospital.

[w7mux]

Are all medications available at outside pharmacies, sleep medication, HIV/AIDS drugs, tranquilzers, etc. I was once told by a pharmacist that a refill of Stilnox (Zolpidem tartrate) had to be filled at a hospital pharmacy.<br>

[w7mux]

Are all medications available at outside pharmacies, sleep medication, HIV/AIDS drugs, tranquilzers, etc. I was once told by a pharmacist that a refill of Stilnox (Zolpidem tartrate) had to be filled at a hospital pharmacy.<br>

[hyperdimension]

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.

Which hospital was this?

Which hospitals would you recommend?

[jfchandler]

In answer to the prior question about drug availability...

No, not ALL drugs are available on demand at pharmacies in Thailand. But, unlike the USA and elsewhere, many common "prescription" drugs are available directly from Thai pharmacies, without requiring a doctor's involvement.

In the best of all worlds, you don't want to be ordering up your own drugs....unless you are a doctor. But, what you might want to be doing, is getting the drug prescription from your outpatient doctor and then having it filled at a private pharmacy rather than the hospital pharmacy in order to save substantial costs.

[junkie]

The Bangkok Phuket Hospital charges double what you will pay for the same drugs from a local pharmacy.<div>My wife has to have regular medication and was actually her doctor at the BP hospital who advised her to get the prescription made up outside.</div><div>When you see a doctor at the hospital you should ask for the prescription not to be made up at the hospital as 100% you will be charged double what you will pay next door at a pharmacy.</div><div><br></div><div><br></div>

[Deeral]

Doctors do not have a monopoly on medical knowledge - and in Thailand that is especially true.

I'm amazed at how many people just assume because a doctor recommends something they just blindly go through with it with so much as considering that the treatment might not be the only alternative but you can be fairly sure it is the one that is most profitable for the hospital.

Especially at risk are those with high value insurance - the hospitals LOVE you! - they'll dream up all sorts of treatments and drugs for you.......

It is also worth bearing in mind how utterly unscrupulous the drug companies are and most offer sizable kickbacks to Doctors who prescribe rtheir drugs or better still get the hospital to buy only their version.

A good pice of advice if you get sick in Thailand - if you can - go for the "alternatives" - get out of the country and get treated at home!

[Farma]

Are all medications available at outside pharmacies, sleep medication, HIV/AIDS drugs, tranquilzers, etc. I was once told by a pharmacist that a refill of Stilnox (Zolpidem tartrate) had to be filled at a hospital pharmacy.<br>

Certain medications are restricted and not all pharmacies can or will stock them. A special license is required for restricted medications. It's up to the registered pharmacist for that pharmacy to decide if they want to obtain the license, or stock a particular medicine.

Some pharmacies will keep a standard range of medicines. It's a business and they don't want to carry extra stock that will only need to be returned to the wholesaler when nearing expiry.

[ianwuk]

And they just figured this out...now?

Wow! Honarary Masters for all these people I say

[hyperdimension]

I feel sorry for anyone that thinks they are being savvy going to Boots for a good deal.

Yes, I know, that's why I rarely actually buy from Boots. But the fact that I was shocked to see how much cheaper Boots' prices were for exactly the same medicine (e.g. off-the-shelf Voltaren gel), shows how absolutely outrageous the hospital's (BNH's) prices were.

[jdk]

... yeah. at all hospitals they send you to the queue for paying first then to the queue to receive meds. i always ask for the list of meds and expenses first and this is always provided. then i look to see what I can get outside and what i cannot. and i decline to purchase whatever meds i decide i can get outside. at Vichayuth hospital (which is quite good in all respects, particularly costs - except for meds... read on) they do not let doctors write prescriptions for outside the hospital! some of my meds are not something can get over the counter - they are type 3 which means controlled. they have morphine component. so i have no choice but to buy from them. and all meds prices at Vichayuuth are more expensive than Paolo for example. I believe they are more expensive than most other hospitals. Anyway if you go to Vichayuth you dont have a choice.

week ago i switched to my Paolo doctor for full time medical stuff and he wrote a script for me to get some meds at the Paolo hospital pharmacy and the price was 50% less than that at Vichayuth. so I know Vichayuth is both making a killing on some meds and also preventing their doctors from writing scripts for patients to get stuff outside the hospital. my doctor told me he cannot write a script because of hospital rules. this is a scam in my opinion - what if i had to go overseas - which i do in 2 weeks - and lost the meds or something?

Edited July 17, 2010 by jdk

[ajarnmark]

There is a cost to physically dispense the medication. There is also a cost associated with maintaining an inventory. Dispensing medications in a hospital is a time consuming process with alot of manual labour that only adds to the costs. The markups on medication adminstered in a hospital are used to help cover the costs of having a hospital that is open and staffed 24/7. Before anyone flies off the handle, consider this: You know the local pharmacy where you can buy the drugs for next to nothing? Ask them how much they would charge to have a doctor write a prescription, deliver it to the pharmacy and then have the pharmacy prepare one or two tablets to be delivered to your bedside by an RN, who would then supervise the dosing.

The markups referenced in the article are insignificant compared to what patients pay in other countries without a government drug plan. It is not unusual for some drugs in the USA to have a 1000% markup. There are however downsides to having a generous drug plan and France illustrates this best. France has a population that is clueless to the costs of drugs since the drugs are covered in large part by the national health plan and/or by supplementary insurance which almost 9 out of 10 people have. The result is that the French spend more on expensive proprietary brands, bypassing generics, and there is a greater likelihood to prescribe drugs in France then there is elsewhere in the EU and North America. When no cost attaches to something, the option is abused.

Yes, Thai hospitals take advantage of a situation. We know that. It is what happens in this part of the world. Personally, I find it repugnant, but we all know that the private healthcare system is run on a for profit basis. It would be great if there was a public drug plan, but who would pay for it? Does anyone think Mr. Abhisit could get away with raising taxes on his supporters to pay for the scheme?

What other countries you are referring to?

Private hospitals in Vietnam are for sure more expensive... but if you goto any government hospitals in asia, they are not only better than those private hospitals but also cheaper.

[ableguy]

<BR>This is very old news for any patient treated in a hospital. I hope that those in an outpatient situation, capable of getting their own medication, get a script or note of the name of the medication from the physician to obtain the medication from a pharmacy outside the hospital. The mark up on medications within the hospital situation is a bloody disgrace. And over-prescription would have me suspect that physicians are on a kickback but would I suggest that???<BR>

<BR><BR><BR>Good post I agree, my advice when visit hospital get the name of the drug from pharmacy in hospital, doseage and strength, and buy in a pharmacy. One example charged 700 bhat for a tube of cream, bought the same in a pharmacy cost 140 bhat. The same applies if you visit a doctor who has his own small pharmacy attatched to his clinic, you will get shafted on price of drugs, I have known some doctors refuse to supply name of drugs they prescribe, answer to this walk out and refuse to pay him anything.

[Deeral]

Bit of cherry-picking going on with the drug pricing thing.

Nationalized healthcare systems are usually fear cheaper to run than private insurance based ones.

The problem really lies with the access allowed and influence of the drug companies - they are the real villains here.

unfortunately Thailand has little or no control over these and they have almost a free rein to run amok

[prinzregent]

PARACETAMOL Zaepfchen 125mg.

Price in Germany 10 p. is 0,89 Euro or about 36 Baht.

So in Germany price for one is 3,6 Baht.

In the Bangkok Pattaya Hopital price for one is 40 Bath.

This is not funny any more ! :annoyed:

Edited July 18, 2010 by prinzregent

[Deeral]

Most paracetamol tabs are 500 mg

Why would a hospital even bother with paracetamol though?

There is deffo a culture in Thailand that if you visit a hospital or clinic you should leave with at least THREE different pills in nicely labelled zip up plastic sachets - whether you need then or not.

whereas the placebo effect is demonstrable so are bad/wasteful medical practices

Edited July 18, 2010 by Deeral

[antony77]

A couple of observations here:

1. As a general rule, prescriptions notwithstanding, the cost of medical care here in Thailand is certainly far more affordable than in the U.S., as is medical insurance... So overall, it's hard to complain too much.

As to quality, for routine medical things, I think the care here at the private hospitals generally is going to be as good as what people might expect to get in the U.S. In my experience in my home country, they have a lot of technology and access to new drugs and specialists and such. But that doesn't mean you're going to get good or competent care, more likely, an indifferent 10 mins and out the door.

2. I have an acquaintance who works for private hospitals here in BKK. After reading the article above, I asked that person: When the doctors here prescribe a medicine, do they end up getting a cut of the cost of the prescription. My acquaintance said NO.... the doctor gets a share of the doctor's fee (with the other part going to the hospital). But my friend said the doctor typically doesn't share in the revenue from the hospital prescriptions.

3. No doubt, the general notion reported in the study about hospitals jacking up the price of presciptions, both for inpatients and outpatients, is correct, as everyone here pretty much already knew. For me, I always wait to get the billing statement at the cashier, and then look at the medicine prescribed and the cost. If it's a small amount, I'll let the hospital prescribe. But if it's any kind of hefty amount, I'll often decline and simply take the invoice showing the medicine/strength/quantity and head to my local pharmacy.

The other issue about that to consider is, if you're care is being covered by medical insurance, then that insurance is going to cover the cost of the hospital-issued medicines...but not if you go on your own and buy at the local pharmacy. So when the insurance is covering, I'm gonna leave it between the hospital and the insurance company.

4. Lastly, and this was a bit of a surprise for me, I've been told that at least at the private hospitals in BKK (and presumably outside), there is a standard double-pricing scheme for farangs vs. Thais - needless to say, Thais are charged the regular price...and farang automatically charged a markup, for the same treatment.

Fair comment except. The elderly are discriminated against here. They can not get medical insurance 65 years or older. This is an offense in some other countries. Health insurance companies love Thailand because they don't have to pay out for the elderly.

I at age 80 have many medical problems and spend a lot of time as outpatient in many different hospitals. Double pricing is very rare and I know only of one time they tried to charge me more than my wife.

I know that most doctors get a cut from prescriptions which makes them tend to over presscribe. But their fees are so small so what can you say.

[Deeral]

as the US has the worst medical care system in the western world - any comparisons are pretty jaded.

Patients or customers are probably the WORSt source of information on a healthcare service you could possibly ask.

Cheap bills in Thai hospitals reflect the wages of the staff, the low cost of real estate more than any savings on medical equipment or drugs.

\

Unfortunately the lack of any satisfactory regulation or monitoring means that they are a law unto themselves and patients - even those who come out satified with their treatment may infact have got a raw deal - they will just nevver know.

Lets face it - people are HUGELY ignorant of all things medical and that's exactly what the medical services want

the heirachical system in Thai hospitals ensures that patients are kept in the dark and fed on bullshit - and half of them never even suspect it.

[chakatee]

When I buy a coke from the minibar in the hotel, they charge me 6 times the price of the exact same can of coke in 7 Eleven.

When I eat a plate of steamed rice in a fancy restaurant, they charge me 10 times the price of the exact same rice at my local food vendor.

Can we request a Thinktank to take a look into that?

Environment, service, logistics, profit margins, ... it all plays a part. As a customer you buy it or you leave it. A customer can overpay but a vendor (be it a hospital or a hotel or ...) can't overcharge as long as the customer is willing to pay that price for it. Basic economics.

[Rucharee]

I suppose 30 baht is a little to steep to pay these days.

[harrry]

I suppose 30 baht is a little to steep to pay these days.

So I take it Rucharee that you do not care that the private hospitals paid for by your government overcharges the government for drugs for those on Social Security. This is the gist of the Prime Minister's statement. Yes farangs are overcharged too and I think this is dispicable but you should care about your own country being defrauded. A little more honesty and less corruption may enable the Government to provide more and better services to it's people who do need it.

[Rucharee]

I suppose 30 baht is a little to steep to pay these days.

So I take it Rucharee that you do not care that the private hospitals paid for by your government overcharges the government for drugs for those on Social Security. This is the gist of the Prime Minister's statement. Yes farangs are overcharged too and I think this is dispicable but you should care about your own country being defrauded. A little more honesty and less corruption may enable the Government to provide more and better services to it's people who do need it.

Quite agree.

IMHO, the level of corruption have greatly reduced over the past couple of years, and you know why.

[selftaopath]

This is very old news for any patient treated in a hospital. I hope that those in an outpatient situation, capable of getting their own medication, get a script or note of the name of the medication from the physician to obtain the medication from a pharmacy outside the hospital. The mark up on medications within the hospital situation is a bloody disgrace. And over-prescription would have me suspect that physicians are on a kickback but would I suggest that???

I agree with you; what do we expect in an environment where Lack of Sanctions (LOS) is so evident.

[Valentine]

I feel sorry for anyone that thinks they are being savvy going to Boots for a good deal.

Yes, I know, that's why I rarely actually buy from Boots. But the fact that I was shocked to see how much cheaper Boots' prices were for exactly the same medicine (e.g. off-the-shelf Voltaren gel), shows how absolutely outrageous the hospital's (BNH's) prices were.

Boots & many other pharmacies will offer imported medications at expensive prices but if you ask for the Thai version it is exactly the same & much cheaper.

[Wozzit]

Yes, hospitals do sell drugs significantly more expensively than most pharmacies. They also prescribe a lot drugs that are unnecessary or ineffective, often without discussing treatment options with the patient. On the other hand their charges for consultations with doctors are incredibly low by most international standards. A consultation with a consultant surgeon in London or New York will cost you at least B10,000, compared to only about B600 in a Bangkok private hospital and most other hospital fees are a lot lower.

Have only just read this thread and hope I am not duplicating an earlier reply. I have been making occasional visits to Bumrungrad for several years. 2 years ago over a period of only 12 months the fee for the specialist doctor I see went up in two jumps from 600 Baht to 1,100 Baht. I wrote to the administrator to ask why. I got a lot of waffle back, but also an agreement to refer the complaint to some internal committee. End result: I was reimbursed about 1,800 Bhat.

In the same hospital,the outpatient department (OPD) facility fee - what you pay for having your weight, temperature and blood pressure noted - has been rising steadily. Now it's 70% up in about 3 years. Once I noted they added this fee plus a full doctor's fee when the only reason for my visit was to go to the pharmacy for repeat medication. I never even saw a doctor! On querying this, the OPD fee was cancelled and the doctor's fee reduced by 50%. How many people have been paying such charges without even checking their bills because they know their insurance companies are paying?

I also agree that I have undergone several expensive procedures which, in the opinion of other doctors I have consulted, were not merited. On a recent visit, it was recommended that I have a special heart scan - when this is not the doctor's speciality and I have never ever had any signs whatever of any heart problems - blood pressure always aggressively normal, stress tests always good etc. He said it was a" good idea". Maybe so, but it seemed to add weight to the view that this hospital does push patients into procedures which are both expensive and not always justified - in addition to the major overcharging on medications.

Edited July 21, 2010 by Wozzit