Private Thai Hospitals Defiant On Medical Plan

[webfact]

Hospitals defiant on medical plan

Pongphon Sarnsamak

The Nation

Major private ones say policy on free emergency services still not clear

BANGKOK: -- With more than 10 leading private hospitals still holding out over murky guidelines, the government’s policy to allow citizens free access to emergency medical services from any provider is not going to happen by April 1.

"The government wants us to join its plan but it does not know about the real costs of emergency medical treatment," Dr Pongsak Viddayakorn, director and executive adviser to Bangkok Dusit Medical Services, a major private hospital chain, said yesterday.

The hospitals are not happy with the reimbursement rates the government plans to offer.

Many of them have not confirmed their participation in the plan even though the government wants to kickstart it on Sunday so that patients will just need to show their national identification card to receive free treatment at the nearest hospital.

The chain operates the famous Bangkok Hospitals in various provinces.

Dr Kittisak Jirasottikuk, director of privately run Suphanimitrsena Hospital in Ayutthaya, believes premium private hospitals would have problems with the new plan relating to emergency medical services.

"Those already belonging to the universal healthcare and social security schemes won't have any problem," he said.

Indeed, Pongsak said that although his chain was going to join the plan, it would withdraw as soon as it realised that participation caused financial problems.

"Keeping private hospitals' healthcare service fees at a low level especially for emergency treatment will risk patients' lives," he said.

"We strictly will not compromise the quality of services. It will hurt our standards. This is not about corporate social responsibility. It's about the standard of care to save a patient's life."

Dr Khamphon Palassin, president of Chularat Hospital, said the government's plan to provide unlimited emergency medical treatment under three healthcare schemes would affect private hospitals and the reimbursement rates were not enough to cover the service expenses, as they did not reflect the true cost.

The Social Security Office says it is ready to put Bt240 million into the plan, the Civil Servant Medical Benefit Scheme Bt400 million and the National Health Security Office (NHSO) Bt5 billion.

Today Prime Minister Yingluck Shinawatra will preside over the launch of the plan as the three agencies sign a memorandum of understanding at Government House.

Authorities have said they would pay attending hospitals at least Bt10,500 per condition. The reimbursement would rise according to how critical the condition is. For example, the rate could go well over Bt100,000 for a heart operation.

Dr Athaporn Limpanyalerd, director of the NHSO's Claim Administration Bureau, said if the cost of treatment went beyond the approved rate, the hospitals would have to shoulder the difference.

"The approved rate can't cover the actual cost of a heart operation," Pongsak said.

Patients needing heart surgery at prestigious private hospitals usually pay about Bt395,000.

The rates should be based on the real cost of providing medical services, but those patients who can afford it should pay some portion for the best treatment possible, he said.

Dr Chalerm Hanpanich, president of the Private Hospital Association, complained that the government's guidelines for the plan were still not clear enough.

"There are no clear reimbursement rates and payment periods. There is also no clear plan about the length of medical treatment for patients with emergency conditions," he said.

Private hospitals want the government to give them sufficient guidelines so that they can manage their expenses.

"We need an effective system," Chalerm said.

The government was always late in paying private hospitals in the past, he added.

Dr Winai Sawasdivorn, secretarygeneral of the NHSO, said the NHSO, which will act as the clearinghouse, has guaranteed private hospitals that they will get reimbursed within 15 days of sending their expense reports to the NHSO.

"Don't worry about the reimbursement. We will not be late," he said.

The upscale private hospitals will absolutely join the scheme, he said without revealing how many.

Last year, the NHSO spent Bt74 million to provide emergency treatment for 3,000 members of its universal healthcare scheme.

-- The Nation 2012-03-28

[rotary]

Maybe they can take a look at Obamacare and just do the opposite

[TerryLH]

"...so that patients will just need to show their national identification card to receive free treatment at the nearest hospital."

This might lead one to think that foreigners in the social security or civil service systems are excluded from this plan. It's more likely that it's just poorly worded or translated.

Has anyone heard anything about that?

Edited March 28, 2012 by TerryLH

[geriatrickid]

Maybe they can take a look at Obamacare and just do the opposite

Ahh you mean, actually making the plan more comprehensive as in France, Scandanavia, Australia etc.?

I think one step would be the nationalisation of the hospitals or at the very least the implementation of a minimum provision of services requirement. The USA is a lot like Thailand with its lack of a true national health system. Thailand's excuse is that it is a developing nation. The USA doesn't really have one and that is why it has some of the worst health stats in the developed world.

Unfortunately, many of the big US health services providers have their grubby hands into Thailand's hospitals and are offering the same advice that has kept the USA with a crippled health care system with overpriced services and some of the most expensive drug prices in the world. It is incredible that the same EU based pharma companies can manufacture and distribute their drugs in the EU and Canada and offer them for sale at a fraction of the cost in the USA. Thailand's private hospital system follow the USA pricing model.

Edited March 28, 2012 by geriatrickid

[geriatrickid]

"...so that patients will just need to show their national identification card to receive free treatment at the nearest hospital."

This might lead one to think that foreigners in the social security or civil service systems are excluded from this plan. It's more likely that it's just poorly worded or translated.

Has anyone heard anything about that?

Hopefully, they will have to offer more evidence than that as Canada has suffered significant losses due to fraud. There are organized crime gangs that cater to North African, Central African and Lebanese medical scamsters that present counterfeit provincial health care cards and defraud the respective provinces for $millions every year. (Not to mention just showing up in an ER and getting healthcare and skipping on the bill, much like some foreigners do in Thailand.) BTW, physicians are not paid in Thailand just like in Canada if the patient does not pay for services. The hospitals just don't give the physicians money.

[Tanaka]

"...so that patients will just need to show their national identification card to receive free treatment at the nearest hospital."

This might lead one to think that foreigners in the social security or civil service systems are excluded from this plan. It's more likely that it's just poorly worded or translated.

Has anyone heard anything about that?

Hopefully, they will have to offer more evidence than that as Canada has suffered significant losses due to fraud. There are organized crime gangs that cater to North African, Central African and Lebanese medical scamsters that present counterfeit provincial health care cards and defraud the respective provinces for $millions every year. (Not to mention just showing up in an ER and getting healthcare and skipping on the bill, much like some foreigners do in Thailand.) BTW, physicians are not paid in Thailand just like in Canada if the patient does not pay for services. The hospitals just don't give the physicians money.

They do not? How then? Does every patient give money directly to the physician? I have never done that.

[geriatrickid]

"...so that patients will just need to show their national identification card to receive free treatment at the nearest hospital."

This might lead one to think that foreigners in the social security or civil service systems are excluded from this plan. It's more likely that it's just poorly worded or translated.

Has anyone heard anything about that?

Hopefully, they will have to offer more evidence than that as Canada has suffered significant losses due to fraud. There are organized crime gangs that cater to North African, Central African and Lebanese medical scamsters that present counterfeit provincial health care cards and defraud the respective provinces for $millions every year. (Not to mention just showing up in an ER and getting healthcare and skipping on the bill, much like some foreigners do in Thailand.) BTW, physicians are not paid in Thailand just like in Canada if the patient does not pay for services. The hospitals just don't give the physicians money.

They do not? How then? Does every patient give money directly to the physician? I have never done that.

Physicians in private hospitals are typically compensated based upon procedure or services performed. Once a patient or the insurer pays, the physician is paid by the hospital, less the costs and fees ascribed. the system is similar to NHS/Medicare systems in other countries. For example, under Canadian medicare, the physician bills the provincial health plan and the health plan pays the physician. If the patient is not covered by the health plan, the physician doesn't get paid and has to chase the patient. If it's done at a hospital the hospital chases the patient and the doctor doesn't get paid, but at least he isn't stuck with the facility costs. This is the same scenario as in Thailand. The fes offered by the Thai government are a fraction of what the hospitals charge. This is why the hospitals do not want any Thai "public plan" patients.

In public hospitals, the physician, particularly the younger ones are typically on a fixed salary. in order to attract and retain experienced medical practitioners, I believe there is an attempt to offer procedure incentives. The end result though is that there is a shortage of medical staff because the physicians can make more at a private hospital. The presence of a 2 tiered hospital system is bad for Thailand. (Actually it is 3 tiered as public hospitals are now allowing patients t pay extra to skip waiting lines and to have enhanced services. This extra revenue is used to compensate physicians.)

[Johpa]

Maybe they can take a look at Obamacare and just do the opposite

Thailand already has a universal healthcare plan that is indeed the exact opposite of the Republican plan that President Obama presented to Congress in the hopes of maiking a concilliatory gesture to the Republican party. I too hope thatThailand would not follow in the footsteps of the second rate US style healthcare system and would look to just about any other "western" country for a healthcare role model, such as Canada, England, France, Germany, or any of the Scandanavian countries.

[hhfarang]

Canada, England, France, Germany, or any of the Scandanavian countries

... and they should also look at the percentage of income that one has to pay in taxes in those countries for that wonderful health care service. You think the average Thai's life will be helped by having to pay 50 to 70% tax on everything they earn?

[Bagwan]

Canada, England, France, Germany, or any of the Scandanavian countries

... and they should also look at the percentage of income that one has to pay in taxes in those countries for that wonderful health care service. You think the average Thai's life will be helped by having to pay 50 to 70% tax on everything they earn?

Where did you get 50 to 70% from? In the UK (N.B. Johpa, and others who are geographically challenged, England is just one part of the UK) you'd be living high on the hog to be paying that much tax. I doubt that even throwing in N.I. contributions and VAT I was contributing that percentage, and my des res was in the better part of town and the cars in the garage were not Fords.

Although I and my family made sparing use of it, the NHS was there if needed and my kids were educated to a high standard without point of delivery payments. I certainly do think that the average Thai's life would be vastly improved if the facilities available to me and to my kids, were on tap for them.

[Bagwan]

I am not at all surprised that the Bangkok Group of hospitals are not keen on this plan. Some 8 years ago they were charging 2,600 baht for a 4 week supply of antivirals i.e. life saving medication, when they were buying in from the Government Laboratory at 1,200 baht. Recently I went to the A&E department of one of their hsopitals with a blistered big toe that had turned septic. A lady 'suit' complete with clipboard told me that the charge for treating would be 5,000 baht. I refused treatment stating that for an analgesic spray and the use of scissors to remove dead skin, a clean up and application of iodine or other antiseptic, their idea of realistic compensation was from another planet. A hurried consultation between the female 'suit' and doctor brought the price down to 4,000. I stood up and started to walk, well limp a bit, really. The final offer was 3,500. I kept walking, scolding myself for being so obtuse in going to the hospital in the first place. Ten minutes attention from a competent nurse and the use of simple non-expensive treatment for 5K? A reminder to me and further confirmation to the Government, as if it were needed, that private hospitals are about money and profit. Treating the hoi polloi for free? Not in my lifetime.

Perhaps if the private hospitals reduced the number of state of the art TVs scattered around their medical/surgical palaces and took a serious look reducing their staff numbers they might be able to make a contribution towards the wellbeing of their fellow Thais.

[hhfarang]

Canada, England, France, Germany, or any of the Scandanavian countries

... and they should also look at the percentage of income that one has to pay in taxes in those countries for that wonderful health care service. You think the average Thai's life will be helped by having to pay 50 to 70% tax on everything they earn?

Where did you get 50 to 70% from? In the UK (N.B. Johpa, and others who are geographically challenged, England is just one part of the UK) you'd be living high on the hog to be paying that much tax. I doubt that even throwing in N.I. contributions and VAT I was contributing that percentage, and my des res was in the better part of town and the cars in the garage were not Fords.

Although I and my family made sparing use of it, the NHS was there if needed and my kids were educated to a high standard without point of delivery payments. I certainly do think that the average Thai's life would be vastly improved if the facilities available to me and to my kids, were on tap for them.

Yes, the UK seems to be one of the lowest of the "socialized medicine" countries but it (tax rate) is still much higher than the U.S. and those other countries mentioned (France, Germany, and the Scandinavian Countries), you will find those 50 to 70% tax rates. I know Swedes who are hiding in Thailand to keep from paying the exorbitant tax rates in their country.