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Expats Views And Experiences Using Local Government Hospitals


mikecwm

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Actually, it would be very interesting (at least for me - Falang 07) to hear about experiences expats might have with using these government hospitals for some more serious health problems. I am almost sure that if you are a paying customer with a good health insurance, there will be no queue to wait in, and it would be definitely much cheaper than those 5-star hospitals which might just concentrate too much on the luxury to justify the Hilton-like prices but the actual treatment might be the same, or who knows, even worse.

I've just copy and pasted this posting from Falang 07 from the posting "Old Expats In Thailand - Possible Hell On Earth?" as I think it deserves its own post in the Health forum. My apologies to Falang 07 for copying his words. I'll let him/her know what I've done. I'm sure it will receive more replies here.

As someone who will be retiring to Thailand in 2 years and plans on 'Self Insuring" I'm very interested in other expats experiences of cheaper treatment away from the medical Taj Mahals of Bangkok and Pattaya.

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Would depend on the facilities the government hospital has in-place to treat your illness/accident e.g. MRI. Maybe a few communication challenges, at least with nursing staff.

EDIT: Members of my Thai family who have been seriously ill have received good treatment & I have seen foreigners in beds in the open ward. You can pay for a private room at the government hospitals; at least in the Chon Buri area

Edited by simple1
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Thanks mikecwm for starting a new thread , I seem to be having the same thoughts as you as regards self insurance, I am 64 and have to make a decision soon.

I have found some good insurance companies, but they seem to be mighty expensive (one was ฿13 000.- a month without outpatient treatment). However although it is true that you can have a heart bypass operation at Bumigrad, assuming that you are able to pay for this, you have no guarantee that you won't be in for a long series of treatments or another operation a few years later. I have also learnt that many illnesses (cancer for instance) require a long series of outpatient treatments, maybe for the rest of your life. Any way you look at it, 'good' insurance is going to be the most expensive item in many people's budget, and many people find themselves deserted or priced out by their insurance company as soon as you look like costing them money.

The government hospital variant seems like a good way out, accompanied by self insurance. (If I could salt away ฿13 000.- a month I should be more than ok). An important element in this would be to have a caring family, preferably Thai, nearby.

When I make my move to Isaan in August I will be visiting the local hospitals and doctors to try to work out the best solution for my particular circumstances. Making friends with a good doctor might be a good idea.

I might get back on what I decide at a later date.

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So it is much better to be young and healthy than old and sick, especially in Thailand.

It must be a very good business to operate a hospital, or anything health-related and farang-oriented, time to get a medical degree :)

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...

Then at the top are the major tertiary care government hospitals in Bangkok, like Chulalonghorn, Siriraj, Ratchawithi, Ramitbodhi etc. These are the best, though among them some have particular areas of strength/specialization.

...

Hello Sheryl,

I enjoy reading your competent postings. Thanks for that.

Do you know tertiary care government hospitals (I have actual no outpatient insurance) in Samutsakorn (or Bangkok) which have a reasonable Urologic Center and are able treating kidney stones (Ureteroscopic surgery).

Thanks a lot.

Peter

Edited by futurespeter
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I used Chula for a reversal, was treated well and as I did the operation within Government time it was cheap. Rooms were okay, food was edible, nurses were great. Although I do not speak Thai and my wife had to work I generally enjoyed the stay.

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An important thing to understand is that there are many different levels of care in the Thai hospital system. it is not at all the case that "a hospital is a hospital". Many farang fail to understand this and go to say a district hospital with expectations that are way out of line with that level facility.

Starting from the lowest level on up, there are:

District Hospitals -- these are small, very basic places with often just 1 doctor on duty, usually a recent graduate. Will usually NOT have Xray or much in the way of a laboratory. Not recommended for anything more than basic wound care or a simple abscess. In a pinch, OK for a normal delivery but not the preferred place. By and large Thais simply bypass these places (since in truth they don't offer much), for which reason they are usually not crowded. one useful tip: most opf them offer traditional Thai massage of excellent quality. They are also a good spot for a pro forma medical certificate. Many of the bad stories you will hear about Thai government hospitals will be the result of someone going to a District hospital. Note that a government hospital in any city which is not the provincial capital -- and this include s Pattaya and Hua Hin! -- will be a District Hospital. In a few cases where th town is larger than most the District Hospitals are a bit more extensive but still a huge step below the next level up which is a:

Provincial Hospital. These are in the provincial capital town. for anything other than the simple things mentioned above, this is the lowest level worth going to. unfortunately as a result they tend to be very overcrowded. These have labs, Xray, surgical capacity and some specialists. Selected provincial hospitals also serve as:

Regional Hospitals - that means they have more areas of specialization, for example, dialysis, cancer chemotherapy, and other provincial hospitals refer to them. often but not always, they are affiliated with a medical school. The government hospital in Khom Kaen is an example of this level, ditto Chiang Mai.

Then at the top are the major tertiary care government hospitals in Bangkok, like Chulalonghorn, Siriraj, Ratchawithi, Ramitbodhi etc. These are the best, though among them some have particular areas of strength/specialization.

And completely aside from the system described above are the various military hospitals (army, navy) etc. these are open to the general public and generally offer a good quality of care, say better than a non-regional provincial hospital but a step below a regional one.

At all levels except the District Hospital, long waits and red taope are the norm. And by long waits, I mean that getting treatment will be an all day affair, and you need to arrive early.

Some of the tertiary level hospitals have established quasi-private wings where you can get appointments, choose you doctor etc, costs more of course but still usually a bargain compared top the private hospitals. I know they have this at Chiang Mai and Chula, and Siriraj plans to open one soon I(though run or has it, it will be very pricey).

I was told by a friend who visited a prominent Doctor in BKK that retiree expats can sign up for some sort of government coverage in Thailand. It seems hard for me to believe but it came from an extremely reputable source. Any one know anything about this?

Edited by georgec77
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Not true to be knowledge..if only it were!

Expats of any age who worked legally in Thailand for a certain period of time (?a year?) are covered under Thai Social Security and can maintain that coverage for life if they keep up the modest payments into the system. perhaps that is what he meant. But it is only an option for people who worked in Thailand, not people retiring here having only worked abroad.

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This is very interesting, so it might be quite useful to work at least for a year before retiring in here.

Absolutely. The Thai SS system is by far the most affordable insurance you can get. It will not let you access the higher priced private hospitals but you can get what you need through the government system which is what the vast majority of Thais do.

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i have to admit that I personally have no problems with the staff at many of the Thai Government hospitals though my own personal involvement has been limited to a couple of stays overnight.

A friends mother travels down 200 kms regularly to chula to be treated and she is delighted with her care (heart problems).

The same friend has used a government place up north quite a few times and never had cause for complaint. She did attend a private hospital when her insurance covered her and she never did sort the problem of her stomach and abdominal pains yet the government hospital did.

I personally believe a lot of government hospitals are either underrated or maybe simply looked down upon yet they can give very good service if, as Sheryl pointed out, they have the facilities.

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An important thing to understand is that there are many different levels of care in the Thai hospital system. it is not at all the case that "a hospital is a hospital". Many farang fail to understand this and go to say a district hospital with expectations that are way out of line with that level facility.

Starting from the lowest level on up, there are:

District Hospitals -- these are small, very basic places with often just 1 doctor on duty, usually a recent graduate. Will usually NOT have Xray or much in the way of a laboratory. Not recommended for anything more than basic wound care or a simple abscess. In a pinch, OK for a normal delivery but not the preferred place. By and large Thais simply bypass these places (since in truth they don't offer much), for which reason they are usually not crowded. one useful tip: most opf them offer traditional Thai massage of excellent quality. They are also a good spot for a pro forma medical certificate. Many of the bad stories you will hear about Thai government hospitals will be the result of someone going to a District hospital. Note that a government hospital in any city which is not the provincial capital -- and this include s Pattaya and Hua Hin! -- will be a District Hospital. In a few cases where th town is larger than most the District Hospitals are a bit more extensive but still a huge step below the next level up which is a:

Provincial Hospital. These are in the provincial capital town. for anything other than the simple things mentioned above, this is the lowest level worth going to. unfortunately as a result they tend to be very overcrowded. These have labs, Xray, surgical capacity and some specialists. Selected provincial hospitals also serve as:

Regional Hospitals - that means they have more areas of specialization, for example, dialysis, cancer chemotherapy, and other provincial hospitals refer to them. often but not always, they are affiliated with a medical school. The government hospital in Khom Kaen is an example of this level, ditto Chiang Mai.

Then at the top are the major tertiary care government hospitals in Bangkok, like Chulalonghorn, Siriraj, Ratchawithi, Ramitbodhi etc. These are the best, though among them some have particular areas of strength/specialization.

And completely aside from the system described above are the various military hospitals (army, navy) etc. these are open to the general public and generally offer a good quality of care, say better than a non-regional provincial hospital but a step below a regional one.

At all levels except the District Hospital, long waits and red taope are the norm. And by long waits, I mean that getting treatment will be an all day affair, and you need to arrive early.

Some of the tertiary level hospitals have established quasi-private wings where you can get appointments, choose you doctor etc, costs more of course but still usually a bargain compared top the private hospitals. I know they have this at Chiang Mai and Chula, and Siriraj plans to open one soon I(though run or has it, it will be very pricey).

Sheryl, your replies are a pleasure to read, I always look forward to them And seldom, if ever, disagree with them. Thanks.

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Sheryl - thankyou for your input - most enlightening.

I don't claim any expertise on the subject and in my 8 years of living here have never had to experience hospitalisation except for an overnight stay in a private hospital in Chiangmai after minor surgery. But in my surprisingly frequent role of "ambulance provider" for medical emergencies in our village, I have come to the conclusion that our Amphur hospital (Fang) is in a category somewhere between the District Hospital which you describe and the Provincial Hospital.

I say this because it not only a relatively modern facility (indeed at present an additional major building is under construction) but they do have x-ray facilities and labs and they use a range of experienced (be they local) doctors. I hasten to add however that if the illness looks at all serious, patients are whisked away to CM very quickly, and clearly Thai people are happy for this to occur.

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An important thing to understand is that there are many different levels of care in the Thai hospital system. it is not at all the case that "a hospital is a hospital". Many farang fail to understand this and go to say a district hospital with expectations that are way out of line with that level facility.

Starting from the lowest level on up, there are:

District Hospitals -- these are small, very basic places with often just 1 doctor on duty, usually a recent graduate. Will usually NOT have Xray or much in the way of a laboratory. Not recommended for anything more than basic wound care or a simple abscess. In a pinch, OK for a normal delivery but not the preferred place. By and large Thais simply bypass these places (since in truth they don't offer much), for which reason they are usually not crowded. one useful tip: most opf them offer traditional Thai massage of excellent quality. They are also a good spot for a pro forma medical certificate. Many of the bad stories you will hear about Thai government hospitals will be the result of someone going to a District hospital. Note that a government hospital in any city which is not the provincial capital -- and this include s Pattaya and Hua Hin! -- will be a District Hospital. In a few cases where th town is larger than most the District Hospitals are a bit more extensive but still a huge step below the next level up which is a:

Provincial Hospital. These are in the provincial capital town. for anything other than the simple things mentioned above, this is the lowest level worth going to. unfortunately as a result they tend to be very overcrowded. These have labs, Xray, surgical capacity and some specialists. Selected provincial hospitals also serve as:

Regional Hospitals - that means they have more areas of specialization, for example, dialysis, cancer chemotherapy, and other provincial hospitals refer to them. often but not always, they are affiliated with a medical school. The government hospital in Khom Kaen is an example of this level, ditto Chiang Mai.

Then at the top are the major tertiary care government hospitals in Bangkok, like Chulalonghorn, Siriraj, Ratchawithi, Ramitbodhi etc. These are the best, though among them some have particular areas of strength/specialization.

And completely aside from the system described above are the various military hospitals (army, navy) etc. these are open to the general public and generally offer a good quality of care, say better than a non-regional provincial hospital but a step below a regional one.

At all levels except the District Hospital, long waits and red taope are the norm. And by long waits, I mean that getting treatment will be an all day affair, and you need to arrive early.

Some of the tertiary level hospitals have established quasi-private wings where you can get appointments, choose you doctor etc, costs more of course but still usually a bargain compared top the private hospitals. I know they have this at Chiang Mai and Chula, and Siriraj plans to open one soon I(though run or has it, it will be very pricey).

Very good info. Great post. Thanks
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I'm afraid my opinion of Thai Government hospitals is not good.

My Thai partner's mother had some eye problems and went to the largest Government hospital in her home province. They didn't have the drugs to treat her and expected her family to try and track them down. The treatment made no difference and she gradually got sicker. After lots of tests and a different doctor with different ideas every week, she was referred to Siriraj in Bangkok. They had no beds so eventually I paid for a room, though she could only have that if a member of her family stayed with her all the time. After another multitude of tests at both hospitals and lots of drugs that were given without diagnosis (they treated for TB before they had the results - she didn't have it). They sent her home, she got worse so was taken back to the local hospital. They wanted her to go back to Siriraj, but again no beds and no ambulance to transfer her. By this time her blood pressure and platelets had dropped dangerously low and she needed oxygen. She was given transfusions and after almost a month she was finally taken up to Siriraj, not in an ambulance but a car, sitting all the way with no medical support. Again, a multitude of tests, admission to ICU and back to a ward, but still no diagnosis except that she had a lung tumour. By this time her kidneys were failing so they did a bone marrow biopsy. She died before we got the results. No final diagnosis except they thought she had disseminated cancer, probably hepatic and the lung tumour was likely to be secondary. The family agreed to an autopsy but the doctor didn't get them to sign the consent so it was never done. My partner is very upset that him mother went from having an eye problem to death in under 6 months and he has never been told why. I cannot believe that someone can go downhill so quickly either.

As he had also been losing weight and couldn't keep food down, he went to the Pattaya Government hospital (we live in Pattaya). Lots of tests and irrelevant drugs given to him and when he saw the doctor for the so-called diagnosis he was told he had Chronic Fatigue Syndrome. Total crap. If the doctor had ever seen anyone with CFS he would have known. The waits were very lengthy, the doctor's English quite poor and the time allowed to see him minimal. Far too busy running through the results on his screen to listen to anything asked of him. Eventually went for a BOGOF health check at BPH and he was diagnosed with Helicobacter Pylori, Very common here and I have it too. We have both finished treatment and he can now eat without throwing it all up. Just need one more test to be sure it's gone. Doctor's English good minimal waiting.

I have health insurance here though it only covers for hospital stays, not for outpatients. I would not chance my health in a Government hospital where the English seems to be only spoken by the doctors and you really need a translator for anything else. Most insurance companies will charge a higher premium the older you are and will not insure people over a certain age if they have not been insured with them for some time.

I would recommend buying health insurance as soon as you can to cover in-patient and accidents and make sure you have money saved to cover out-patients. If you end up with a major illness you should be covered for out-patient treatment related to a hospital stay, but it will have a limit.

At the end of the day, although a lot of the private hospitals are over priced, it seems you still get what you pay for.

Hope this helps and good luck with whatever you decide.

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I'm afraid my opinion of Thai Government hospitals is not good.

My Thai partner's mother had some eye problems and went to the largest Government hospital in her home province. They didn't have the drugs to treat her and expected her family to try and track them down. The treatment made no difference and she gradually got sicker. After lots of tests and a different doctor with different ideas every week, she was referred to Siriraj in Bangkok. They had no beds so eventually I paid for a room, though she could only have that if a member of her family stayed with her all the time. After another multitude of tests at both hospitals and lots of drugs that were given without diagnosis (they treated for TB before they had the results - she didn't have it). They sent her home, she got worse so was taken back to the local hospital. They wanted her to go back to Siriraj, but again no beds and no ambulance to transfer her. By this time her blood pressure and platelets had dropped dangerously low and she needed oxygen. She was given transfusions and after almost a month she was finally taken up to Siriraj, not in an ambulance but a car, sitting all the way with no medical support. Again, a multitude of tests, admission to ICU and back to a ward, but still no diagnosis except that she had a lung tumour. By this time her kidneys were failing so they did a bone marrow biopsy. She died before we got the results. No final diagnosis except they thought she had disseminated cancer, probably hepatic and the lung tumour was likely to be secondary. The family agreed to an autopsy but the doctor didn't get them to sign the consent so it was never done. My partner is very upset that him mother went from having an eye problem to death in under 6 months and he has never been told why. I cannot believe that someone can go downhill so quickly either.

As he had also been losing weight and couldn't keep food down, he went to the Pattaya Government hospital (we live in Pattaya). Lots of tests and irrelevant drugs given to him and when he saw the doctor for the so-called diagnosis he was told he had Chronic Fatigue Syndrome. Total crap. If the doctor had ever seen anyone with CFS he would have known. The waits were very lengthy, the doctor's English quite poor and the time allowed to see him minimal. Far too busy running through the results on his screen to listen to anything asked of him. Eventually went for a BOGOF health check at BPH and he was diagnosed with Helicobacter Pylori, Very common here and I have it too. We have both finished treatment and he can now eat without throwing it all up. Just need one more test to be sure it's gone. Doctor's English good minimal waiting.

I have health insurance here though it only covers for hospital stays, not for outpatients. I would not chance my health in a Government hospital where the English seems to be only spoken by the doctors and you really need a translator for anything else. Most insurance companies will charge a higher premium the older you are and will not insure people over a certain age if they have not been insured with them for some time.

I would recommend buying health insurance as soon as you can to cover in-patient and accidents and make sure you have money saved to cover out-patients. If you end up with a major illness you should be covered for out-patient treatment related to a hospital stay, but it will have a limit.

At the end of the day, although a lot of the private hospitals are over priced, it seems you still get what you pay for.

Hope this helps and good luck with whatever you decide.

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This is very interesting, so it might be quite useful to work at least for a year before retiring in here.

Absolutely. The Thai SS system is by far the most affordable insurance you can get. It will not let you access the higher priced private hospitals but you can get what you need through the government system which is what the vast majority of Thais do.

Just to clarify: you are saying that the Thai SS system won't let you access higher priced private hospitals, right? I was insured by that system, and assigned Paolo Memorial Hospital in Saphan Kwai, a private hospital, and had a fairly serious procedure there, and it was totally covered. Paolo is not Bumrungrad, certainly, but thay are not particularly cheap either.

I agree that it is probably the best insurance available to foreigners, but I believe there is an age restriction (60), after which you either cannot maintain coverage, or cannot obtain coverage - not sure which.

Thanks for all your thoughtful replies.

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I have a medical insurance with a Thai Company and when the policy matures when I am 70 years of age, the insurance is terminated and I receive one millions baht on maturity. I intend to deposit this in a savings account and leave it there until needed for medical requirements, and hopefully when it is time to go to the "pub in the sky", it will be a relatively quick and cheap departure - economy class so to say!wai.gif

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...

Then at the top are the major tertiary care government hospitals in Bangkok, like Chulalonghorn, Siriraj, Ratchawithi, Ramitbodhi etc. These are the best, though among them some have particular areas of strength/specialization.

...

Hello Sheryl,

I enjoy reading your competent postings. Thanks for that.

Do you know tertiary care government hospitals (I have actual no outpatient insurance) in Samutsakorn (or Bangkok) which have a reasonable Urologic Center and are able treating kidney stones (Ureteroscopic surgery).

Thanks a lot.

Peter

Yan Hee hospital Bangkok

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Living in Hua Hin I have had minor surgery three times at government hospital ( Hua Hin )

Large tumour remove4d from my back size of a quall egg, 30 minute op under a local total cost inc follow up 3000 baht, skin cancer removed twice under a local each cost 2000, Problem very busy however they have a fast track system where for an extra 200 baht you go to the front of the cue on initial visit as for surgery waiting time 4 days, Surgeons all speak good English and they have a special office for farangs to explain how things work with English speaking staff.

Went once to Bangkok hospital for skin cancer removal on my face 20 minute op undaer a local total cost 37,000 baht ( never again )

hope this answers some of your questions by the way I am 69 and find insurance very very expensive. I have a wad in the bank for emegency medical treatment and anything really big will go home for it.

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Not true to be knowledge..if only it were!

Expats of any age who worked legally in Thailand for a certain period of time (?a year?) are covered under Thai Social Security and can maintain that coverage for life if they keep up the modest payments into the system. perhaps that is what he meant. But it is only an option for people who worked in Thailand, not people retiring here having only worked abroad.

Your information is great but one thing not mentioned so far is---- how far will a yellow book get you in the Thai government hospital system. I am about to apply for one. Thank you.
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Not true to be knowledge..if only it were!

Expats of any age who worked legally in Thailand for a certain period of time (?a year?) are covered under Thai Social Security and can maintain that coverage for life if they keep up the modest payments into the system. perhaps that is what he meant. But it is only an option for people who worked in Thailand, not people retiring here having only worked abroad.

Your information is great but one thing not mentioned so far is---- how far will a yellow book get you in the Thai government hospital system. I am about to apply for one. Thank you.

Yellow Tambien Ban has no relevance for a foreigner at a Thai Government Hospital, other than proving your residential address

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This is very interesting, so it might be quite useful to work at least for a year before retiring in here.

Absolutely. The Thai SS system is by far the most affordable insurance you can get. It will not let you access the higher priced private hospitals but you can get what you need through the government system which is what the vast majority of Thais do.

It is important that you enter the system before you are 60 as you must be under that age to start. Once you are enrolled you can retain your benifits by paying a fee.

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Not true to be knowledge..if only it were!

Expats of any age who worked legally in Thailand for a certain period of time (?a year?) are covered under Thai Social Security and can maintain that coverage for life if they keep up the modest payments into the system. perhaps that is what he meant. But it is only an option for people who worked in Thailand, not people retiring here having only worked abroad.

Your information is great but one thing not mentioned so far is---- how far will a yellow book get you in the Thai government hospital system. I am about to apply for one. Thank you.

Yellow Tambien Ban has no relevance for a foreigner at a Thai Government Hospital, other than proving your residential address

Then how come one foreigner that i know had 70,000BHT hospital expences waived because he has got a Ywllow Tambien Ban and its not the first time. The only thing he had to pay for was his private room.
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