Need Info On Current Thai Government Health Insurance Scheme

[AbeSurd]

I'm trying to help the three-year old grand-daughter of a Thai acquaintance of mine get some hospital treatment. However, before forking out for this myself I'd just like to understand what options are (or are not) available to her family under Thai government funded health care. They are a relatively poor family.

I understand from talking to another Thai acquaintance today that the so-called "30 baht" Thai government health insurance scheme no longer exists. Instead this Thai acquaintance showed me a pink card she has which is for something similar. She called it something like "bpra-gan su-ka-paap tuan-naa" which I've tried to look up in the dictionary. I can get as far as "bpra-gan su-ka-paap" (health insurance) but I don't know what "tuan-naa" is. In order to get the card she told me she had to go a local government office with her Thai ID card and the title deed to her home.

Three questions....

Does what I've said so far sound correct?

Has anyone got any more details about this "bpra-gan su-ka-paap tuan-naa" scheme?

I believe not every type of treatment is available under these government schemes, or that cover can be very limited. The medical condition here is strabismus ("crossed eyes"). Does anyone have any idea whether treatment for it would be covered under the current government scheme?

Thanks for your help.

PS: I'm not sure whether this post is better in the health forum or the insurance forum. I've gone for the latter. Mods please move it if you see fit. Thanks.

[citizen33]

Take a look here.

http://www.nhso.go.t...te/Default.aspx

You'll see a page about the benefits package under 'information'.

In recent years the 30 baht scheme has been known as the universal coverage scheme, but in September the 30 baht co-payment was reintroduced so it is possible that the old name will reappear. The scheme has evolved since its inception in 2001, but still has the main characteristics of the original 30 baht model,

My understanding is that this condition would be covered, but it can sometimes be difficult to get the directors of smaller hospitals to provide treatment according to the terms of the scheme. You could get a Thai friend to call the free 1330 NHSO telephone helpline to make ask about this treatment,

Loosely translated 'tuan na' means 'for everybody'. Gold cards are being phased out and UCS members can use their new-style citizen identity cards instead. To gain membership Thai citizens still need to establish their place of residence via a house registration document to determine which primary care and hospital network they are entitled to use as point of entry to the system.

If you want to learn more about Thai public health care look here.

http://www.social-pr...ssourceId=28441

[AbeSurd]

Thank you citizen33.

All of that is very helpful indeed.

Much appreciated.

[citizen33]

I did make a slight mistake in quoting your passage. It should be 'tua na'.

[AbeSurd]

For what it's worth, I asked my Thai teacher about this word today. She suggested it was spelt ถ้วนหน้า in Thai which, looking at it, I would transliterate as something like "tuan-naa".

If you put ถ้วนหน้า into Google Translate it comes out as 'coverage'.

But I'm not much wiser for all that!

[citizen33]

For what it's worth, I asked my Thai teacher about this word today. She suggested it was spelt ถ้วนหน้า in Thai which, looking at it, I would transliterate as something like "tuan-naa".

If you put ถ้วนหน้า into Google Translate it comes out as 'coverage'.

But I'm not much wiser for all that!

Thanks. Actually your pronunciation is probably correct, but I think 'for everybody' is a fair translation having checked here.

http://www.thai-language.com/id/216562

[AbeSurd]

Things have moved on a little bit.

The family are currently taking the little girl to Ratchawithi Children's Hospital (I think known more formally as Queen Sirikit National Institute of Child Health) in Bangkok.

The information from the doctor there is that the special glasses they're currently prescribing are not covered by the 30 baht scheme, so I'm going to be paying for those. This fits in with what another Thai acquaintance told me the other day, namely that spectacles aren't covered by the 30 baht scheme at all.

I'd be interested to hear if anyone (citizen33?) thinks that is not the case?

In three or four years time the doctor says he may advise an operation for the strabismus - and that might be available under the 30 baht scheme. But that would be at another hospital.

So on that front we'll have to wait and see. In three or four years time I guess no one knows what might be (or might not be) in place.

Thanks.

[citizen33]

I checked the position with two Thai colleagues in senior positions to be sure my advice was correct. They agree that eye glasses and other ophthalmology procedures are included in the benefit package of the universal coverage scheme. However, NHSO has avoided publicising cover for free eye glasses because of worries about stoking up demand and costs. There is also a problem of access since most MoPH providers do not currently have any facilities for supplying eye glasses, even though reimbursement may be available. It seems that the issue of eye glasses for children is currently preoccupying policy makers and that a clearer statement on this issue may be made soon.

So as I said in my earlier post a call by a Thai speaking family member to the free 1330 helpline might help.

The other thing that is lurking in the background in your account concerns referral pathways. In theory the family should in the first instance take the girl to a facility within her registered contracting unit for primary care (i.e. CUP - a health centre or hospital in the network where was she signed up for the scheme). A health professional within the network will then make any necessary referral to an outside hospital. The problem is that if the parents take her direct to a specialist hospital (even one that does some UCS work) that provider will treat her as a private patient. It seems likely that the specialist hospital you mention does do some UCS work, but is not a hospital to which the girl’s CUP normally makes referrals. Certainly an operation to correct this condition is clearly within the benefits package.

[AbeSurd]

Citizen33, first of all, I must thank you again. Your advice is proving to be a tremendous help to me. Thank you.

From my recent communications with the family it now seems there is another rather different slant to the story. From what they tell me it sounds like the main problem is that the little girl doesn't have access to ANY treatment under government health insurance scheme(s). And the reason why she doesn't have access is to do with her parents splitting up. (This is also why the little girl is being looked after by her grandmother now.) As I understand it, although Granny herself gets treatment at the local government hospital here in Pattaya under the 30 baht scheme, when they take the girl along to the hospital they have to pay the full cost for her.

A bit of background. I met the father (briefly) some months ago here in Pattaya, when he was on a brief visit. He must've been about 17 or 18 when the child was born. From what I can gather he moves around the country working. He's currently in Bangkok. A while ago he was in Samui. (A friend of the family has suggested to me his drinking is a problem.) As for the mother: from what the grandmother tells me, when she was around she was cruel to the little girl. Granny doesn't think she will ever return.

Incidentally, as far as I'm aware, everyone in the family is a Thai citizen. The paperwork from Queen Sirikit National Institute of Child Health (aka Ratachwithi Children's Hospital) has on it a 13 digit number on that relates to the girl. I'm told it will go on her ID card once she's seven years old.

Now I have this information I can make enquiries elsewhere. And in my stumbling Thai I will of course be asking the family more about all this in due course - although it's obvious to me now that they are very reluctant to talk about it with me. In the meantine perhaps I can ask citizen33 or anyone else reading this thread: do you have any idea what the grandmother has to do to get the girl access to treatment generally under government health insurance scheme(s)? As the girl already has a Thai ID number (though not an actual ID card as she is too young), it seems to me the likely problem is one of residence. That she needs to be listed on a house book somewhere? And perhaps that needs to be the house book where her parents live (or one of her parents lives)? Alternatively, if she had an official guardian, the house book for her guardian's place of residence? (I'm guessing here that granny is not an official guardian.) Am I along the right lines here?

Many thanks.

[citizen33]

Although I have a reasonable knowledge of macro health policy, I'm not sure about the 'nuts and bolts' in a case like this. I think you need:

(1) To get the child's name added to the grandmother's house registration document (tabien baan) in the relevant local government office. In my area this would be the amphur office, but as Pattaya is a special administrative zone I'm not sure what your office is called.

(2) The grandmother will need the child's birth certificate to do this. If there is no birth certificate one can be obtained from the local government office in the district of birth, but one would need full details of mother, and date/place of birth to get one (I'm hazy about exact requirements here).

(3) Once in possession of the tabien baan bearing the child's name and a birth certificate, the grandmother can present these at the district health office or community hospital in the area where the grandmother is registered to gain membership of the universal coverage scheme.

Once again a call to the 1330 helpline to get advice might be worthwhile. Sorry this is not 100% definitive but it should be possible to get the child registered with a little digging.

[AbeSurd]

Again my big thanks to you citizen33.

I'll see where I get with this. It all seems a little odd because the family definitely care about the girl. And they're not stupid or lazy people either.

Thank you.

[revar]

I have a tabian baan (yellow) and have been under treatment/checkup for high bloodpressure in the ampeuh goverment hospital for over 2 years. A year ago the local hospital made some calls and told me that I could join the free healthcare. It took about 8 months but now I have been accepted and get treatment and medicines for free at local, ampeuh and province hospital. I am not thai

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[AbeSurd]

I have a tabian baan (yellow) and have been under treatment/checkup for high bloodpressure in the ampeuh goverment hospital for over 2 years. A year ago the local hospital made some calls and told me that I could join the free healthcare. It took about 8 months but now I have been accepted and get treatment and medicines for free at local, ampeuh and province hospital. I am not thai

That's very interesting to know. So have they issued you with one of those "bpra-gan su-ka-paap tuan-naa" pink cards that I referred to in my OP?

Couple of other related questions, if that's okay....

What kind of visa do you have?

What area of Thailand do you live in?

Thanks.

[revar]

Don't need a card. As C33 said, thais use their ID card and I use my passport. The hospital sees in the computer that I am covered by the scheme. As with thais this only applies to my local hospital, the ampeuh hospital and the provincial hospital. In any other hospital I have to pay.

If they call up my medical file in these hospitals it mentioned that I am covered with my passport nummer (I'll have tokeep carying my old passport if it expires and I get a new one with a new number). I am here on a non-o visa with anual mariage extentions. I live in a small vilage in Khorat province.

I do now that both my doctor and the pu yai ban put in some effort to get this done. So it may be one of those cases where an exception was made. I was the first farang in the ampeuh to get married there 13 years ago, the first to get a tabian baan and the first to adopt his sons. All these took a lot of time and effort but can be done even if the first reaction is not positive.

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[revar]

Just reread your earlier posts mentioning a different hospital.

In my case there are three hospitals where I am covered.

1) Sub-district hospital. First point of contact for small problems + no beds, like a general doctor.

2) district(ampeuh hospital). You go there/are send for more serious problems. They have labs /equipment etc.

3) provincial hospital. The dustrict hospital will transport you here for very serious cases or surgery.

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[citizen33]

Some other members have reported situations similar to that described by Revar. All I can say is that some very senior people in the NHSO have told me that this was something that occasionally happened by mistake in the past but should not occur now. So I guess it is a case of enjoying a benefit that has come your way, but being aware that there might be some questions raised in the event of an expensive referral.

The 'three hospitals' mentioned are just the normal referral network found in most contracting units for primary care (CUPs). Ideally the member is supposed to start in the health centre (or variants such as the sub-district health promotion hospital and PCU), and may then be referred to the community hospital or provincial hospital depending on what is needed. In fact the universal coverage scheme also makes provision for referral to specialist tertiary care facilities away from the local area when this is necessary.

[phutoie2]

I have a tabian baan (yellow) and have been under treatment/checkup for high bloodpressure in the ampeuh goverment hospital for over 2 years. A year ago the local hospital made some calls and told me that I could join the free healthcare. It took about 8 months but now I have been accepted and get treatment and medicines for free at local, ampeuh and province hospital. I am not thai

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"Free medicine", you are indeed very fortunate. I have hyper tension issues too and see my local Poly Clinic Thai doctor. The consultation/check up is always free, and I have to pay for the BP tablets.

If I cannot make it too the clinic, Facino's in Tesco Lotus sell the same medicine.

From what I see at the Poly clinic desk for collecting your medicine, the local people are paying too. Perhaps they are not all members of the free health care scheme that is being discussed here.

[revar]

This was my situation before also when I had a hospital card. Checks were free but I had to pay for medicines. Locals did not. This was in both the hypertention 'clinic' and for normal visits. Then the first contact doctor who lives across the street called my wife and told her eules had changed and she made some calls and got me accepted. I think c33 is correct that it was only possible for a short time because other farangs I know have tried later but have to pay for everything or only medicines.

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[starship]

Hi.

I have mentioned this 30 baht scheme before to my Thai partner and she seems convinced that you get nothing but the most basic treatment. As with all things in Thailand it matters who you know and things can sometimes be achieved. If you know any government employees, certainly more senior ones, doors can sometimes be opened. My partner knows some government employees and says that when you go to do something at various places there is a record of state employees on their systems which they can refer to. As another poster mentioned it is best to get referred to another facility rather than going directly as this is frowned upon. Queen Sirikit hospital is well regarded my partner tells me. I forget if this is private or government. Chulalongkorn hospital near silom is perhaps regarded as one of the top government places. A lot of their doctors work elsewhere in top private hospitals i am told. Any government hospital should treat a child but in terms of choice you will obviously have to pay something to go to a particular government hospital of your choosing or potentially a lot to get quick high quality healthcare at one of the many private hospitals as i understand it. Your decision.

Hope this is of some use. Good luck.

[kamalabob2]

Starship: I'll respectfully disagree with your partner on the "30 baht" Government insurance scheme for Thai citizens. My wife has two conditions not covered by BUPA in patient which require quite a bit of pharmacy drugs EACH month to control her conditions. She knows NO ONE in local Government, she has a 6th grade village education and comes from a humble but honest family background. I certainly have "no clout" at the Government Hospitals. She went "step by step" and followed procedures to get quality treatment for two conditions not covered by BUPA as they were pre-existing AND/OR treated as an OPD procedure. Sure it means 10 hours, no kidding 10 hours at the Buriram Government hospital from first blood tests in the morning to seeing the specialist, to getting the 30 baht worth of real drugs. She has gone through the steps in Buriram to be able to be treated at a top hospital in Kohn Kaen, at no charge, just our time and gas to go to Kohn Kaen if we wanted to pursue the medical course of action. My wife has been an inpatient of Bumrungrad, Bangkok Christian, and several other private hospitals covered 100% by BUPA.

The point is that if a Thai citizen has a condition that is going to be denied for a period of time by ANY private health insurance company, OR if the treatment for a condition is done on OPD and you do not want to pay for OPD private health cover, you can with "no connections" get top grade medical care, and top pharmacy drugs for 30 baht. But plan ALL day, up to and 10 hours and wait to be give tests, wait her turn to see a Doctor and wait her turn to pay at the pharmacy window and wait her turn to pick up the drugs. No bribes, no attitude, but first the local hospital, to get the note to go to the provincial hospital, and then after two trips to the provincial hospital was the letter written and faxed if she wanted more tests at the regional hospital in Kohn Kaen. Step by step, but in her recent experiences, Doctors in the Government system that would give her a 30 minutes in the hospital office consultation, go over each test result, do an in room exam, and not be shy on the prescription pad. I tried two different approaches to get on this same 30 baht health plan, but "No longer can do for Farang" was both times the final answer in November 2012 and I did have a local Government official try for me, and my wife approached the right office of the right hospital with my yellow house book, but "rules have changed". I paid my BUPA premium. There are Farang who might have "lucked out" and gotten on the 30 baht plan, but they are the exception, rather than the current rule and I do not begrudge them one minute.

My wife is NOT in the same health scheme that Government Employees or people who pay into a Social Security due to gainful on the books employment.

[revar]

I agree with above poster. You can get good quality medical treatment for free at goverment hospitals but you need time. My Mother in law has diabetus and is over 70. I have hypertention. We go to the 'clinics' at 05.00 am for the diabetus clinic to get a low number( be first in line). Over 200 people get checked at the same time. We get back around 3 pm. So its a whole day. Next day I have to go doe my htpertention clinic.

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