Hospitals Balk At Taking Patients In Payment Row: Thailand

[webfact]

Hospitals balk at taking patients in payment row

Chularat Saengpassa,

Pongphon Sarnsamak

The Nation

'Emergency care' definition causes clash with health funds

BANGKOK: -- The government should replace the term "emergency" with "critical" when defining medical conditions that require urgent attention, as the definition has caused confusion among both healthcare providers and patients while making private hospitals reluctant to provide life-saving treatment for state-sponsored patients, health experts say.

"There's no authority that can identify which diseases or conditions are eligible for 'emergency' medical services," Dr Samrit Srithamrongsawat, director of the Health Insurance System Research Office (HISRO), said recently.

Samrit was on a research team that evaluated the government's plan to merge its three main medical care schemes, which cover unlimited emergency medical treatment. The team studied 7,805 cases of private hospitals admitting patients for emergency medical services and receiving reimbursement from a state health agency.

He found that in 90 per cent of the cases, the emergency care patients were required to pay their medical bills themselves at full prices, then asked to check with their state health insurance providers about eligibility for reimbursement. If approved, the hospital would refund the reimbursable amounts to the patients and charge for only the excess costs.

"They are not confident that they will get full repayment from the government, so they charge patients with the full price of treatment and get reimbursed later" he added.

On April 1 last year, the government's policy went into effect to give citizens free access to emergency medical services from any hospital, no matter which national healthcare scheme they belonged to - the National Health Security Fund (NHSF), Social Security Fund (SSF) or Civil Servant Medical Benefit Fund (CSMBF).

This plan was supposed to protect people with an unexpected critical condition or severe injury in an accident, especially during festive seasons such as New Year's, which this year killed 365 and injured 3,329.

In principle, citizens just need to show their national identification card to receive emergency medical services at the nearest hospital. They would be treated until they recover and the NHSF would pay the hospital directly for their medical charges.

Emergency conditions are divided into three colour-coded categories. Red refers to a critical condition that needs emergency life-saving medical treatment. Yellow is for an acute condition that can wait a few hours before emergency treatment. Green designates moderate symptoms that can wait for medication.

However, sometimes a private hospital would categorise a patient's case as red or yellow, but when it sought reimbursement, the NHSF would categorise the case as green and not follow the hospital's request. This is why private hospitals need to charge patients the full price first, Samrit said.

According to the NHSF's report, as of November 30, 12,845 patients had received emergency medical services under this scheme at 239 private hospitals nationwide. The NHSF had paid Bt205 million to the private hospitals that joined the scheme.

However, Prof Paibul Suriyawong-paisal of Ramathibodi Hospital, head of the research team, said some people did not go to a private hospital to receive emergency medical services, as they were afraid of being charged.

But the directors of private hospitals said some of those patients had decided to go to another private hospital located far from their home instead of the nearest.

Dr Chalerm Harnpanich, chairman of the Private Hospital Association, said he wants the government to hold a meeting to discuss the problem and find a solution soon.

Dr Varunee Jinarat, director of Rajavithi Hospital, said some patients had admitted to her medical staff that they were confused about the definition of emergency medical services. However, she allowed them to receive the treatment first then request reimbursement later.

Dr Surasak Leela-Udomlipi, director of Ramathibodi Hospital, said he had instructed his staff to clearly explain to patients the medical conditions that are categorised as critical or acute. If they do not qualify, staff will advise them to go the hospital that they are registered with under their health scheme.

Samrit said the government should set up a neutral agency to point out at the first step of treatment which diseases or conditions are classified as emergencies.

Dr Winai Swasdivorn, secretary-general of the National Health Security Office, said his office is making a proposal to the NHSO's board and the government to improve the emergency medical policy, but acknowledged that there's still uncertainty over what constitutes an emergency.

To help clear up the situation, Winai will ask the government to set up a middleman to inform private hospitals and patients which medical conditions are listed as critical, acute or moderate.

-- The Nation 2013-01-14

[InActionMan]

The Hippocratic Oath starts with "first do no harm" in Thailand it's "first do nothing without cash, preferably up front"

[scotto]

Always cash up front you can die later

[SparklingCascades]

Anecdotal data suggests that 80% of patients admitted to Thai public hospitals as "emergency" or "serious" never make it out alive. So much for charging for an inept public service.

[Locationthailand]

What a cluster xxxx. User pays - T.i.T. No chance if you are a Farang without insurance. But even in some of the cases I have had, simply put down the insurance card on check in and it is taken care of. A lot of what is being said here is the rejection by the hospitals of the way they get paid out. The right insurance companies do not seem to have an issue but then again, I am not Thai so no way of knowing.

Edited January 17, 2013 by metisdead
: Profanity

[chiangmaikelly]

Anecdotal data suggests that 80% of patients admitted to Thai public hospitals as "emergency" or "serious" never make it out alive. So much for charging for an inept public service.

What anecdotal evidence? That is a very serious charge to make without data.

[Fookhaht]

Anecdotal data suggests that 80% of patients admitted to Thai public hospitals as "emergency" or "serious" never make it out alive. So much for charging for an inept public service.

What anecdotal evidence? That is a very serious charge to make without data.

Hey, ChiangMaiKeilly, don't fret. The word "anecdotal" alone tells us that he's giving us probably unreliable, and at best, dubious hearsay/gossip. By dressing it up as "data," he tries to make it look respectable. I have Thai friends in the medical profession who would would consider this a ludicrous claim.

"The expression anecdotal evidence refers to evidence from anecdotes. Because of the small sample, there is a larger chance that it may be unreliable due to cherry-picked or otherwise non-representative samples of typical cases. Anecdotal evidence is considered dubious support of a claim; it is accepted only in lieu of more solid evidence. This is true regardless of the veracity of individual claims." [source: Wikipedia]

Edited January 14, 2013 by Fookhaht

[stoli]

Anecdotal data suggests that 80% of patients admitted to Thai public hospitals as "emergency" or "serious" never make it out alive. So much for charging for an inept public service.

If this is true, they had better collect first. Probably won't change the outcome though.

[CMTourist]

Thonburi wanted over 150k per patient and ended up getting about 28k per patient. Whereas Kasemrad only claimed 60k per case and got 14.6k. Interesting.

I wonder if the rest of us can negotiate the bill down 70-80%

[Mudcrab]

The Hippocratic Oath starts with "first do no harm" in Thailand it's "first do nothing without cash, preferably up front"

same as the US system from what i saw...but definately upfront there or insurance documentation

Edited January 14, 2013 by Mudcrab

[Bluespunk]

So the hospitals put in emergency care costs when there is no emergency (who decides this, by the way?) according to the state and the state underpays when emergency care is given according to the hospitals. Hum that is a conundrum for sure. Still at least we can all agree that the patients are the ones being screwed over by this dispute.

Edited January 14, 2013 by Bluespunk

[Bagwan]

The one and only time that I have tried to avail myself of the services of the Emergency Department of what I consider Pattaya's most notorious hospital I was confronted by a "lady suit' complete with brisk manner and clipboard who, after a cursory examination told me that the cost of treatment would be 5K baht. I said that I had a septic toe and wasn't asking for an organ transplant. As I went to leave she asked me to wait while she consulted a doctor. She came back and told me that the doctor would attend to me for only 4K baht. I wished her good evening and left but couldn't resist telling her that I wished the doctor a speedy and safe return to Mother Earth. The following day in another department of the same hospital, a nurse dealt with cleaning the wound, smearing it with an antiseptic cream and applying a bandage. Total cost 350 baht.

Since there is an strong element of need in the people attending hospital emergency departments it would take a very moral Thai not to bang a few thou onto the bill. If you have been scraped up off the road or suffered an heart attack or stroke, you are not really in a position to argue any point. However those who will be asked to foot the bill, i.e.the insurers, will have a pretty good idea of the costs involved in any treatments supplied.

[Foggy Bottom]

Seems most of you are approaching Thai hospitals the wrong way. Two experiences I've had ...

In 2002, after a heavy tumble from the motorbike, I spent the night in A&E at Chiang Mai Suan Dok. Top to toe Xrays, constant medical attention, a LOT of gravel rash treated and dressed, some stitches, and a carrier bag of pills. Total bill 350 Baht and allowed to walk out to go to the ATM at the end of it. All I showed them was my Thai driving license.

In another incident where I suffered bronchiospasms and was rushed into A&E at a small rural hospital near Korat with paralysed lungs, I was given over an hour of doctor's assessment, chest Xrays, blood tests, an hour on a ventalin mask, another carrier bag of pills, and two follow up appointments for the grant total of 120 Baht. Again, all I showed was my Thai driving license (which my wife had to do as I was out of action).

If you lot are in Thailand on dubious visa conditions, haven't bothered with a Thai driving license and have no work permit, then expect to get your wallet gouged in private hospitals, especially if you want your insurance to foot the bill. If you do things properly and go into a Thai State hospital saying you'll pay for the treatment etc. you'll get the same service, just as fast, for a fraction of the price, and often from friendlier and more cheerful staff. Don't badger and be pushy, display a lot of jai yen and kreng jai - it works wonders.

[OzMick]

IMHO this is just an Thaksin-style promise of medical care with no intention of funding it. The figures show that private hospitals were willing to follow the directive until they realised that their bills would not be met. Yes, they probably overcharge, but as soon as they realised that their ability to make a profit was reduced, if not an actual loss on treatment, that goodwill went down the gurgler.

There is no such thing as free medical treatment, somebody has to pay for it, and robbing Peter to pay Paul won't work when Peter is a private company and tells you to make love elsewhere.

[BradinAsia]

My experiences with Thai hospitals are similar to those of Foggy Bottom (post # 13).

Over a period of several years, I made a dozen or more visits to Kasemrad in Bangkok. Each time, I simply told them I'd pay the bill myself. I received treatment for a variety of problems, including a nasty ear infection and 2 minor surgeries, but the bills were always so small I didn't even bother to submit them to my health insurance plan. More importantly, I was constantly impressed with the prompt and professional treatment by a very capable, friendly and efficient staff. Also, their facilities are beautiful, spic n span and spotless. Frankly, my experience with Thai medical treatment is much better than I ever had in 25 yrs in the U.S.

[smileydude]

As person who works in the thai healthcare industry let me say this:

Thailand is not the only country in the world where hospitals do not give treatment without providing some evidence that you can pay or have coverage, eg. credit card, medicare card, private insurer card etc. Same thing in the US, you have to show you can pay for the service before it is provided. Whether this is unethical or inhumane can be debated.

Thailand's National healthcare office pays each hospital around 670 baht/per patient/per year to take care of all OPD treatment (out-patient deparatment) costs.

Most of those covered by the NHC scheme are the elderly(non-employed) and epideomologically 30% of those covered by NHC are people with chronic diseases like diabetes and hypertension who require monthly visits (12/year) and medication costs average 2-3000 baht/visit. The other 70% visit the hospital on average about 2.2 times a year.

Do the math. In terms of medical economics the hospitals are losing money and except for private hospitals where it is optional to join the scheme, all hospitals under the Ministry of Public Health MUST participate in this medical coverage scheme even though they are losing money.

So instead of blaming the hospitals who are trying to survive and want fair rules on reimbursement on what is considered an emergency or critical to avoid unnecessary costs often accrued by those who abuse the system and come to the ER claiming an emergency just because they don't want to wait in the normal cues, we should take a hard look at the NHC, Social Security and Civil Service systems as a whole. The problem is Thais pay alot less in tax then say the Scandanavians or Europeans yet they want great medicare coverage and get mad having to wait a week for a hernia operation when the waiting list in the UK NHS is on average 6 months.

I place the blame on the politicians who initiated the NHC due to populist agendas to make the voting population happy for FREE medicare without caring that the system is not economically feasible and is becoming a war between the patients and the hospitals. All those fancy private hospitals don't have to give a rat's ass because they're not part of the system and its a pay-per-service business but what about all those state and university-based hospitals who have to provide UNLIMITED hospital accredited-level (HA) treatment for a capitated cost of 670 baht/patient?

There are no free rides or lunches on medicare. Pay your taxes and ask your government to appropriate more of the GDP towards healthcare (Thailand appropriates less then 5% of its GDP , its about 11% in the UK and 20% in the US). Take responsibility on caring for your own health (proper exercise, eat healthy, avoid drinking and driving etc.) and please stop whining and abusing your health benefit rights.

Then maybe we have hope the system won't crash and burn.

Edited January 17, 2013 by smileydude