Does Bangkok Hospital Double Charge?

[Satcommlee]

Sheryl,

Don't know if your native language is British English or not..

But when I went to school this expression pretty much means lying.

You are of course talking through your backside

Anyway don't panic, I am not about to have an argument with an online persona, I'm nearly 40 - bit too old for that.

Edited April 23, 2013 by Satcommlee

[THAIPHUKET]

If you are referring to getting given an excess number of medications, this has nothing to do with being a foreigner; it is a deeplky ingrained part of Thai medical culture. Thai patients often equate the number of different medications given with the quality of the care and feel poorly treated if they don't get a number of different things. Thai doctors assume all patients feel this way.

The private hospitals actively encourage this for profit reasons, but it happens even in the government ones where the economic incentives are in the opposite direction.

I used to get upset , not loud but simply upset about the over-medication. Now I understand and accept, very helpful indeed, Sheryl

[Totster]

Sheryl,

Don't know if your native language is British English or not..

But when I went to school this expression pretty much means lying.

You are of course talking through your backside

Anyway don't panic, I am not about to have an argument with an online persona, I'm nearly 40 - bit too old for that.

Actually, it means more like you are replying without actually knowing what you are talking about, different from deliberately giving a wrong answer - that would be lying.

totster

[Sheryl]

Thanks Totster, I'm not a Brit but that was my understanding as well. (Not that it was a polite thing to say, it wasn't. )

[Soutpeel]

But when I went to school this expression pretty much means lying.

No it doesnt...if I thought your were lying, I would have said so

Why do you keep harping on about this ?

[Soutpeel]

If you are referring to getting given an excess number of medications, this has nothing to do with being a foreigner; it is a deeplky ingrained part of Thai medical culture. Thai patients often equate the number of different medications given with the quality of the care and feel poorly treated if they don't get a number of different things. Thai doctors assume all patients feel this way.

The private hospitals actively encourage this for profit reasons, but it happens even in the government ones where the economic incentives are in the opposite direction.

I used to get upset , not loud but simply upset about the over-medication. Now I understand and accept, very helpful indeed, Sheryl

If you feel you are being "over-medicated" you can refuse to accept all the medication, just ask them to give you a script nad you can pick and choose what you want and buy from a pharmacy...no one is holding a gun to your head

[uhuh]

The idea that health care in Thailand knows no double-pricing based on race is very strange, indeed.

Why should this be the only sector in the Thai economy where there is no double pricing?

Government hospitals have officially sanctioned higher prices for farang since about the year 2000.

Private hospitals sometimes dont have double-pricing, but if they have a lot of foreign patients, they usually - but not always - have a complicated system of various price tiers:

Thai (cheapest)

resident farang

resident farang with local insurance

resident farang with international insurance

tourist farang

tourist farang with insurance (most expensive, several times more than Thai)

Things are more complicated than this.

The doctor can charge whatever he wants (many doctors in Bumrungrad will charge a Thai 500 B, a farang 1000 .

According to nationality, patients will be put in different rooms (with different prices - and of course, the patient doesnt even know there are different rooms), may be treated by different doctors (same) and so on.

Things do vary from hospital to hospital. Eg, Bumrungrad is actually quite cheap for Thais, but the most expensive hospital for foreign tourists, whereas Samitivej is very expensive for everyone, it doesnt help if you are Thai.

[ableguy]

When you walk in they will measure you, take your temp and blood pressure charge 150 baht, you cannot decline this, Be aware the dr gets paid 180 every time he writes a prescription I wised up and asked for the name of the meds to buy outside but he insisted on writing a prescription for one pill so I could take it and shop around still cost me 180 baht plus the pill. They are good docters but the Baht is whats on there mind and seem to think every farang is loaded, they usually try and get you to back as much as they can. I went to see the dentist there in Hua Hin to ask the cost of dentures question cost 550 Baht and he suggested loads of work ( many many thousand Baht that I did not need)

That was the final straw for me, I could tell many horror stories about the one in BKK but wont hope you get the drift, unless on insurance stay clear.

[kriswillems]

Government hospitals have officially sanctioned higher prices for farang since about the year 2000.

Really? What's your source?

[Soutpeel]

When you walk in they will measure you, take your temp and blood pressure charge 150 baht, you cannot decline this, Be aware the dr gets paid 180 every time he writes a prescription I wised up and asked for the name of the meds to buy outside but he insisted on writing a prescription for one pill so I could take it and shop around still cost me 180 baht plus the pill. They are good docters but the Baht is whats on there mind and seem to think every farang is loaded, they usually try and get you to back as much as they can. I went to see the dentist there in Hua Hin to ask the cost of dentures question cost 550 Baht and he suggested loads of work ( many many thousand Baht that I did not need)

That was the final straw for me, I could tell many horror stories about the one in BKK but wont hope you get the drift, unless on insurance stay clear.

But you do know private hosptials are business's dont you ?....same as when you take your care for a service they will charge you for many things you may not need at inflated prices....its called captalism, and within captialism you have choice..they are holding a gun to your head

As to the first part of your post..."you cannot decline"....BS...yes you can...its your money, your paying the bill...you can decline anything you want.

I get the distinct impression that there are numerous people commenting believe they are entitled to private health care at nominal cost....in all my experiences at private hosptials in various parts of the world, I have are given an indicative cost upfront as regards the treatment and its been my choice alone as to whether to proceed or not.

This is not NHS or any other goverment subsidised health care your dealing with..

[Soutpeel]

Thai (cheapest)

resident farang

resident farang with local insurance

resident farang with international insurance

tourist farang

tourist farang with insurance (most expensive, several times more than Thai)

Do you really believe hospitals have a table like this with the various costs detailed..

[uhuh]

Government hospitals have officially sanctioned higher prices for farang since about the year 2000.

Really? What's your source?

???why do i need a source for that???

[uhuh]

Thai (cheapest)
resident farang
resident farang with local insurance
resident farang with international insurance
tourist farang
tourist farang with insurance (most expensive, several times more than Thai)

Do you really believe hospitals have a table like this with the various costs detailed..

its not that i believe it

i just happen to know it

those hospitals who deal with farangs a lot and who make most of there money from foreigners do have detailed lists like these

[kriswillems]

Government hospitals have officially sanctioned higher prices for farang since about the year 2000.

Really? What's your source?

???why do i need a source for that???

Because I would like to know if it's true and who decided it and if this is a nationwide thing or a personal experience. With more information we/I might be able to make better choices next time we/I need to go to a hospital. Some other people in this thread also have problems believing your claims. Telling them why you know all these things would take away much doubt. Edited May 2, 2013 by kriswillems

[uhuh]

Sorry, im not in the business of "taking away much doubt".

I couldnt care less if someone believes what i write or not.

Yes, it is a nationwide thing.

But different hospitals do things differently.

It depends on their owner, its his decision.

Hospitals with the same owner may follow different policies (almost all private hospitals in Thailand nowadays have the same owner anyway), e.g. Samitivej Sukhumvit and BPH.

The staff implementing these policies may get confused with all these rules and regulations, so sometimes the result is a mess.

This is not Prussia, after all.

As stated many times on this board, doctors fees are up to the doctor. Many doctors will charge a foreigner 2 or 3 times what they would charge a Thai, but there are also many doctors who dont do this.

As for your choices: try to find out whether they have a price for resident foreigners (they may not want to tell you), and try to get this price.

Telling them you have insurance roughly doubles the price, and drastically alters the care you get, sometimes for better (you may get an expensive test done that they wouldnt even dare to suggest if they thought you pay out of pocket, and they will perform all necessary surgery), sometimes for worse (they will keep you hospitalised for a week if you could just as well stay at home, and they will perform unnecessary surgery).

If your Thai partner goes to a hospital, and you accompany him/her, thats the same as telling them you have insurance.

[wprime]

I've seen no evidence to suggest that Bangkok Hospital charges foreigners more. However, it's a very expensive place. I do know of one example where the Hospital loaded the price of medication 10 times above the normal pharmacy price.

Their other trick is to attempt to persuade patients to take a private room when they expected out patient treatment. After being caught once, I was prepared when I took my wife there for a minor operation to lance a blocked saliva duct. During the consultation with a doctor, two women in office uniform burst into the consulting room and took over the conversation. They had been briefed on why we were there and wanted to book my wife into a room and suggested that a general anaesthetic was required. The doctor hadn't even got that far in what she was saying. I suggested that a room overnight wasn't necessary. Their response was that she would be tired after the operation. I mentioned that we had beds at home and that this was a matter for an out patient operation under local anaesthetic. When they persisted I let them know that I was familiar with the game and asked them to leave. The doctor agreed with my view on what was required The next day, we returned. The operation took thirty minutes and my wife was fine to travel. Beware the smiling sales ladies in navy blue uniforms.

I got tricked by that too, they dosed me up on pethidine before getting me to sign the paperwork.

[seadoo]

Simple answer yes, if you think a tourist attraction can charge double if not more for foreigners then obviously the hospitals will do same.

I once went to pay my bill for an outpatient service and they thought I was paying cash, that in itself was highly priced, they presented me with the bill and then I told them no it was on my insurance and then after a few key punches on the computer the price almost doubled.

If I have to get medicine I ask for a prescription and then take it to the pharmacy outside at the front and the price is more than half for the same medicine. For example I buy a special vitamin for my eye condition in the hospital its sold at 1050 baht just outside at the pharmacy on Sukhumvit its 490 baht same brand etc.

[Woolybully]

Simple answer yes, if you think a tourist attraction can charge double if not more for foreigners then obviously the hospitals will do same.

I once went to pay my bill for an outpatient service and they thought I was paying cash, that in itself was highly priced, they presented me with the bill and then I told them no it was on my insurance and then after a few key punches on the computer the price almost doubled.

If I have to get medicine I ask for a prescription and then take it to the pharmacy outside at the front and the price is more than half for the same medicine. For example I buy a special vitamin for my eye condition in the hospital its sold at 1050 baht just outside at the pharmacy on Sukhumvit its 490 baht same brand etc.

Not only the disgusting Bangkok Hospital but all private hospitals overcharge foreigners ! As a foreign friend was seeking for a hospital with an incubator because his two days old daughter had contracted pneumonia, he was quoted THB 100.000 a day. Other hospitals quoted more or less the same. The only one quoting a much lower price was Phyathai at THB 20.000 a day. When we confirmed the room , they organized an ambulance with incubator to pick up the mom and baby. Upon arrival at the hospital they were told that they made a mistake with the price and Farangs pay THB 50.000 to 75.000 per day. Same goes at event parks etc. This is a disgraceful scam and stinks of prejudice and racism. In our western countries, the hospitals charge the same regardless of race , colour, believe and origin....but then again...we have only few Private Hospitals that can charge whatever they want. However if the baby would have gone to a government hospital it may have died as they did not have the oxygen combined with some sort of gas to enable the pneumonia to heal. The baby was released after 4 days and THB 200.000 plus....I would pay anything to save my baby´s life , but if I would not have the money...my baby would die ? Where is the Doctor codex to save life...yeah at any cost !

[Sheryl]

Simple answer yes, if you think a tourist attraction can charge double if not more for foreigners then obviously the hospitals will do same.

I once went to pay my bill for an outpatient service and they thought I was paying cash, that in itself was highly priced, they presented me with the bill and then I told them no it was on my insurance and then after a few key punches on the computer the price almost doubled.

If I have to get medicine I ask for a prescription and then take it to the pharmacy outside at the front and the price is more than half for the same medicine. For example I buy a special vitamin for my eye condition in the hospital its sold at 1050 baht just outside at the pharmacy on Sukhumvit its 490 baht same brand etc.

Not only the disgusting Bangkok Hospital but all private hospitals overcharge foreigners ! As a foreign friend was seeking for a hospital with an incubator because his two days old daughter had contracted pneumonia, he was quoted THB 100.000 a day. Other hospitals quoted more or less the same. The only one quoting a much lower price was Phyathai at THB 20.000 a day. When we confirmed the room , they organized an ambulance with incubator to pick up the mom and baby. Upon arrival at the hospital they were told that they made a mistake with the price and Farangs pay THB 50.000 to 75.000 per day. Same goes at event parks etc. This is a disgraceful scam and stinks of prejudice and racism. In our western countries, the hospitals charge the same regardless of race , colour, believe and origin....but then again...we have only few Private Hospitals that can charge whatever they want. However if the baby would have gone to a government hospital it may have died as they did not have the oxygen combined with some sort of gas to enable the pneumonia to heal. The baby was released after 4 days and THB 200.000 plus....I would pay anything to save my baby´s life , but if I would not have the money...my baby would die ? Where is the Doctor codex to save life...yeah at any cost !

I cannot imagine why you say this. Tertiary level government hospitals most certainly do have this and all other advanced facilities.

[Soutpeel]

I've seen no evidence to suggest that Bangkok Hospital charges foreigners more. However, it's a very expensive place. I do know of one example where the Hospital loaded the price of medication 10 times above the normal pharmacy price.

Their other trick is to attempt to persuade patients to take a private room when they expected out patient treatment. After being caught once, I was prepared when I took my wife there for a minor operation to lance a blocked saliva duct. During the consultation with a doctor, two women in office uniform burst into the consulting room and took over the conversation. They had been briefed on why we were there and wanted to book my wife into a room and suggested that a general anaesthetic was required. The doctor hadn't even got that far in what she was saying. I suggested that a room overnight wasn't necessary. Their response was that she would be tired after the operation. I mentioned that we had beds at home and that this was a matter for an out patient operation under local anaesthetic. When they persisted I let them know that I was familiar with the game and asked them to leave. The doctor agreed with my view on what was required The next day, we returned. The operation took thirty minutes and my wife was fine to travel. Beware the smiling sales ladies in navy blue uniforms.

I got tricked by that too, they dosed me up on pethidine before getting me to sign the paperwork.

I dont beleive you

[Soutpeel]

we have only few Private Hospitals that can charge whatever they want.

All private hosptials charge what they want....its called Capitalism and under captialism you have choice..

[kriswillems]

My neighbor is a doctor that worked all his life in a government hospital ( he is retired now). He said that more than once the hospital paid for the treatment/operation of a farang in this hospital because the farang had no money.

If you go to a government hospital and you really need help, they will help you. If you really can't pay the chance is high that they will also help you.

As said the doctor has the freedom to charge a bit more or a bit less based on his personal impression. If the doctor sees someone is poor he might charge a lower price (by not charging for some parts of the treatment). It works in two directions: some people are undercharged and others are overcharged. I think this also happens with Thai people, it's not really a farang only thing.

Edited May 3, 2013 by kriswillems

[uhuh]

Simple answer yes, if you think a tourist attraction can charge double if not more for foreigners then obviously the hospitals will do same.

I once went to pay my bill for an outpatient service and they thought I was paying cash, that in itself was highly priced, they presented me with the bill and then I told them no it was on my insurance and then after a few key punches on the computer the price almost doubled.

If I have to get medicine I ask for a prescription and then take it to the pharmacy outside at the front and the price is more than half for the same medicine. For example I buy a special vitamin for my eye condition in the hospital its sold at 1050 baht just outside at the pharmacy on Sukhumvit its 490 baht same brand etc.

Not only the disgusting Bangkok Hospital but all private hospitals overcharge foreigners ! As a foreign friend was seeking for a hospital with an incubator because his two days old daughter had contracted pneumonia, he was quoted THB 100.000 a day. Other hospitals quoted more or less the same. The only one quoting a much lower price was Phyathai at THB 20.000 a day. When we confirmed the room , they organized an ambulance with incubator to pick up the mom and baby. Upon arrival at the hospital they were told that they made a mistake with the price and Farangs pay THB 50.000 to 75.000 per day. Same goes at event parks etc. This is a disgraceful scam and stinks of prejudice and racism. In our western countries, the hospitals charge the same regardless of race , colour, believe and origin....but then again...we have only few Private Hospitals that can charge whatever they want. However if the baby would have gone to a government hospital it may have died as they did not have the oxygen combined with some sort of gas to enable the pneumonia to heal. The baby was released after 4 days and THB 200.000 plus....I would pay anything to save my baby´s life , but if I would not have the money...my baby would die ? Where is the Doctor codex to save life...yeah at any cost !

I cannot imagine why you say this. Tertiary level government hospitals most certainly do have this and all other advanced facilities.

yes, they do have almost all advanced equipment - but not nearly enough of it.

For example, several weeks ago a German guy tried to commit suicide in Phuket (it was covered by the media), and he was hospitalized in Vachira Hospital.

He was on a ventilator, but he had to stay in the normal ward as there was no bed available in ICU.

[Sheryl]

Vachira is not a tertiary level facility. Note that I said tertiary.

Public hospitals in Thailand are organized in a tier, as they are in most countries. What level of care you can get and what is available relates to the level you go to. certainly a district or ordinary provincial hospital would not be able to provide sophisticated neonatal intensive care, but a regional or national level hospital would.

[captainwillie]

I have a question regarding government hospitals and hospital charges

I am living in bangkok for four years,with work permit etc etc etc.

Over the past 4 months or so I have been undergoing twice weekly treatment for an unfortunate reoccuring chronic health problem at a large Government hopsital in bangkok that specializes with the treatment of this problem. I have insurance at another private hospital but they cannot offer this treatment and also the insurance will not cover the pre existing condition

Each time I go for the treatment which has been quite successul I pay a treatment fee of 200baht which is absolutely ok.

Each time I see the consultant there is a standard bill for 50baht (on bill says doctors fee) which again is absolutely ok.

The doctor I have seen has been by my opinion quite insulting bordering on the rude with some of the things that have been said. Comments like why dont you learn to speak Thai properly and then stating they they woud refuse to speak english.

I am no stranger to thai ways and habits so I don't react to this which is usually said to belittle me in front of a group of junior doctors. He has also in the past told me that he wanted to put me on a particular treatment (which would cost me 100,000baht annually) and asked me how I intended to pay for it. I declined this potentially dangerous and toxic treatment because for one the cost, two it would not be a long term solution and three once you stop taking it the condition flares up much worse than before. This was also the opinion of specialists in farang land in recent years regarding this particular treatment.

Today I saw this doctor once again for a routine follow up appointment. Upon entering the room he asked the usual questions and I replied I was delighted with the progress and quite happy. Infact I have never felt better regarding his condition. I was in a very positive mood.

The doctor then after once gain asking how long I was in Thaiand said that I should have been paying 500baht doctors fee each time and from now on thats the cost for all farang. I politely questioned this stating that both my wife and i have been here 4years on permits etc. He asked if we paid tax to the thai government and I replied absolutely. I explained about the reduced price as with thai citizens at national parks, monuments etc that we get becuse of the fact we hold w, permits,Thai driving licences etc and I politely mentioned that while I wasnt a cheap farang and 500bht was not a great deal for me there was a question of equality. The doctor then quite rudely told me that this money does not go to his pocket but to the government and this doctor then told me that he refused to treat me in the future unless I paid 500bht each time. His tone was downright insulting and very intimidatory. He then asked me if I was going to pay 500baht or not. With great difficulty I remained polite and said that if I had to pay 500 baht then not a problem but I did advise him that I would question it. He then got on the telephone to cashiers and I heard him going on about ha roy baht. He then ranted at me that I had to pay 500baht saying this is because he had to speak english to me. I was flabbergasted at this and asked him if a Burmese person was a patient would he also charge them 500baht. He then told me that "farang cannot own land in Thailand" my reply to the irrelevance of this was yes they can if they invest 20million baht or own a company and the company purchases and holds the chanote, for good measure I mentioned leases and usufruchts.Then he said because I am farang in Thailand I must pay extra because if he went to america his insurance would go up. He further told me that this was a decision by the cashiers not him. Obviously my reply was that I wasn't American and if he was legally in my country and paying taxes he would be paying exactly the same as locals and citizens. I politey stated that we were two intelligent people and it was my intention to remain respectful.

He then said he wanted me to start another treatment, this was one that didnt work in 1988 in farangland. This info was in my medical history and this expensive and in particular very toxic and potentially dangerous treatment caused me difficulties in the past and becuse of side effects I had to stop taking it. We seemed to agree on a simpler treatment and he wrote the prescription for it telling me I needed lots of it when in fact I only needed half of what he was suggesting. He then crossed out the 50baht on the doctors fee bill and entered 500bht in its place. You could have cut the atmosphere in the room with an axe.

I went to the cashiers and asked to see the head cashier/boss I didnt say what it was about but when the cashier was on the telephone I heard her explain about the falang and ha sip and ha roy baht. The headcashier who spoke good english attended and I asked her if she knew what the issue was she replied yes. I noticed signs on the wall at the cashiers had been replaced and that they stated " foreigner must pay doctor fee 500baht ". We spoke about the fee and I explained about work permits etc showing her my 5year Thai licence, I even invited her to request info from immigration if she required. Ater listening to me and seeing my licence etc she immediatey apologised to me and said I should be charged 50baht and she changed and countersigned my bill stating the same along with the details of my licence and entered the 50baht billing info onto my hospital records for future reference. I paid the 50baht doctors fee and obviously I purchased all my over priced medicene before leaving.

I am stiil beyond upset with this doctor and his attidude. This cannot be put down to communication issues as his english is excellent. I have also no doubt that there will be a repeat performance of some kind at the next appointment and I will probably have to expose my falang jai ron. I am familiar with Thai ways at this stage and consider Thailand my home and while there are some wonderful Thai people I am shocked and still quite annoyed by this doctor/consultant, a person of obvious high education and social standing.

I am sorry for the long post and I did not write it to deride Thailand or Thai people in anyway whatsoever but after reading this long post can anyone advise me regarding the correct doctors fee ? I am still quite annoyed over this whole ssue.

[Sheryl]

Many Thai government hospitals have indeed begun two tier pricing and charging foreigners more. This seems to have occurred after foreigners began using Thai public hospitals more which in turn occurred after the private hospital rates went up sharply. Whether or not resident expats have to pay this or not is a bit unclear and I am not sure there is a uniform rule. The cashier at the hospital you go to seems to have indicated clearly that as a resident expat you pay the Thai rate and I would think the cashier has the last word on that.

What I do not understand is why your treatment is not covered under the Thai Social Security system which you would be covered by as you are employed under a work permit. There is no exclusion of pre-existing conditions under that scheme. You might have to switch your enrollment from the private hospital to a government facility, but that can be done (and is advisable in any case, given the limited range of care available in the private hospitals that accept SS patients). . There is probably also some system or process for being referred elsewhere when the hospital you are enrolled in cannot provide the care required, and the SS Office can explain all this to you: call center 1506 or see here for offices http://www.sso.go.th/wpr/eng/contactus.html

Chances are that if the hospital you are registered under refers you elsewhere for care they have to pay for that and the private hospitals are somewhat notorious for trying to minimize costs of caring for SS clients, which is another reason why it is best not to enroll in one.

In short I think your financial issues could be resolved by getting yourself registered in a hospital with the capacity to treat your condition or (more difficult) by insisting the hospital you are registered in go through the process of referring you for care (which they may drag their heels on and may require assistance from the SS office to achieve). Once you are covered under SS and no longer self-pay the double pricing issue goes away.

Now the other issue is the complete lack of medical ethics and decency shown by the doctor. If at all possible you should get under someone else's care. I cannot advise a particular hospital as I don't know what your condition is, but if you could inform of that perhaps I can.

[macleans]

The behavior of your doctor is unacceptable even by the Thai standard (I'm Thai btw). You should write the hospital a complaint. Is there a reason(s) why you've been sticking with this hospital and, in particular, this doctor for this long? I don't know about the two tier pricing policy, whether it is universally applied in all govt hospitals or just adopted by some, but you can obsviously call to check with them.

Yes, SS is one route you might consider for your future care. But if, for whatever reasons, you can't use your SS or SS isn't the best possible choice, I'd like to suggest after hour clinics at say Chula or Siriraj as alternatives. Last time I went to Chula I paid 400 baht for doctor fee (the doctor I saw was an associate professor so it was well worth it) plus a 50 or 70 baht hospital fee. However, the prices of the medicines prescribed to you are in a range you typically find at private hospitals (if you don't tell your doctor in advance that you are on a cheap budget you'd likely get quality medicines, often imported ones, at high prices. In contrast, you'd likely get local made medicines during the hospital hours).

After seeing the doc for the first time, you might ask him/ her if it is possible to have your subsequent appointments during the hospital hours because of the cost reasons.