medical transparancy in Thailand.

[watcharacters]

I want to start by quoting below another members post in a TV forum which is related to my question. The poster did not ask prior to receiving tratment the charges for treatment. I can't let that happen.

My event:

I realized it's been over a year since the Missus had a gynecological exam so I asked her to schedule one for herself.

She asked me to join her in the doctors office/cube because I asked her to inquire about the cost of an additional specific test.

The doctor said she didn't know the specific cost and said that information is in the records/billing dept. Knowing the difficulty I'd face getting information from there, I asked the kind doctor if one of the assistants or nurses could make the short (30 seconds) walk to that department and find out the cost.

The doctor replied "we are not a supermarket here". I didn't want to disagree and so I acquiesced. I merely said upon leaving her office, "prior to performing the test, I do need to know the cost". I don't give a blank check to anyone.

I knew this was generally considered an expensive hospital and wanted to find out how much it would cost. I was OK to shop the cost if necessary. As we left the place, I counted 15 cinema sized posters on the hallway advertising their services from the parking lot entrance. Yes that's fifteen and 5 of them had a specific price listed. Almost sounds like a supermarket to me.

The reality:

I've had this battle a few times in the USA as doctors and hospitals are used to charging whatever they deem OK to charge. Some of them are absolutely certainly "beyond the pale".

I've been told "why do you care if you have insurance"? I've told them them I've paid for the insurance and the future cost of the policy is based on the expense of the plan. Yes I do care.

The cost of a specific lab test is a fixed cost and refusal to give that cost to the customer is just being rude IMHO. I wonder how many people take their car to a shop and never ask beforehand how much a charge will be? What I wanted was the cost for a totally voluntary exam. I meant no offense.

How, if you do so, do you inquire about the cost of medical treatment prior to receiving it.

`When I've asked dentists here and in the USA what they charge, I've never been made to feel I offended them.

I'd like to know the best approach with medical doctors to learn their costs and charges.

"Went to the hospital, I guess one of the expensive ones.

Did a Biochemistry test, checked my diabetes, blood sugar levels, Cholesterol, triglycerides, etc.

It cost me 6000 thb, and a doctors fee 1900 thb, for a 2 min chat about the results.

8000 thb for a check up and a doctors fee.

I think it is expensive.

Anyone else goes to regular check up and some consulting with a doctor about our diabetes, who can tell me how much you pay?

I think I want to change hospital next time"

[Sheryl]

"I'd like to know the best approach with medical doctors to learn their costs and charges."

The best approach is what you did -- ask. In your case it was not the doctor's charges that you were asking about, so of course the doctor might not know off hand, but a simple telephone call to either Billing or the Lab would have elicited the information.

The doctor was simply rude, and I would cross a doctor like that off my list. They aren't all that way, many will be glad to take the time to find out costs for you. Indeed I have many times had doctors volunteer information on the cost of various tests without my asking, especially if the test was costly or if I seemed to be hesitating about it.

In fact, I have never encountered this problem -- but I carefully choose my doctors with a lot of preliminary research. Sounds like your wife made the appointment so this may not have been done. Try where possible to stick to doctors who trained in the West, as it guarantees a high level of English and familiarity with Western client expectations as to communications etc. Saves a lot of trouble in the long run.

(I have, however, several times encountered significant billing errors at the point of payment, so always check your bills carefully.)

[AnotherOneAmerican]

Many Thai hospitals charge approx 90-120bht for a private consultation with a doctor.

Hospital services, nursing services and materials are extra.

Edited July 16, 2013 by AnotherOneAmerican

[watcharacters]

Many Thai hospitals charge approx 90-120bht for a private consultation with a doctor.

Hospital services, nursing services and materials are extra.

Thanks AOA for your reply.

I've had a fair idea of those costs for a consultation and I wouldn't be likely to ask about them. I'm really focusing on general medical transparency such as Sheryl addressed.

I elected to go to the hospital I did because it certainly appears better organized and cleaner than the other ones I've seen in this town. It's also, however, considered on the relatively expensive side. Certainly for something elective such as the test I wanted done, I'd to know the cost prior to the consumption.

I was disappointed to find I seemed to offend the lady OB/GYN we saw. That was not my intention in any way.

[TallGuyJohninBKK]

(I have, however, several times encountered significant billing errors at the point of payment, so always check your bills carefully.)

Sheryl...one of the things I find MOST annoying about dealing with Thai hospitals here..and it's happened in every private one I've visited the same.

I go for an appointment, finish, go the pay the bill, and the receptionist just hands me a piece of paper with the total price.

Not once at any of the privates I've visited have they EVER voluntarily given me a detailed/itemized cost of the bill.

Every time, I have to ask for them to print out a statement that shows me how much for the doctor fee, how much for any test, how much for any medicine, etc etc..

It's kind of crazy to me that I walk up to the billing counter, and they expect me to just hand over my cash or credit card without them giving me any information about how the bill was totaled/calculated.

[watcharacters]

"I'd like to know the best approach with medical doctors to learn their costs and charges."

The best approach is what you did -- ask. In your case it was not the doctor's charges that you were asking about, so of course the doctor might not know off hand, but a simple telephone call to either Billing or the Lab would have elicited the information.

The doctor was simply rude, and I would cross a doctor like that off my list. They aren't all that way, many will be glad to take the time to find out costs for you. Indeed I have many times had doctors volunteer information on the cost of various tests without my asking, especially if the test was costly or if I seemed to be hesitating about it.

In fact, I have never encountered this problem -- but I carefully choose my doctors with a lot of preliminary research. Sounds like your wife made the appointment so this may not have been done. Try where possible to stick to doctors who trained in the West, as it guarantees a high level of English and familiarity with Western client expectations as to communications etc. Saves a lot of trouble in the long run.

(I have, however, several times encountered significant billing errors at the point of payment, so always check your bills carefully.)

.

Thanks once again for a genuine and positive reply Sherly. I sincerely appreciate it.

I'd like to add a question to your reply please.

I realize many people simply ask friends about which doctor the friend chooses but I wonder if such a recommendation would be based on personality and interaction factors as much as the doctors qualifications

I tried google by asking how to choose a doctor in Thailand and only came up with the typical list of doctors by a paid service.

Can you please offer some suggestions about how an expat in Thailand should go about researching a doctor in terms of qualifications and etc. I'm really at a total loss.

I realize you obviously have excellent qualifications to do proper research that others, myself included, may not have but maybe you can give some insight for me and the rest of the interested board members as to a reasonable search approach

TIA

[chiang mai]

There is a whole range of charges that can be levied for the same procedure based on which hospital you elect to go to, at the bottom end of the scale is the local governement hospital out in the sticks and at the top end is one of the large private hospitals in Bangkok, the difference between the two will be several hundred percent if not a thousand per cent. Personally I think there are a number of variables when making a decision of where to go and how much to pay and these include:

- what's the nature of expertise that's needed, is it common place or highly specialised;

- what level of urgency is required;

- where am I, in Bangkok, a large city, small remote town or in the sticks:

- what can I afford;

- am I comfortable putting my health care matters into the hands of a local hospital where communication in English is uncommon:

- what am I comfortable with.

If a person works their way through those questions, the correct level of care will be apparent and along with it the cost of that care.

Finally, if the OP looks at the pinned topics in the Health Care Forum he'll see lists of medical specialists that have been developed for use by members, they are worth checking, based on where you are located.

[pinfold]

I know Sheryl hates me butting in with this particular suggestion,but for years I have done it and for me its a no-brainer.

India,only 2 to 3 hours away,finest of the finest medical care the world can offer at a tiny fractions of Thailand's, and courteous to the point of embarrassment. I know its a step into the unknown for most,but as an individual who cannot obtain medical insurance any more,its better than sliced bread.Cheap airline pricing too.

Preventative cancer screening,surgery for whatever, it really is heaven sent

I had a quote ,recently of £800 as admission fee at Pattaya hospital for one night,ended up in Indian hospital day after at £28 a night,was half dead though,superb care thoughout

[jrtmedic]

pinfold

Having spent some time as a guest lecturer at an Indian Medical School I believe I have , perhaps, some insight into what is available.

If one looks for medical staff with Western European, UK or American education/training/qualifications you perhaps will not go far wrong.

However India whilst home to some of the best medical care it is also home to some of the worst! ( Just believe me! I have no wish to debate this !)

in Thailand choosing a medical provider solely on the basis of cost ( cheap or expensive!) may not always be a good idea!

Personal recommendation is good but not always possible to obtain, so in the case of non urgent issues, remember that Doctors only offer advise. It is you, the patient, who determines if that advice is acceptable. It is always possible (and relatively cheap) to obtain a second opinion.

In the case of English speaking expatriates who do not speak Thai it is worth seeking a Doctor who is able to communicate well in English.

Edited July 19, 2013 by jrtmedic

[Sheryl]

"I'd like to know the best approach with medical doctors to learn their costs and charges."

The best approach is what you did -- ask. In your case it was not the doctor's charges that you were asking about, so of course the doctor might not know off hand, but a simple telephone call to either Billing or the Lab would have elicited the information.

The doctor was simply rude, and I would cross a doctor like that off my list. They aren't all that way, many will be glad to take the time to find out costs for you. Indeed I have many times had doctors volunteer information on the cost of various tests without my asking, especially if the test was costly or if I seemed to be hesitating about it.

In fact, I have never encountered this problem -- but I carefully choose my doctors with a lot of preliminary research. Sounds like your wife made the appointment so this may not have been done. Try where possible to stick to doctors who trained in the West, as it guarantees a high level of English and familiarity with Western client expectations as to communications etc. Saves a lot of trouble in the long run.

(I have, however, several times encountered significant billing errors at the point of payment, so always check your bills carefully.)

.

Thanks once again for a genuine and positive reply Sherly. I sincerely appreciate it.

I'd like to add a question to your reply please.

I realize many people simply ask friends about which doctor the friend chooses but I wonder if such a recommendation would be based on personality and interaction factors as much as the doctors qualifications

I tried google by asking how to choose a doctor in Thailand and only came up with the typical list of doctors by a paid service.

Can you please offer some suggestions about how an expat in Thailand should go about researching a doctor in terms of qualifications and etc. I'm really at a total loss.

I realize you obviously have excellent qualifications to do proper research that others, myself included, may not have but maybe you can give some insight for me and the rest of the interested board members as to a reasonable search approach

TIA

Most of the larger private hospitals have doctor qualifications on the website, you just type in specialty and then review.

Hospital website vary in how thorough they are, the best ones will indicate special areas of clinical interest as well as list board certifications, place and year of residency and fellowships, etc.

The other thing I sometimes do, but which would be hard for a non-helth professional (tghough not necessarily imposisble) is google the subject matter abnd Thailand and look for which Thai doctors ahve publsihed on the subject then try to track down where they work. i generally reserve this for highly specialized needs as it is time consuming to do.

[pinfold]

pinfold

Having spent some time as a guest lecturer at an Indian Medical School I believe I have , perhaps, some insight into what is available.

If one looks for medical staff with Western European, UK or American education/training/qualifications you perhaps will not go far wrong.

However India whilst home to some of the best medical care it is also home to some of the worst! ( Just believe me! I have no wish to debate this !)

in Thailand choosing a medical provider solely on the basis of cost ( cheap or expensive!) may not always be a good idea!

Personal recommendation is good but not always possible to obtain, so in the case of non urgent issues, remember that Doctors only offer advise. It is you, the patient, who determines if that advice is acceptable. It is always possible (and relatively cheap) to obtain a second opinion.

In the case of English speaking expatriates who do not speak Thai it is worth seeking a Doctor who is able to communicate well in English.

Your right,but there are web sites offered by ex-pats,such as this over there too, that give precise information

[pinfold]

pinfold

Having spent some time as a guest lecturer at an Indian Medical School I believe I have , perhaps, some insight into what is available.

If one looks for medical staff with Western European, UK or American education/training/qualifications you perhaps will not go far wrong.

However India whilst home to some of the best medical care it is also home to some of the worst! ( Just believe me! I have no wish to debate this !)

in Thailand choosing a medical provider solely on the basis of cost ( cheap or expensive!) may not always be a good idea!

Personal recommendation is good but not always possible to obtain, so in the case of non urgent issues, remember that Doctors only offer advise. It is you, the patient, who determines if that advice is acceptable. It is always possible (and relatively cheap) to obtain a second opinion.

In the case of English speaking expatriates who do not speak Thai it is worth seeking a Doctor who is able to communicate well in English.

Sheryl and yourself are to put it mildly are an absolute rock upon the ex-pats which they should always turn to for advice,and personally I thank you wholeheartedly Long since I have been here I have looked at Sheryl's advice to others and they are gems.

But I know once your past your sell by date insurance wise you should not be in Thailand,if by sheer luck and keeping yourself fit that many an aging ex-pat has got away without medical bills ,good for them,but the body is only a machine,somewhere along the line it will break down, I just do not want to fall seriously ill or die in Thailand thank you

For me all of Thailand's hospitals should have a bright neon sign alongside the word "hospital" and that is "come hither and we'll soak you" What rhyme or reason a charge of £800 for basically for a watch and monitor exercise over a 24 hour period,its sickening to even comprehend

Yes I do frequently go to India for treatment,for me its the best in the world,better than the NHS in many ways,I can get procedures done that the NHS would consider unnecessary ,but the last pneumonia scare put the frighteners under me,not that I want to return to the UK ,but the Canary islands would be a good option free medical and warm weather.

Anyway jrtmedic and especially Sheryl,thanking you two especially

[GreenSnapper]

I have no personal experience, but heard from several sources that Malaysia has cheaper, but more or equally professional health care than Thailand. Rip-off factor is less and they can speak good English.

Probably not as cheap as India, but worth to check out.

[pinfold]

I have no personal experience, but heard from several sources that Malaysia has cheaper, but more or equally professional health care than Thailand. Rip-off factor is less and they can speak good English.

Probably not as cheap as India, but worth to check out.

Yes I know Malaysia has a good write up medically wise. Guy I used to speak to at the California WOW gym told and re-told a story of a guy wind surfing in Phuket,broke his hand and went down to Penang. The doctor could not do enough for this guy x-rayed, bones re-set,strapped up for one ringit. Impossible to believe? who knows but the doctor knowing the guy was English was all over him because of the empire past. Good option though

[Sheryl]

Costs of health care in Thailand vary enormously. Sounds like Pinfold has encountered the large private hospitals in Pattaya.These are the highest prices to be found in the country. A 15 minute drive to Sri Racha, or a trip to Bangkok, and costs in private hopsitals drop dramatically. Or go to a government hospital where they are a fraction of this.

Quality of care also varies enormously, from world class to completely unacceptable. Need to do one's homework in selecting a doctor.

[watcharacters]

pinfold

Having spent some time as a guest lecturer at an Indian Medical School I believe I have , perhaps, some insight into what is available.

If one looks for medical staff with Western European, UK or American education/training/qualifications you perhaps will not go far wrong.

However India whilst home to some of the best medical care it is also home to some of the worst! ( Just believe me! I have no wish to debate this !)

in Thailand choosing a medical provider solely on the basis of cost ( cheap or expensive!) may not always be a good idea!

Personal recommendation is good but not always possible to obtain, so in the case of non urgent issues, remember that Doctors only offer advise. It is you, the patient, who determines if that advice is acceptable. It is always possible (and relatively cheap) to obtain a second opinion.

In the case of English speaking expatriates who do not speak Thai it is worth seeking a Doctor who is able to communicate well in English.

.

Thank you jrtmedic for your reply. I value your opinion and suggestions as I do those of Sherly.

I do want to emphasize what may not have been quite clear. I do not and will not chose any important medical treatment BASED on cost.

What I will do, however, is wish for transparency when I inquire. That goes for both cost as well as condition and treatment for both me and the Missus. To me it's no different than a department store failing to clearly post prices.

I know they exist but I personally don't know anyone who buys things without having an idea of the cost. I believe failure to have awareness of the cost of a received service or product is akin to writing a blank check to someone.

The concept of medical transparency is, in fact, so rare in the USA that The Los Angeles Times once did a fairly large article on a medical provider in the Greater LA Basin that did post a list of standard charges. They really were the hen that had teeth. 555

I don't expect a posting of costs but if i'm one of those who inquires, I do expect a clear answer without upsetting someone.

I couldn't have been more polite and respectful than I was with the doctor I mentioned in my OP. If the same thing happens in the future, possibly my best course of action is to politely decline any services and move on. I'd rather it not come to that.

Again, thanks to both of you.

[Sheryl]

jrtmedic and I were responding to pinfold.

Your situation is crystal clear and you did nothing at all wrong. In the future absolutely do not use doctors who show this type of rudeness nor hospitals that will give clear advance info on costs.

In this instance from the sounds of it the doctor was the problem because she was unwilling to take a few minutes time to make a simple inquery.

The US is a different situation owing to the fact that almost no-one pays out of pocket for care, so the whole cost thing is actually a prolonged and subjective negotiation between insurance companies and hospitals and there are no fixed costs, just a price that the third party payer ultimately agrees to -- which is almost never the price the hospital initially sought. It's a total mess. Some payers, like Medicare, have opted to just establish their own flat rates of reimbursement and stick to them as a result.