Affordable health insurance.

[seajae]

I have my tests booked in for next week, when we went in the other day a different worker said it was not for westerners but they checked with Bangkok and today phoned and told me to bring in my passport and make the booking for the tests to be done. Surat Thani can be added to the list of accepting hospitals now.

[scorecard]

I have my tests booked in for next week, when we went in the other day a different worker said it was not for westerners but they checked with Bangkok and today phoned and told me to bring in my passport and make the booking for the tests to be done. Surat Thani can be added to the list of accepting hospitals now.

Just picked up my card at Nakorn Ping hospital In Chiang Mai.

The application process couldn't be easier. The very pleasant initial lady that I saw just copied my name etc., into her computer from my passport. I took several documents in regard to address and photos, I offered these, got a very pleasant response of 'mai ow' (not want).

Staff taking care of blood tests and the X ray staff totally pleasant, caring and helpful. First visit (name, blood test, X ray) and done with about 40 minutes.

[Issangeorge]

Citizen33, do you know if cataract operations are covered?

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[maingmoom]

Although I am the only farang to join the scheme in Sanam Chai Khet Chachoengsou it is now full. My friend went to join today and was refused as they have no more places.We are the only two farangs living in this area. .

[citizen33]

Citizen33, do you know if cataract operations are covered?

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Cataract surgery is an interesting case because it has been one of the procedures that was covered in theory by the universal coverage scheme, but was often not available in practice, either because of shortages of specialists in public hospitals or because hospitals felt the money paid by the UCS was an insufficient incentive to make it worth providing. This meant that many patients were steered towards paying out of pocket, or at best faced a long wait. So this was a good example of the gap between de jure and de facto availability of a treatment under the UCS.

The NHSO tried to address this problem by 'unbundling' cataract removal from the usual diagnosis-related group reimbursement (DRG) system, and paying according to a schedule of fees. DRG rates were both lower and could be lowered further because they were subject to a global budget and reduced when the NHSO region hit its budget ceiling. The fees schedule is fixed so hospitals get what they expect. You'll find this tucked away about halfway through this article.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735425/

In practical terms I would guess that access to cataract surgery can be a bit hit or miss, especially in rural provinces such as Kalasin, but should be slowly improving. It probably depends on whether you can get a gate-keeping doctor (i.e. one who can refer you on from the first point of contact) interested. I am told that a relative of my Thai wife presented at Mahasaraham provincial hospital after referral from her community hospital, and was told she would have to pay about 6K baht to get the procedure done (anecdotal evidence only I'm afraid).

[harrry]

Citizen33, do you know if cataract operations are covered?

Sent from my i-mobile IQ X using Thaivisa Connect Thailand mobile app

Cataract surgery is an interesting case because it has been one of the procedures that was covered in theory by the universal coverage scheme, but was often not available in practice, either because of shortages of specialists in public hospitals or because hospitals felt the money paid by the UCS was an insufficient incentive to make it worth providing. This meant that many patients were steered towards paying out of pocket, or at best faced a long wait. So this was a good example of the gap between de jure and de facto availability of a treatment under the UCS.

The NHSO tried to address this problem by 'unbundling' cataract removal from the usual diagnosis-related group reimbursement (DRG) system, and paying according to a schedule of fees. DRG rates were both lower and could be lowered further because they were subject to a global budget and reduced when the NHSO region hit its budget ceiling. The fees schedule is fixed so hospitals get what they expect. You'll find this tucked away about halfway through this article.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735425/

In practical terms I would guess that access to cataract surgery can be a bit hit or miss, especially in rural provinces such as Kalasin, but should be slowly improving. It probably depends on whether you can get a gate-keeping doctor (i.e. one who can refer you on from the first point of contact) interested. I am told that a relative of my Thai wife presented at Mahasaraham provincial hospital after referral from her community hospital, and was told she would have to pay about 6K baht to get the procedure done (anecdotal evidence only I'm afraid).

Cateract surgery involves the surgery and the supply and fitting of a lens...does this count as a prothesis and hence require self payment?

[citizen33]

I'm more a policy person, so I don't have that level of detail I'm afraid. The few discussions I've heard in meetings about the problems of financing cataract surgery were along the lines in the article - i.e. it should be covered but often isn't in practice. But.does this relate to only part of the cost that excludes the intraocular lenses? Guess we would have to ask a specialist in that area.

Edited November 20, 2013 by citizen33

[harrry]

That is the problem unfortunately with this type of discussion. I know when I had each of mine done in Australia under Medicaire there was a year waiting list each time. The lens would have been the biggest part of the cost. That was free but many prefer to pay the high charges there to get it done quickly privately. Same quality faster time. It is the same with hip replacements which take 2 or three years often there and here I believe 6 months though if you pay you can get them quicker.

Hard to know just what is the real story. From what I have seen of my wife's family they do try to do a very good job here but they may just have been lucky.

Waiting when getting served may involve a whole day here but at least you get everything done most of the time on the same day. In Australia you do have an appointment which may be 9 am but you are lucky often to be seen by 12 and then if there is a test you may get that done that afternoon but then have to have another appointment for the doctor for the results. Less crowded but not really better.

[Issangeorge]

I had s cataract operation at Kalasin Hospital and the cost was ฿18,000 and I believe ฿7,500 of that was for the lens, so Citizen33, that ฿6,000 may have been for the lens. If you only had to pay for the lens, it would still be a great savings.

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[Mike45]

My MIL is on the Universal Health. She had to pay $5000 baht to the doctor to "move up" her appointment. Paid nothing else.

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[khunPer]

Surat Thani, Samui Hospital.

I went to the public hospital in Nathon today and talked to the very kind and well English speaking Foreigner Coordinator Officer, Hathairat Luanggrittivutti (Ting), about the health scheme for foreigners. (I have been there before and talked to some other staff, and they told me to come back in about a month, which is now.)

She told me, that I am not the only foreigner asking for it, and that a number of people have been there with reference to, what has been written in Thai Visa Forum. That is not correct, she said. Samui Hospital does not provide any health scheme or insurance for foreigners, others than the one the Government has issued for workers from Burma, Cambodia and Lao. Someone from Thai Visa even sent her an E-mail with some documents in Thai, but if you can read Thai then you will know that in Thai we use different words for people from Burma, Cambodia and Lao, and other foreigners. She found the E-mail with the documents and turned the screen, your girlfriend – who was together with me – can read it, she said.

I showed her a print with the information where HigThai insurance should have stated, that »the insurance was designed for foreigners regardless of their nationality, thus also for farangs,« and the telephone number, but she told me, that the information was not correct. Then she explained, that only Udon Thani has a scheme for other foreigners with a tessa ban (Yellow House Book) and legally married to a Thai, and the number is limited to 195 people this year only. Nowhere else has it, not Samui nor Surat Thani. You will need a private insurance by for example Bupa. If something comes up, Samui Hospital will state it on their Internet Home Page, she said.

[harrry]

Surat Thani, Samui Hospital.

I went to the public hospital in Nathon today and talked to the very kind and well English speaking Foreigner Coordinator Officer, Hathairat Luanggrittivutti (Ting), about the health scheme for foreigners. (I have been there before and talked to some other staff, and they told me to come back in about a month, which is now.)

She told me, that I am not the only foreigner asking for it, and that a number of people have been there with reference to, what has been written in Thai Visa Forum. That is not correct, she said. Samui Hospital does not provide any health scheme or insurance for foreigners, others than the one the Government has issued for workers from Burma, Cambodia and Lao. Someone from Thai Visa even sent her an E-mail with some documents in Thai, but if you can read Thai then you will know that in Thai we use different words for people from Burma, Cambodia and Lao, and other foreigners. She found the E-mail with the documents and turned the screen, your girlfriend – who was together with me – can read it, she said.

I showed her a print with the information where HigThai insurance should have stated, that »the insurance was designed for foreigners regardless of their nationality, thus also for farangs,« and the telephone number, but she told me, that the information was not correct. Then she explained, that only Udon Thani has a scheme for other foreigners with a tessa ban (Yellow House Book) and legally married to a Thai, and the number is limited to 195 people this year only. Nowhere else has it, not Samui nor Surat Thani. You will need a private insurance by for example Bupa. If something comes up, Samui Hospital will state it on their Internet Home Page, she said.

You should have rang the number and given her the phone. She is wrong.

[Sheryl]

As this thread has discussed, there is indeed some grounds for confusion ground the initial intent of the system in terms of coverage, but the directive does not state migrants, it states foreigners. She also is definitely wrong in saying nowhere but Udon is issuing this. All the hospitals in Chiang Mai are as well along with a number of other places. If you call the number (which is an office in the MoPH) they will tell her that. However, they have no means of compelling a hospital to comply, and this is not the only one that is taking a "migrants only" position.

[mikekim1219]

Does plan cover foreign wife?

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[Sheryl]

Foreign wife can get coverage of her own under it. It is not a family plan, but an indivbidual one i.e. each person has to separately apply and pay premium.

[mikekim1219]

Got it. Thanks a bunch. I just received mine at Chiang rai 2 hospital. I will be marrying a Chinese girl soon and it would be nice to know she can be covered.

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[casicook]

Surat Thani, Samui Hospital.

I went to the public hospital in Nathon today ....she said.

This has been published by the Ministry of Public Health on HIGTHAI's website on the 15th of this month and it really couldn't be much clearer than it is!

Health Care for Immigrants and Foreigners

The Ministry of Public Health (MoPH) provides a health care program for immigrants and foreigner, who are not enrolled in the Social Security System. These individuals can now receive medical services and health insurance with the following rates:

1. For immigrants currently waiting for their applications to be processed in the

Social Security System, their payment will be 1,150 Baht for a service coverage

period of 90 days.

2. For immigrants who are not enrolled in the Social Security System, Their payment

rate is 2800 Baht , which covers the following rate:

- Health Care Cost: 600 Baht

- Health Insurance Cost: 2,200 Baht

3. Children ages 7 or less will have a payment rate of 365 Baht. In addition, children from the second and third payment plans will have a service coverage period up to one year. They will be able to receive medical services and insurance in the medical facilities which under Office of Permanent Secretary within their area of residence.

4. Include Foreigners who are residence in Thailand without any Health Insurance coverage.

Benefits

1. General Health Care and Rehabilitate

2. High health care cost as stipulated in the Ministry of Public Health committee regulations.

3. In case of Accident and Emergency

4. Referrals System

5. Disease Control for Immigrants/Foreigners

6. Diseases Surveillance

7. Administering antiretroviral

8. Benefits are not provided for individuals with mental disorders

9. Services provide health support, preventative and Disease Control.

Health Insurance Group, Office of Permanent Secretary Ministry of Public Health (MoPH)

Phone 0 2590 1580, 0 2590 2415, 0 2590 2417 Fax 0 2590 1579

Link to the document on HIGTHAI website

In Udon Thani the situation is this:

Health insurance for foreigners: Udon Thani to remain on the waiting list

In Udon Thani no new applications will be processed for inclusion in the state's health insurance scheme until further notice.

Whilst in the province of Chiang Mai, for example, the conditions and the procedures for the admission of foreigners into the scheme have been clearly worked out, Udon Thani still only operates a waiting list for applicants.

........

Link to the original news

Edited November 22, 2013 by casicook

[Sheryl]

Thank you for that link. Yes, it is clear, but many hospitals continue to interpret this as migrants only -- probably because the inititial discussions preceding the issuance of the directive said that.And maybe because some of them have done the math and realize the 2800 a person for uninsured resident expats is a losing proposition.

Prior posts have indicated that HIG is aware some hospitals are refusing and to date have no means of ensuring compliance. The government does not subsidize the system so if hospitals feel they cannot afford to enact it there isn't much MoPH can do to compel. Again, development of an appropriate premium based on actuarial calculations specific to uninsured resident expats would help. We can only hope the health financing gurus in MoPH/NHSO are working on this.

[TallGuyJohninBKK]

Prior posts have indicated that HIG is aware some hospitals are refusing and to date have no means of ensuring compliance. The government does not subsidize the system so if hospitals feel they cannot afford to enact it there isn't much MoPH can do to compel.

Sheryl, I must be missing something here. Outside BKK, where there's NO hospitals enrolling anyone as best as we know and there apparently are no MOPH hospitals, isn't it supposedly MOPH hospitals in the various other upcountry cities that ARE enrolling farangs under this insurance plan?

If they are MOPH hospitals, presumably the MOPH has every ability to tell them what to do, and they certainly receive their funding from the MOPH -- although I haven't seen any mention in these threads of what kind of financial arrangement will exist between the MOPH and an MOPH hospital when a covered farang receives care under this new insurance scheme.

Edited November 23, 2013 by TallGuyJohninBKK

[Sheryl]

There is NO financial arrangement - the premiums the hospital collects is supposed to cover the costs (which it will not, hence the looming problem). No additional budget from MoPH for this. Which is likely why some hospitals are balking.

Yes, they are all MoPH hospitals but that does not mean MoPH can readily force them to comply nor would be inclined to. The hospitals have a degree of autonomy in deciding when and how to implement the directive.

Of all the provinces Chinag Mai is most on top of this, actively enrolling foreigners and even issuing their own directive detailing procedures. I beleive they will watch the results carefully and this may generate financial data that can be used to improve the costing of the system (improve in terms of making sure it is cost neutral for the hospitals, not in terms of being cheap for clients).

[JackisBack]

Ive been reading this topic and thought to day I would try and apply at my local Amphur government hospital for an insurance card , I downloaded from here all the information I could and printed it off , then went to a small local rural government hospital ( Nakhon Ratchasima Province ) with my Thai wife and my Yellow house book

We were shown into the hospital administrators office where my wife handed over all the printed information I had downloaded, to the administrator officer, then my wife asked if her farang husband could apply for the insurance card as outlined on the printed paperwork . The officer asked to see my yellow house book and then entered the books details into a computer and a printed sheet was given to my wife as shown below.



The hospital administrator officer told my wife that as I was all ready registered on their computer system , ( which showed all my yellow book details ) That I would not need to apply for the paid insurance card , and should I ever want any medical treatment , just take along my yellow house book and I would be entitled to the same level of free treatment as any Thai citizen , the administrator officer called the level of health benefits I would be entitled to as the '' Gold Card '' which I believe could mean the same as the Thai 30 Baht card.


My wife was all so told that for me to obtain free treatment , I would need to be first seen by a doctor at my local government amphur hospital and then if a situation arose where the local government hospital could not offer or provide the level of medical assistance needed then I would be transported to a large central government hospital in the city , but still under the '' Gold Card '' scheme.

What I could not do is to first request free medical treatment using my yellow house book at any other government hospital other than the one in my local amphur .

My wife did ask even if I was on the hospitals computer system as some one entitled to free treatment , could I still apply for the paid insurance option, the hospitals administrators answer was no.

I came away from the hospital a little confused , after reading here that in some cases it was necessary to have a yellow house book first to apply for the paid insurance card option.

The exact scale / level of what treatment I would receive free as I'm on the local government hospitals computer , is in my mind still hazy , from what my wife was told the only amount I would have to pay for any medical treatment would be 30Baht for all drugs required and any up grades to a better private room , which are very nice.

This small rural government hospitals administrators officer was all ready fully aware of the information I had downloaded and printed out .


Next time I need simple medical treatment , I'm taking my yellow house book with me and see what happens.

[Sheryl]

You do not have to have a yellow tabian baan to get the insurance card but most hospitals will ask to see some sort if proof of where you live.

In your particular case the hospital has mistakenly enrolled you for free based on your yellow tabian baan. This has happened in a few hospitals here and there. The problem with that is that it is an error and if you need to be referred to a higher level of care may be discovered at that stage.

You could try having your wife call to MoPH office in charge of this and explain the situation and then have them explain to the hospital. While it may seem silly to push them to take your money, it may help avert a disallowal at some later (and highly inauspicious) point.

[citizen33]

Yes, I fear that Sheryl is right and that Jackisback cannot rely on this. One interesting point is that Jack's paperwork shows him registered under the National Health Security Office gold card scheme (as indicated by the สปสช logo at the top), but the new foreign resident scheme is administered by the Ministry of Public Health. As far as I can gather there is a lot of confusion in the NHSO about the new scheme, which probably makes mistakes in local hospitals harder to correct,

Edited November 25, 2013 by citizen33

[meatboy]

Ive been reading this topic and thought to day I would try and apply at my local Amphur government hospital for an insurance card , I downloaded from here all the information I could and printed it off , then went to a small local rural government hospital ( Nakhon Ratchasima Province ) with my Thai wife and my Yellow house book

We were shown into the hospital administrators office where my wife handed over all the printed information I had downloaded, to the administrator officer, then my wife asked if her farang husband could apply for the insurance card as outlined on the printed paperwork . The officer asked to see my yellow house book and then entered the books details into a computer and a printed sheet was given to my wife as shown below.

The hospital administrator officer told my wife that as I was all ready registered on their computer system , ( which showed all my yellow book details ) That I would not need to apply for the paid insurance card , and should I ever want any medical treatment , just take along my yellow house book and I would be entitled to the same level of free treatment as any Thai citizen , the administrator officer called the level of health benefits I would be entitled to as the '' Gold Card '' which I believe could mean the same as the Thai 30 Baht card.

My wife was all so told that for me to obtain free treatment , I would need to be first seen by a doctor at my local government amphur hospital and then if a situation arose where the local government hospital could not offer or provide the level of medical assistance needed then I would be transported to a large central government hospital in the city , but still under the '' Gold Card '' scheme.

What I could not do is to first request free medical treatment using my yellow house book at any other government hospital other than the one in my local amphur .

My wife did ask even if I was on the hospitals computer system as some one entitled to free treatment , could I still apply for the paid insurance option, the hospitals administrators answer was no.

I came away from the hospital a little confused , after reading here that in some cases it was necessary to have a yellow house book first to apply for the paid insurance card option.

The exact scale / level of what treatment I would receive free as I'm on the local government hospitals computer , is in my mind still hazy , from what my wife was told the only amount I would have to pay for any medical treatment would be 30Baht for all drugs required and any up grades to a better private room , which are very nice.

This small rural government hospitals administrators officer was all ready fully aware of the information I had downloaded and printed out .

Next time I need simple medical treatment , I'm taking my yellow house book with me and see what happens.

what hospital did you go to,if you are if you are in korat the gov.hospital where you have to register is theparat.i wouldnt wait till you need treatment as you didnt have a medical or enroll for the scheme[2,800]bht in total,if they did have to transfer what if any info have they,eg.past med.history,allergies and if taking what medication.

[Sheryl]

It sounds like he lives outside the ampur and his "home" hospital is a small district hospital.

I suspect that if he goes to Theparat they will tell him to get the card at the hospital he just tried at. He could, however, at that point tel them (Theparat) about the problem he had and ask them to call and explain to the district hosp. District hospitals generally listen to what the provincial hosp. says.

[JackisBack]

I live about 70Km out side of Korat near Khonburi , and the small government hospital I tried to apply for the paid insurance card is the only one in my Amphur . The hospital administrator was adamant that I did not need the paid insurance card and from what my wife now tells me the hospital administrator became agitated when my wife re questioned them on the subject .

I have never received any treatment at this small local government hospital so they hold no medical records on me.

I'm wondering what sort of reception I may get when I go to Theparat hospital in Korat to try and apply , its going to be interesting to see how it turns out , but I'm going to give it a go .

[Sheryl]

Do, and if you can, bring the name and number of the person you dealt with at the district hosp with you as you may nee to ask the Prov Hosp honchos to call there and explain things.

I suspect they just didn't want to deal with figuring out a new system and associated paperwork, but it does yo ua disservice as you risk later being denied care at higher levels.

[meatboy]

I live about 70Km out side of Korat near Khonburi , and the small government hospital I tried to apply for the paid insurance card is the only one in my Amphur . The hospital administrator was adamant that I did not need the paid insurance card and from what my wife now tells me the hospital administrator became agitated when my wife re questioned them on the subject .

I have never received any treatment at this small local government hospital so they hold no medical records on me.

I'm wondering what sort of reception I may get when I go to Theparat hospital in Korat to try and apply , its going to be interesting to see how it turns out , but I'm going to give it a go .

your best bet is to give them a ring. tel.no. 044-305750 best your wife speakes to them.

ask for the extension for registering a foreigner for the medical card.

directions on how to get there, go past the mall westbound mittrapap rd.,past save one market heading towards kokrut.

50mtrs.past the garden center on the left go off the motorway to the inside rd that runs parrarel, the hospital is on the left well signposted.in through the main entrance to window no 1.

[raybarrell]

U

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[seajae]

UPDATE After going for my tests at the Surat Thani govt hospital this morning I now have my medical card, they had me pay 2,800 baht and gave me the card before I had the xray and blood tests. I was the only westerner/farang there but there were lots of burmese , took 2 hours to complete it all and I will go back tomorrow to pick up my doctors certificate that will be used for my visa.