"30 baht" vs. "govenment" healthcare?

[WyattEarp]

My wife has asthma and ever couple of months she goes to Banglamung hospital and gets some treatment involving sitting with a mask on for about half an hour, breathing some stuff, and ending with a bag of pills. Normally she'd pay 30 bath for this, some government scheme.

Now after having had a job for years she finally got her government healthcare card that she and the employer pays for. She offered that, but was told that only works in Sriracha and Sattahip, and she now had to pay 470 baht for what she used to pay 30 baht for.

What's the logic in this? She pays for health insurance and in return now has to go 60+ (there and back) to get this service, and they couldn't even tell her if she could get a refund of what she had to pay at Banglamung.

[harrry]

She had the right to select which hospital to go to under the SS. She could have chosen the government hospital when she got the card where she would have got a wider range of treatment than the Government scheme or a selected private hospital where she is entitled to treatment.

Most select the private because of the shorter waiting time and the higher quality of room.

I understand at least one major hospital group has pulled out of the Social Security (workers) scheme starting next year as they believe they do not make enough from it.

[Sheryl]

Yes, she can change her registration to a more convenient location. Under SS there is a choice of hospital but once registered, that's where you have to go (unless emergency).

[WyattEarp]

The problem is there are no hospitals in Pattaya that work with the government insurance, as I understand it.

Anyway what surprised me is that the price goes from 30 baht to 470 baht just because you have government health insurance, it doesn't make any sense.

[Sceptict11]

If your wife needs hospital treatment for asthma every couple of months her asthma is clearly poorly controlled.

It would be well worth her seeking advise at the hospital she is now registered with.

The aim of seeking advise would be to reduce her need to seek the emergency "mask" treatment .

Your wife should ask to see a Physician with an interest in respiratory diseases.

Your wife should have two inhalers one which is used every day and one , usually blue in colour, which is used when she is short of breath.

Frequent use of the blue inhaler indicates a need for her condition to be urgently reviewed.

[harrry]

The problem is there are no hospitals in Pattaya that work with the government insurance, as I understand it.

Anyway what surprised me is that the price goes from 30 baht to 470 baht just because you have government health insurance, it doesn't make any sense.

It does not.

If it is free on the 30 baht it is free on the Government plan. (with a few exceptions not relevant here).

It is possible she is not going to the one hospital she is regered at on the plan.

It is possible though that some of the little bag of pills she gets includes medicine that is not on the free plan though for asthma most of the more commonly used ones are free. The Goverment employee pplan does give a lot more medicine for this than the 30 baht scheme so this is unlikely.

[WyattEarp]

She is already being seen by a specialist and using her two inhalers + a bunch of pills as directed.

The closest hospitals she could chose were in Sriracha and Sattahip, but she prefer to go to Banglamung to avoid the 30+ km ride each way to go to them.

She got the same pills this time as she used to get @ 30 baht per visit before gettign the government healthcare.

[harrry]

She is already being seen by a specialist and using her two inhalers + a bunch of pills as directed.

The closest hospitals she could chose were in Sriracha and Sattahip, but she prefer to go to Banglamung to avoid the 30+ km ride each way to go to them.

She got the same pills this time as she used to get @ 30 baht per visit before gettign the government healthcare.

Well that explains it. She is paying for the treatment at Banglamung rather that going to the hospital she is insured at and will get it free. Nothing to do with either the SS scheme or the 30baht scheme.

Edited October 7, 2013 by harrry

[TerryLH]

She should check at the Social Security Office to see if and when there might be another hospital to choose.

If she can get her registered hospital to give her a referral to where she needs to get treatment, SS will pay for it.

If her registered hospital offers the same treatment (and she chooses not to be treated there), or doesn't think she needs it, she will have to continue paying the fees herself.

[Sheryl]

SS Office in Chonburi:

101/10 Moo 1 Sukumvit Road, Samed,
Muang District, Chon Buri 20000
Tel. 0 3878 4420-4, 0 3878 4750-4
Fax. 0 3826 1332, 0 3878 4260

[WyattEarp]

Well that explains it. She is paying for the treatment at Banglamung rather that going to the hospital she is insured at and will get it free. Nothing to do with either the SS scheme or the 30baht scheme.

Harry, she has been going to Banglamung hospital for years for this treatment, always got the same treatment, the mask, some inhalers and a couple of bags of pills. This always cost her 30 baht. The only difference is now she has a health insurance from her work, and therefore they charge her 470 baht for that same treatment that used to cost 30 baht.

It doesn't make much sense to me but the way I understand it, none of the hospitals in Pattaya work with the government healthcare, she has to go to either Sriracha or Sattahip for it. This is what makes no sense, she would have to take a day off to go to there, instead of an hour or two to go to Banglamung.

If I remember well, when she applied for the insurance (which is very long time ago, over a year, which it has taken to get it) she was told there is only a simple clinic available in Pattaya, she can go there and if they can not treat the ailment they will arrange to drive her to Sriracha. She just thought for this it made more sense to just pay the darn 30 baht and be over with it. The surprise, as I've tried to bring across a couple of times now, is that because she is registered for government healthcare she can no longer get the 30 bath treatment.

Thanks for the address details for the SS office, she will contact them tomorrow and see if there is a smarter way, and I'll of course update this thread with the result. She might simply cancel it if it doesn't make any sense to have it.

[Sheryl]

First of all you need to avoid the term "government healthcare" as most people would interpret that to mean the government UC ("30 baht") scheme which most definitely Banglamung does accept. You are talking about Social Security, which is not the same thing. She is not anymore registered for "government healthcare" as that term is usually understood, and she is no longer eligible for it due to having SS. The government UC ("30 baht") system only covers people who are not covered by SS. So as soon as she became eligible for SS she lost her eligibility under the UC system.

Usually government hospitals accept SS, so it would be odd for Banglamung not to, but the SS office is the best source of this info. Possibly they already had as many people registered as they could handle and were not accepting new patients for that reason.

I don't think she can choose to opt out of SS to get under UC while employed, but again, the SS office is the best place to ask.

[TerryLH]

"The Goverment employee pplan does give a lot more medicine for this than the 30 baht scheme so this is unlikely."

The government employee plan is neither the '30 baht' plan nor Social Security.

It's for government civil service employees and their families.

[Firefan]

And the big difference with the government employee plan is also that nearest family is included in the plan - which confuses many Thai married (to teacher/public servant Etc.) farangs into thinking they are getting the "free/30b" health care while in actuality covered under their Thai wife's/husbonds plan. Cheers!

Edit; just see that Terry covered my comment partly sorry - but I think important to add that farang married to Thai public servant covered too - as it causes a ton of confusion here.

[WyattEarp]

First of all you need to avoid the term "government healthcare" as most people would interpret that to mean the government UC ("30 baht") scheme which most definitely Banglamung does accept. You are talking about Social Security, which is not the same thing. She is not anymore registered for "government healthcare" as that term is usually understood, and she is no longer eligible for it due to having SS. The government UC ("30 baht") system only covers people who are not covered by SS. So as soon as she became eligible for SS she lost her eligibility under the UC system.

Usually government hospitals accept SS, so it would be odd for Banglamung not to, but the SS office is the best source of this info. Possibly they already had as many people registered as they could handle and were not accepting new patients for that reason.

I don't think she can choose to opt out of SS to get under UC while employed, but again, the SS office is the best place to ask.

I already put "government" in quotes in the topic as I realized this is not the correct term, but didn't know what else to call it. I'm fine with using the terms UC and SS for clarity. Thanks for the clarification!

Yes now you mention it, I think she was told that they were no longer accepting registrations with Banglamung. Whatever the reason, it just doesn't seem right to me that someone who is unemployed get UC for 30 baht, and someone who works and pays social security has to pay 15 times more. The staff at Banglamung hospital told her that she could try to go to the SS office for a refund, but didn't think she would get any, apart from spending a half day going up to the SS office in Laem Chabang.

[Sheryl]

I already put "government" in quotes in the topic as I realized this is not the correct term, but didn't know what else to call it. I'm fine with using the terms UC and SS for clarity. Thanks for the clarification!

Yes now you mention it, I think she was told that they were no longer accepting registrations with Banglamung. Whatever the reason, it just doesn't seem right to me that someone who is unemployed get UC for 30 baht, and someone who works and pays social security has to pay 15 times more. The staff at Banglamung hospital told her that she could try to go to the SS office for a refund, but didn't think she would get any, apart from spending a half day going up to the SS office in Laem Chabang.

The is simply not the case. in both the UC and SS schemes, care costs full price at any hospital other than the one you are registered at. If while she was under UC at Banglamiung and had gone to another hospital, she's have been charged similiar to what she is now paying at Banglamung. There is no inequity in that sense between the two systems. Your problem is that she prefers a hospital other than the one she is now registered at.

Under SS there is a choice of hospitals, under UC there is none, it is fixed based on where you live.

[Sceptict11]

WyattEarp

Using your argument all the unemployed should pay tax because that is what is expected of the employed.

Or would you prefer the employed to not pay tax because the unemployed do not .

Bit of a silly debate really!

[TerryLH]

"Under SS there is a choice of hospitals, under UC there is none, it is fixed based on where you live."

In either system, if the facility you are registered at doesn't provide the service you need, they can give you a referral to one that does.

That's a written referral, not just some staff telling you to go to another place.

Under the SS system, it's fairly common practice that when you are first enrolled, you won't actually choose where you are assigned. Often the employer will make that decision based on what they think you might want.

[WyattEarp]

The is simply not the case. in both the UC and SS schemes, care costs full price at any hospital other than the one you are registered at. If while she was under UC at Banglamiung and had gone to another hospital, she's have been charged similiar to what she is now paying at Banglamung. There is no inequity in that sense between the two systems. Your problem is that she prefers a hospital other than the one she is now registered at.

Under SS there is a choice of hospitals, under UC there is none, it is fixed based on where you live.

The problem is Banglamung hospital is the only government hospital in the Pattaya area. The nearest alternative would be Sriracha.

SS gave her the choice between Sriracha or Sattahip hospitals, both a minimum 60 km round trip. Who in their right mind would spend this time if the care required can be given right here in Pattaya.

[harrry]

The is simply not the case. in both the UC and SS schemes, care costs full price at any hospital other than the one you are registered at. If while she was under UC at Banglamiung and had gone to another hospital, she's have been charged similiar to what she is now paying at Banglamung. There is no inequity in that sense between the two systems. Your problem is that she prefers a hospital other than the one she is now registered at.

Under SS there is a choice of hospitals, under UC there is none, it is fixed based on where you live.

The problem is Banglamung hospital is the only government hospital in the Pattaya area. The nearest alternative would be Sriracha.

SS gave her the choice between Sriracha or Sattahip hospitals, both a minimum 60 km round trip. Who in their right mind would spend this time if the care required can be given right here in Pattaya.

Apparently care can be given in Pattaya. She stated there is a clinic here which is the first point of call. If she goes there she is either treated if that is available at that clinic or refered to the main hospital and even transport provided. Pretty good service it seems to me.

[WyattEarp]

I don't understand why we need to take this discussion in this direction, that was not my point. Yes it can be done but this would probably be wasting the best part of a day, where going to Banglamung can be done in an hour. Maybe you lived here too long and have become used to time being of no value.

[harrry]

I don't understand why we need to take this discussion in this direction, that was not my point. Yes it can be done but this would probably be wasting the best part of a day, where going to Banglamung can be done in an hour. Maybe you lived here too long and have become used to time being of no value.

If she is in the UC scheme she can get 30 baht healthcare. If she is working why should the state pay for this. She has insurance which provides her health care incidently private type with private room and less waiting.

Of course if she stops working she can enrol in the UC scheme.

If she is sick she is entitled to paid sick leave too. Why does she not obtain this too.

[Sheryl]

OK, I think we are starting ti go in circles. Obviously the best solution for the OP's wife is to switch her registration to Banglamung and a call to the SS office is in order.