The new Government Health Insurance - info for TV members in Chiang Mai

[harrry]

Many of the government hospitals have a section where you can pay and get the same packages of tests you get at private hospitals. Thais pay for these as do foreigners. In this case if you watch the specials a private hospital which generally costs about twice as much for them can occasionally be cheaper.

In the case of a diabeties screen the hospital would be happy to test for this under the 30 baht scheme as well as provide any needed treatment or advice re diet and management together with follow up.

The results of the tests I did for the card only included the diseases banned such as syphallis elephantitis filaria leprosy and chest x-ray and drugs. The are to elimininate those not eligible for the program.

Edited November 14, 2013 by harrry

[meechai]

At Nakorn Ping the proof of residence requirement has been pretty open -- utility bill in your name, letter from condo or guest house manager, rental contract -- heck they'd probably take the sticker from the home delivery of our newspaper. No need to go to Immigration to get a TM 30 or pay your consulate to do a Cert of Residency. What they're looking for is your postal code or statement of Amphur. Your address is on the back of your Thai drivers license, in Thai, also. Be sure to bring your passport and copy of the photo page of your passport.

Uptheos -- where you do live -- what district (amphur)? Then I can tell you which hospital is your MOPH hospital.

(List coming soon!)

So I am guessing if I take my wife with her blue book I should be fine at NP?

We own our condo but it is in the Thai quota so in her name

[NancyL]

The results of the tests I did for the card only included the diseases banned such as syphallis elephantitis filaria leprosy and chest x-ray and drugs. The are to elimininate those not eligible for the program.

Actually the only positive result that is going to disqualify you from enrolling is illegal drug use. With the rest, you'll be treated. We've already had a report of a foreigner who tested positive for syphilis -- when he returned to pick up his insurance card, they gave it to him and then quietly ushered him to a private room to review the results of his health screening where they discussed the test results and treatment program.

The purpose of this insurance is to detect and prevent the spread of disease -- not exclude people who already have diseases that can be treated!

[NancyL]

At Nakorn Ping the proof of residence requirement has been pretty open -- utility bill in your name, letter from condo or guest house manager, rental contract -- heck they'd probably take the sticker from the home delivery of our newspaper. No need to go to Immigration to get a TM 30 or pay your consulate to do a Cert of Residency. What they're looking for is your postal code or statement of Amphur. Your address is on the back of your Thai drivers license, in Thai, also. Be sure to bring your passport and copy of the photo page of your passport.

Uptheos -- where you do live -- what district (amphur)? Then I can tell you which hospital is your MOPH hospital.

(List coming soon!)

So I am guessing if I take my wife with her blue book I should be fine at NP?

We own our condo but it is in the Thai quota so in her name

You probably should bring proof that the lady with the blue book is indeed your wife.

[Mapguy]

The results of the tests I did for the card only included the diseases banned such as syphallis elephantitis filaria leprosy and chest x-ray and drugs. The are to elimininate those not eligible for the program.

Actually the only positive result that is going to disqualify you from enrolling is illegal drug use. With the rest, you'll be treated. We've already had a report of a foreigner who tested positive for syphilis -- when he returned to pick up his insurance card, they gave it to him and then quietly ushered him to a private room to review the results of his health screening where they discussed the test results and treatment program.

The purpose of this insurance is to detect and prevent the spread of disease -- not exclude people who already have diseases that can be treated!

Yes, but WOW !!

How in the world is this going to work on such a low annual capitation fee ?! Stay tuned!

For now, God bless the MOPH!

Edited November 14, 2013 by Mapguy

[Mapguy]

Actually the only positive result that is going to disqualify you from enrolling is illegal drug use. With the rest, you'll be treated. We've already had a report of a foreigner who tested positive for syphilis -- when he returned to pick up his insurance card, they gave it to him and then quietly ushered him to a private room to review the results of his health screening where they discussed the test results and treatment program.

The purpose of this insurance is to detect and prevent the spread of disease -- not exclude people who already have diseases that can be treated!

I think that the lack of treatment for addictive drug use is regrettable regardless of its source. Too many foreigners probably indulge and need a lot of help. And what about alcoholism? This is a medical problem nor just a behavioral quirk . I would think that there are any number of bar buddies and isolated drinkers who need treatment. On the other hand, both conditions really seem beyond the capacity of the Thai MOPH ability to respond.

[meechai]

So I am guessing if I take my wife with her blue book I should be fine at NP?

We own our condo but it is in the Thai quota so in her name

You probably should bring proof that the lady with the blue book is indeed your wife.

Thank you Nancy although my visa ext is based on marriage that is a good idea just in case

[NancyL]

The results of the tests I did for the card only included the diseases banned such as syphallis elephantitis filaria leprosy and chest x-ray and drugs. The are to elimininate those not eligible for the program.

Actually the only positive result that is going to disqualify you from enrolling is illegal drug use. With the rest, you'll be treated. We've already had a report of a foreigner who tested positive for syphilis -- when he returned to pick up his insurance card, they gave it to him and then quietly ushered him to a private room to review the results of his health screening where they discussed the test results and treatment program.

The purpose of this insurance is to detect and prevent the spread of disease -- not exclude people who already have diseases that can be treated!

Yes, but WOW !!

How in the world is this going to work on such a low annual capitation fee ?! Stay tuned!

For now, God bless the MOPH!

Mapguy, God bless you for starting a thread on "Implications of the Gov't Health Insurance" (or whatever you called it). That's the place for speculative and judgmental comments about the new program.

But, I'll bite -- it's much, much cheaper for Thailand to treat one male foreigner with syphilis than all the other Thai women he might infect -- remember the symptoms aren't as evident in women and the health consequences can be more devastating, especially if they become pregnant while infected.

Edited November 15, 2013 by NancyL

[uptheos]

The results of the tests I did for the card only included the diseases banned such as syphallis elephantitis filaria leprosy and chest x-ray and drugs. The are to elimininate those not eligible for the program.

Actually the only positive result that is going to disqualify you from enrolling is illegal drug use. With the rest, you'll be treated. We've already had a report of a foreigner who tested positive for syphilis -- when he returned to pick up his insurance card, they gave it to him and then quietly ushered him to a private room to review the results of his health screening where they discussed the test results and treatment program.

The purpose of this insurance is to detect and prevent the spread of disease -- not exclude people who already have diseases that can be treated!

Yes, but WOW !!

How in the world is this going to work on such a low annual capitation fee ?! Stay tuned!

For now, God bless the MOPH!

Mapguy, God bless you for starting a thread on "Implications of the Gov't Health Insurance" (or whatever you called it). That's the place for speculative and judgmental comments about the new program.

But, I'll bite -- it's much, much cheaper for Thailand to treat one male foreigner with syphilis than all the other Thai women he might infect -- remember the symptoms aren't as evident in women and the health consequences can be more devastating, especially if they become pregnant while infected.

I'll go one step further.

Mapguy please leave this thread for useful information and don't try to hi-jack it with self righteous drivel.

[cheeryble]

Are lipids included in blood panel for the initial health check?

If chest X-ray is included how often is it advisable for a symptomless person to be having a chest X-ray?

I'm far from a health nut but generally try to keep my frequency of radiation down.

Thanks to Nancy and other contributors (oh, including me!)

BTW someone gave a short list of hospitals doing this.

You can add Sarapee.

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[NancyL]

No, at this time lipids (and blood sugar) are not included in the initial health screening. They're screening all foreigners, migrant workers and elderly westerners alike, will the same tests, but this could change in the future. You could request screening for lipids for a modest charge when you go for your check-up or return once enrolled and ask a doctor to order the test with just the 30 baht charge which he'll probably do if you have certain risk factors (age, weight, family history, etc), especially if you're currently taking meds to control lipids.

Over the weekend, we posted the English translation of Chiang Mai Provincial Min. of Public Health's Explanation of Procedure to Apply and Utilize Foreigner Health Insurance for Muang and Mae Rim Districts on LannaCareNet.org

http://www.lannacarenet.org/foreigner-health-insurance-program-moph-directive/

Within a week, we hope to add another page to that website with FAQs -- other hospitals in the areas enrolling foreigners, photos/maps to locate Nakorn Ping Hospitals, what's covered, experience of some initial patients, etc.

Meanwhile, we encourage everyone to enroll. It's a good "back-up" insurance for catastrophic events for those who would otherwise prefer the convenience of paying out-of-pocket at a private hospital where you can make appointments and be seen quickly. If you have a limited budget, patience and perhaps some Thai language skills, the plan covers some unexpected things like take-home medication for blood pressure, diabetes, cholesterol, enlarged prostrate; dental care, cataract surgery, etc, etc. Even if you never use the insurance, I think it shows support for the Thai government to go up to Nakorn Ping and enroll in the insurance scheme.

Edited November 19, 2013 by NancyL

[cheeryble]

Thankyou for the sterling effort on providing that doc in English Nancy.

Only disappointed I can't get "beauty enhancement" my mum always said I was "tall enough and ugly enough" and that was 50 pr 60 years ago imagine me now!

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[Sheryl]

The results of the tests I did for the card only included the diseases banned such as syphallis elephantitis filaria leprosy and chest x-ray and drugs. The are to elimininate those not eligible for the program.

Actually the only positive result that is going to disqualify you from enrolling is illegal drug use. With the rest, you'll be treated. We've already had a report of a foreigner who tested positive for syphilis -- when he returned to pick up his insurance card, they gave it to him and then quietly ushered him to a private room to review the results of his health screening where they discussed the test results and treatment program.

The purpose of this insurance is to detect and prevent the spread of disease -- not exclude people who already have diseases that can be treated!

Yes, but WOW !!

How in the world is this going to work on such a low annual capitation fee ?! Stay tuned!

For now, God bless the MOPH!

It is not, that is certain. As mentioned towards the beginning, the capitation fee was calculated based on the expected health care utilization patterns of migrant workers. Somewhere along the line the decree came out for all foreigners without the people who do these sort of calculations being r in the loop.

The big question is how will hospitals and the MoPH respond when it becomes evident that this is not financially feasible. Hopefully, by just adjusting the premium rate to a more realistic level....as opposed to putting the whole thing on indefinite hold or discontinuing it. This is one of the reasons why I strongly advise against dropping private insurance if you have it (though you may want to add this as well, especially if your insurance does not cover outpatient visits & meds, or has low caps on pay-outs for certain things).

As long as you do not forego the option of private insurance (if you have it) or reduce your emergency savings (ditto), then you have nothing to lose by getting this even if it later collapses or premiums go up.

The intent is for it to be cost neutral for the hospitals, certainly not for it to yield a profit, so any revised premium will likely still be less than private insurance in addition to being open to groups of people private companies will not cover (elderly, pre-exisitng conditions etc).

[Sheryl]

.....

Meanwhile, we encourage everyone to enroll. It's a good "back-up" insurance for catastrophic events for those who would otherwise prefer the convenience of paying out-of-pocket at a private hospital where you can make appointments and be seen quickly. If you have a limited budget, patience and perhaps some Thai language skills, the plan covers some unexpected things like take-home medication for blood pressure, diabetes, cholesterol, enlarged prostrate; dental care, cataract surgery, etc, etc. Even if you never use the insurance, I think it shows support for the Thai government to go up to Nakorn Ping and enroll in the insurance scheme.

Indeed, the more people who enroll but don't use it, or use it very little, the lower premiums will end up being in the long run. The system will end up out of soem people's price range if the only people who enroll are those with heavy utilization and frequent hospitalization. SO all you healthy folk -- enroll, enroll!! You never know when you may be in an accident, and if you aren't, you will still have helped keep costs reasonable ofr everyone else.

[Oscar2]

.....

Meanwhile, we encourage everyone to enroll. It's a good "back-up" insurance for catastrophic events for those who would otherwise prefer the convenience of paying out-of-pocket at a private hospital where you can make appointments and be seen quickly. If you have a limited budget, patience and perhaps some Thai language skills, the plan covers some unexpected things like take-home medication for blood pressure, diabetes, cholesterol, enlarged prostrate; dental care, cataract surgery, etc, etc. Even if you never use the insurance, I think it shows support for the Thai government to go up to Nakorn Ping and enroll in the insurance scheme.

Indeed, the more people who enroll but don't use it, or use it very little, the lower premiums will end up being in the long run. The system will end up out of soem people's price range if the only people who enroll are those with heavy utilization and frequent hospitalization. SO all you healthy folk -- enroll, enroll!! You never know when you may be in an accident, and if you aren't, you will still have helped keep costs reasonable ofr everyone else.

good point. i went ahead and enrolled even though i have private insurance but i agree and before i even read this last post i had thought the same thing - show support for the program as you never know when it might come in handy. i would not go there for routine medical check ups as i could not be bothered but it is a good back up plan to have. took me all of 40 minutes to complete the entire process.

[mimithewoof]

Don't know if this is a warning as I don't know yet how it will play out - my husband got an infection in his nailbed three days ago after he'd lost the nail last month. It looked dodgy, so he went to the small Sansai hospital on Monday just in case. The doctor insisted there was no infection and that it was just inflammation and gave him ibuprofen but no antibiotics, Tuesday morning it was worse, and our pharmacist at Mee Chok Plaza gave him antibiotics.

He was due to collect his medical insurance card from Nakornping tomorrow, but the finger was so bad this morning he decided to go a day early. After collecting his card, he saw a doctor who said he would need to have the top part of his finger amputated as the infection needed to be totally cleaned out.

He was told to wait until a surgeon was free as the operation would only need a local anesthetic. Almost FOUR hours later, by which time his finger joint had swelled to resemble a ping-pong ball with pus oozing out, he was told to come back tomorrow as he would now need a general anesthetic and 24 hours on an antibiotic drip.

I'm from the UK, and know full well that the NHS is quite capable nowadays of appalling mistakes as well, but...no infection????

He was too old to be able to get private health insurance here when we arrived and his existing conditions and hypertension would have excluded him anyway - so this plan did seem useful, but now I wonder. Just hope his operation goes OK...I seem to be the only person who's worried about the infection spreading a lot further in the next 24 hours.

[MadMac]

That's serious. Go to a private hospital and get immediate treatment. Regardless of the cost, you may even be able to claim some of it. Not worth a few thousand baht to risk your life.

Edited November 20, 2013 by MadMac

[muchogra]

At first, I thought you could only enroll at the amphur hospital where you reside. Then, I was made to understand that you could choose any hospital under MOPH - Nakornping being one. Now, MESmith said otherwise. For him, living in Sankampaeng, he could only pick Sankampaeng Hospital as his choice of hospital. This seems to confirm what the lady at Window 4 in Sankampaeng Hospital told me, which is: could only go to Nakornping when it's referred to it by SKP Hospital. Now, I also seem to get the impression that Nakornping would enroll only residents from Amphur Muang and Mae Rim. I'm a bit confused now. I'm in Amphur Doi Saket. Can I enroll in Nakornping?

[elektrified]

Don't know if this is a warning as I don't know yet how it will play out - my husband got an infection in his nailbed three days ago after he'd lost the nail last month. It looked dodgy, so he went to the small Sansai hospital on Monday just in case. The doctor insisted there was no infection and that it was just inflammation and gave him ibuprofen but no antibiotics, Tuesday morning it was worse, and our pharmacist at Mee Chok Plaza gave him antibiotics.

He was due to collect his medical insurance card from Nakornping tomorrow, but the finger was so bad this morning he decided to go a day early. After collecting his card, he saw a doctor who said he would need to have the top part of his finger amputated as the infection needed to be totally cleaned out.

He was told to wait until a surgeon was free as the operation would only need a local anesthetic. Almost FOUR hours later, by which time his finger joint had swelled to resemble a ping-pong ball with pus oozing out, he was told to come back tomorrow as he would now need a general anesthetic and 24 hours on an antibiotic drip.

I'm from the UK, and know full well that the NHS is quite capable nowadays of appalling mistakes as well, but...no infection????

He was too old to be able to get private health insurance here when we arrived and his existing conditions and hypertension would have excluded him anyway - so this plan did seem useful, but now I wonder. Just hope his operation goes OK...I seem to be the only person who's worried about the infection spreading a lot further in the next 24 hours.

I would not go back. Go to a private hospital immediately. What are you waiting for?

[mimithewoof]

He's booked in tomorrow - flatly refuses to go to Ram or suchlike, saying he hates being ripped off.

His decision, I'm his wife, not his Mum! It's not worth a divorce...

[NancyL]

At first, I thought you could only enroll at the amphur hospital where you reside. Then, I was made to understand that you could choose any hospital under MOPH - Nakornping being one. Now, MESmith said otherwise. For him, living in Sankampaeng, he could only pick Sankampaeng Hospital as his choice of hospital. This seems to confirm what the lady at Window 4 in Sankampaeng Hospital told me, which is: could only go to Nakornping when it's referred to it by SKP Hospital. Now, I also seem to get the impression that Nakornping would enroll only residents from Amphur Muang and Mae Rim. I'm a bit confused now. I'm in Amphur Doi Saket. Can I enroll in Nakornping?

They seem to keep changing "the rules" At one point I truly thought I heard the head nurse responsible for intake at NKP say they'd enroll people who lived in neighboring amphurs if they were close to NKP, but now they seem to be referring them to the hospital serving their amphur. That could change -- doesn't hurt to ask.

I've found that in Thailand when dealing with bureaucracies, if you don't like the answer you receive the first time, just hang around, be polite and ask someone else -- often the answer can change, especially if your request is reasonable. It's worked for me sometimes at Immigration, maybe it would work at NKP!

[mimithewoof]

We're living in Doi Saket - my husband registered at Nakornping with no problems - although I'm beginning to think it wasn't such a smart idea given the chaos he's in now.

He was told last night to come back for his operation and overnight stay today, and arrived at 10.00 - he's now had to have all the same tests,X-ray, etc as yesterday, see the same junior doctor and then be passed on to the surgeon who saw him yesterday evening. And all the time,in spite of the the antibiotics he's been taking, the infection is getting worse. So much for urgency - still sounds like the NHS!

[NancyL]

Mimi, actually it is much like the NHS in that if you want priority, immediate treatment you have the freedom to seek treatment at a private hospital -- there are much cheaper options than CM Ram, incidentally, for something like this. It's totally understandable that they're going to want to run screening tests again prior to surgery -- after all your husband has an infection and they want to put him under with a general anesthetic. It would be irresponsible of any hospital to rely on old test results prior to doing this surgery.

It's unfortunate what's happened to your husband and frustrating that he isn't able to obtain immediate treatment, but remember this insurance scheme is the insurance of last resort for the poorest of the poor and they have to triage their cases to appropriately utilize resources like operating rooms, doctor's time, etc.

[harrry]

of course some of the delay could be that he self medicated through a pharmacy.

Edited November 21, 2013 by harrry

[elektrified]

...remember this insurance scheme is the insurance of last resort for the poorest of the poor and they have to triage their cases to appropriately utilize resources like operating rooms, doctor's time, etc.

Exactly, and which is why so many Thais are scared to death of ending up in a government hospital and why so many are privately insured.

I don't understand why the ex-pat husband of mimithewoof doesn't get over to a private hospital ASAP? Forget Ram, there are many other cheaper choices...like McCormick.

[mccw]

And so it begins........

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[citizen33]

...remember this insurance scheme is the insurance of last resort for the poorest of the poor and they have to triage their cases to appropriately utilize resources like operating rooms, doctor's time, etc.

Exactly, and which is why so many Thais are scared to death of ending up in a government hospital and why so many are privately insured.

Actually Thailand has low rates of private medical insurance, About 1% of the population was covered in 1992 and this had only risen to 8% by 2010. Many middle-class people use the public social security scheme or civil servant medical benefits scheme, and some even use the universal coverage scheme, especially as a back up. The latter was designed to be a universal service for all, rather than a safety net service targeted at the poorest, but admittedly it still has a long way to go. About 25% of Thai health care expenditure is private money, usually in the form of out-of-pocket payments rather than payments from PMI. I do not know of any large healthcare system around the world that relies on voluntary private insurance to fund the medical care of older people. This is because they are not a good risk, so that some kind of risk pooling arrangement is needed. Even the USA has Medicare.

A small district hospital is not the best place to present with a life-threatening condition, but some of the worst horror stories I have heard concern small private hospitals in provincial towns. The better larger MoPH, university and military hospitals provide quite a good standard of treatment, though without the plush front desk and nice 'hotel' services that many lay people mistakenly assume to be an index of treatment quality.

[Sheryl]

As this thread ha become somewhat unwieldy in length we are closing it and opening a new one for up to date reports, comments and questions.

We will also today pin a permanent reference thread.