Implications of New Government Health Insurance Policy in Chiang Mai

[mccw]

Sorry - I must not be so well informed. How can the government only pay the hospital 2000bht for an operation or ICU stay which costs many times more than that? Or medication that costs more than that monthly- let alone this yearly charge. It must be subsidised from tax payers- I can see how its economically possible otherwise

[harrry]

Sorry - I must not be so well informed. How can the government only pay the hospital 2000bht for an operation or ICU stay which costs many times more than that? Or medication that costs more than that monthly- let alone this yearly charge. It must be subsidised from tax payers- I can see how its economically possible otherwise

Yes you are not well informed.

The National scheme is funded by the governent paying that amount. It does not pay more. It is an insurance type scheme where the low users subsidise the high.

The actual amount provided per head is round 2200. of this 50 baht goes to a central fund which provides the high cost care for such things as cancer and HIV. 12.5% is taken for funding the central administration of the scheme. I said 2000 because that is the amount the hospital actually gets per person on the tabian bans of the district who are not included in other schemes.

Edited October 23, 2013 by harrry

[ramrod711]

I have had access to government healthcare for over a year, i requested a yellow book, my wife took it and all required documents to the hospital in our area and i was covered. I have never used it, not for medications that i require, or for the eye surgery that i paid for at ram. I think my wife is concerned about a sudden illness.

[citizen33]

I don't disagree with Harry's main thesis that a reasonable contribution from insured members under a voluntary card scheme (I'd say quite a bit higher than 2000 baht because of adverse selection) would reimburse the hospitals at the same rate as the public UC scheme, but - as I 've said before - he doesn't seem to understand the financing system, It is the Contracting Unit for Primary Care rather than the hospital that receives the capitation payment (the 2755), which is then parceled off to pay for both primary care and referrals to secondary care. It is true that in recent years the NHSO regional office typically top slices part of this money to pay the hospitals direct for inpatient services, but this is done on the basis of Diagnosis Related Groups or fees schedules for actual treatments provided. The hospitals are not paid on a capitation basis. Most CUPs are linked to a district hospital but they are conceptually separate entities.

Edited October 23, 2013 by citizen33

[mccw]

I find it hard to believe that the existing scheme is self funding without further government subsidy. Like the National insurance in UK , theory and reality are totally different. Maybe a leap of reasoning could justify such possiblity in Thailand because of the younger demographic supporting proportionally less old people as a western set up does. But in future and now all the old retirees of other countries will come to have care it will drastically change the demographics/ economics of the system.

Even if in Chiang Mai it is at a guess maybe 10% more people (probably a much higher % of elderly) will they be building another 10% of ward space and hiring another 10% of staff do you think?

From what I see and hear these hospitals are already stretched as it is.

[harrry]

I don't disagree with Harry's main thesis that a reasonable contribution from insured members under a voluntary card scheme (I'd say quite a bit higher than 2000 baht because of adverse selection) would reimburse the hospitals at the same rate as the public UC scheme, but - as I 've said before - he doesn't seem to understand the financing system, It is the Contracting Unit for Primary Care rather than the hospital that receives the capitation payment (the 2755), which is then parceled off to pay for both primary care and referrals to secondary care. It is true that in recent years the NHSO regional office typically top slices part of this money to pay the hospitals direct for inpatient services, but this is done on the basis of Diagnosis Related Groups or fees schedules for actual treatments provided. The hospitals are not paid on a capitation basis. Most CUPs are linked to a district hospital but they are conceptually separate entities.

OK I know I oversimplified. In most cases the CU is directly linked to a Regional Hospital. As the source of all the funds for the UC sheme is the capitation payment which you have stated is 2755, my sources gave less which then has deductions to fund the High Cost Care and Administration costs I contend that that the hospitals funds for UC from the government (or as mccw put it the taxpayer) is all from that pool. Yes there may be cross subsidisation from profits from out of area care given and other sources but the "taxpayer's" contribution that the hospital recieves is limited to that.

It is not really relevant who actually partitions the money.

In the case of this scheme the user contributes round that amount that the hospital would normally recieve directly.

I do not disagree that it would be nice if the UC scheme was funded at higher level. What I disagree with is the contention of some that as foreigners we should pay several hundred dollars for the scheme.

I also agree that there is some subsidisation from the taxpayer in that workers at government hospitals recieve a range of tax concessions. How far we go back in sorting out costs is arguable.

I contend that having lived here for some time contributing to the economy at the rate of a medium level or government official I have over that period paid a fair proportion of the VAT for that period.

I have also provided some assistance to enable my wife's neices to recieve a slightly better education than they otherwise would have. It is not me that will suffer if my savings are expended in private care. It is my neice who probably would not be able to complete her degree.

All told I think my financial and other contributions have not had a negative impact on Thailand.

As far as what is fair I definitely do not agree that western or private style prices should be used to calculate the contribution. The contribution should be based on the same rate as the UC scheme with a possible adjustment for age related services if they are signifigently more than those of the thai population.

THe argument that there are 10 % more people in the scheme if foreigners are included is farcical. The city has 150000 people in it. say 20% at most are covered by other schemes we would need 12000 people to join the scheme. It is more likely to be less than 500 but could be 1000.

On a country wide basis the figures are even more insignifigent.

It is a very very good basic scheme and in my case would take some worry from my family.

[Beetlejuice]

I am sure all the old sods,have their pensions transfered to Thailand,which gives a year round

boost to the local economy,and most ,if not all have been able to provide for themselves before

the Government introduced their new health care policy, they live here,buy property (by proxy)

pay taxes if even just in the form of VAT.

So are you making the point that Chiang Mai would be a better place without all (too many)

old sods as you put it,just remember you will also be an old sod one day.

Really its none of your business,this is Thailand, the Thai Government make the policies,

some good ,some bad, this I feel is one of their better ones,not often you find a caring Govt.

regards Worgeordie one of the old sods.

But there are today far too many farangs plonking themselves in Thailand living hand to mouth existences on a hope and a prayer that all will work out for them and when events don`t go to plan they expect that Thailand owes them a life here and should take care of them if they become in need.

And this is what`s causing the problems, because the actions of these people have a knock on affect for all of us and we all end up having to endure tighter controls and paying the price, so in fact these issues do become all our business, because everyone gets drawn into it and the situations ends up being our problem too.

I do feel that there are too many, as some have described old sods in Thailand who have decided to move here with inadequate funding with no liquid asset investments for a rainy day and are already or potential burdens to themselves and Thailand in the future and therefore should not be here under these circumstances.

[OneZero]

I am sure all the old sods,have their pensions transfered to Thailand,which gives a year round

boost to the local economy,and most ,if not all have been able to provide for themselves before

the Government introduced their new health care policy, they live here,buy property (by proxy)

pay taxes if even just in the form of VAT.

So are you making the point that Chiang Mai would be a better place without all (too many)

old sods as you put it,just remember you will also be an old sod one day.

Really its none of your business,this is Thailand, the Thai Government make the policies,

some good ,some bad, this I feel is one of their better ones,not often you find a caring Govt.

regards Worgeordie one of the old sods.

But there are today far too many farangs plonking themselves in Thailand living hand to mouth existences on a hope and a prayer that all will work out for them and when events don`t go to plan they expect that Thailand owes them a life here and should take care of them if they become in need.

And this is what`s causing the problems, because the actions of these people have a knock on affect for all of us and we all end up having to endure tighter controls and paying the price, so in fact these issues do become all our business, because everyone gets drawn into it and the situations ends up being our problem too.

I do feel that there are too many, as some have described old sods in Thailand who have decided to move here with inadequate funding with no liquid asset investments for a rainy day and are already or potential burdens to themselves and Thailand in the future and therefore should not be here under these circumstances.

+1

[scorecard]

I am sure all the old sods,have their pensions transfered to Thailand,which gives a year round

boost to the local economy,and most ,if not all have been able to provide for themselves before

the Government introduced their new health care policy, they live here,buy property (by proxy)

pay taxes if even just in the form of VAT.

So are you making the point that Chiang Mai would be a better place without all (too many)

old sods as you put it,just remember you will also be an old sod one day.

Really its none of your business,this is Thailand, the Thai Government make the policies,

some good ,some bad, this I feel is one of their better ones,not often you find a caring Govt.

regards Worgeordie one of the old sods.

But there are today far too many farangs plonking themselves in Thailand living hand to mouth existences on a hope and a prayer that all will work out for them and when events don`t go to plan they expect that Thailand owes them a life here and should take care of them if they become in need.

And this is what`s causing the problems, because the actions of these people have a knock on affect for all of us and we all end up having to endure tighter controls and paying the price, so in fact these issues do become all our business, because everyone gets drawn into it and the situations ends up being our problem too.

I do feel that there are too many, as some have described old sods in Thailand who have decided to move here with inadequate funding with no liquid asset investments for a rainy day and are already or potential burdens to themselves and Thailand in the future and therefore should not be here under these circumstances.

And the o perfect one has spoken.

[Chiengmaijoe]

I find it hard to believe that the existing scheme is self funding without further government subsidy. Like the National insurance in UK , theory and reality are totally different. Maybe a leap of reasoning could justify such possiblity in Thailand because of the younger demographic supporting proportionally less old people as a western set up does. But in future and now all the old retirees of other countries will come to have care it will drastically change the demographics/ economics of the system.

Even if in Chiang Mai it is at a guess maybe 10% more people (probably a much higher % of elderly) will they be building another 10% of ward space and hiring another 10% of staff do you think?

From what I see and hear these hospitals are already stretched as it is.

Where does the extra 10% come from? At a guess I would say that expats account for less than 1% of the population in Thailand. Of that 1% I reckon about 10% would use the local government hospitals because most people would probably have personal health cover or prefer to pay for a quicker , better service at the private hospitals.

Who are the non-paying farangs that you referred to in an earlier post? You do like to exaggerate or let's say embellish your statements don't you. "Immigrants on mass"' , "daily stories about how farang have just overburdened the health service". I'd like to see what figures you estimate are going to use this service. Round it up to the nearest dozen if you like.

[FiftyTwo]

I wonder how many of these farangs now queuing up at the Thai government hospitals were until recently moaning over their jars about all the immigrants using the health facilities in the home countries- especially those doing so with out contributing any taxes.

This is really an amazing development.

I can't say I agree with it all. Look how over burdened the British, Italian, etc health systems are because of the policies like this. It will cost a fortune and I see no moral reason got Thai tax payers to have to provide for retired farangs health care; especially those who live very unhealthy life styles, diabetics, obesity and alcohol related problems. Terrible.

At least there should be a minimum length of stay before being allowed to claim this for farang retires- 5 or 10years maybe. Perhapse an exemption for those married with children.

Obviously people are out for themselves- its understandable- but come let's have a bit of objectivity.

I'm thinking at just under 3k a pop, the government hospitals will be making money out of the foreigners joining up. It's all extra money for them, and very little in the way of extra costs. The doctors, nurses and facilities are already in place. Only the meds cost money, and most of those are produced very cheaply within Thailand.

Thai tax payers, very few Thais paying income tax, we all pay import duty taxes and VAT.

Tell me what you imagine all these 'extra costs' are that the Thai tax payers will be making for foreigners using the system?

[FiftyTwo]

But there are today far too many farangs plonking themselves in Thailand living hand to mouth existences on a hope and a prayer that all will work out for them and when events don`t go to plan they expect that Thailand owes them a life here and should take care of them if they become in need.

Most of the 'hand to mouth' foreigners I know are living on an income of 2x to 3x more than the average Thai family.

These guys are still considered a catch by many younger Thai girls, because they have so much money.

You really are totally out of touch with reality.

[Oscar2]

I wonder how many of these farangs now queuing up at the Thai government hospitals were until recently moaning over their jars about all the immigrants using the health facilities in the home countries- especially those doing so with out contributing any taxes.

This is really an amazing development.

I can't say I agree with it all. Look how over burdened the British, Italian, etc health systems are because of the policies like this. It will cost a fortune and I see no moral reason got Thai tax payers to have to provide for retired farangs health care; especially those who live very unhealthy life styles, diabetics, obesity and alcohol related problems. Terrible.

At least there should be a minimum length of stay before being allowed to claim this for farang retires- 5 or 10years maybe. Perhapse an exemption for those married with children.

Obviously people are out for themselves- its understandable- but come let's have a bit of objectivity.

Only the meds cost money, and most of those are produced very cheaply within Thailand.

to give you an idea, most of the pills (but not all, such as imported brand name drugs) cost the pharmacies on average less than 25 Satang each if they buy them from the factories direct in Bangkok. if a distributer (middle man) is involved, their cost might be 30-50 Satang per pill. they turn around and sell them retail for 10 Baht per pill. do the math. that is why pharmaceuticals are the some of the most profitable commodities in the world.

[FiftyTwo]

That Thai hospitals have been left out of pocket up until now by non paying foreigners/ farangs is not a reason to celebrate this scheme as a solution. What it is doing is moving that cost on to the Thai tax payers and multiplying it exponentially.

But the paying foreigners are often charged 2x or more the usual cost.

I'm thinking the hospitals are quids in from the foreigners who pay, even if you deduct the few that don't pay.

And the private sector even more, I had a small operation at a local hospital, a friend had the same operation at CM RAM and paid over 10x my fee, for exactly the same operation, using the same doctors.

Edited October 23, 2013 by FiftyTwo

[FiftyTwo]

to give you an idea, most of the pills (but not all, such as imported brand name drugs) cost the pharmacies on average less than 25 Satang each if they buy them from the factories direct in Bangkok. if a distributer (middle man) is involved, their cost might be 30-50 Satang per pill. they turn around and sell them retail for 10 Baht per pill. do the math. that is why pharmaceuticals are the some of the most profitable commodities in the world.

You're right!

I bought some meds (privately) for my kid this week (at San Sai government hospital), two types of anti-biotics, burn cream, anti-bacterial cream, all for 77bht, and they were making a profit on that.

These guys posting about expense, all Americans that have been gouged by the medical establishment all their lives.

Edited October 23, 2013 by FiftyTwo

[Frank James]

you, in my last post refers to the OP! In other words, I quite agree with the OP on his inferences.

I do not. Sounds like another self-important well-fixed burgher making generalizations about others not in his privileged cohort. Go play golf, or something.

[muchogra]

you, in my last post refers to the OP! In other words, I quite agree with the OP on his inferences.

I do not. Sounds like another self-important well-fixed burgher making generalizations about others not in his privileged cohort. Go play golf, or something.

Pardon me if my posts have made you feel like what you had stated here.

Let me clarify that my posts are not meant to be demeaning or discriminating toward any expats here. Rather, I just want to bring out precaution to any expats pinning too much hope on the said program. Shryl, NancyL, and among others are doing a good job exploring and updating the said program; my thanks go to them accordingly with genuine sincerity.

One thing that bothers me is whether an enrollee is restricted to receive its benefits at ONLY the amphur hospital where the enrollee resides. As I have posted elsewhere that some amphur hospitals are poorly equipped and, mostly, lack motivated and conscientious personnelswith common sense.

[Thailand]

you, in my last post refers to the OP! In other words, I quite agree with the OP on his inferences.

I do not. Sounds like another self-important well-fixed burgher making generalizations about others not in his privileged cohort. Go play golf, or something.

Pardon me if my posts have made you feel like what you had stated here.

Let me clarify that my posts are not meant to be demeaning or discriminating toward any expats here. Rather, I just want to bring out precaution to any expats pinning too much hope on the said program. Shryl, NancyL, and among others are doing a good job exploring and updating the said program; my thanks go to them accordingly with genuine sincerity.

One thing that bothers me is whether an enrollee is restricted to receive its benefits at ONLY the amphur hospital where the enrollee resides. As I have posted elsewhere that some amphur hospitals are poorly equipped and, mostly, lack motivated and conscientious personnelswith common sense.

I thought the benefits were only available at the hospital where the individual signs up, not the Amphur?

[nivram4491]

One thing that bothers me is whether an enrollee is restricted to receive its benefits at ONLY the amphur hospital where the enrollee resides. As I have posted elsewhere that some amphur hospitals are poorly equipped and, mostly, lack motivated and conscientious personnelswith common sense.

My understanding is that you can enroll in a hospital outside your amphur but once you have enrolled, that is the hospital you have to use. The hospital you choose cannot be a top tier hospital like Suan Dok.

[Mapguy]

Here are a couple of questions to consider.

1. What is the availability and cost of health insurance abroad for foreigners living in Thailand? (I grant you that there are many, many factors that complicate such calculations --- and, yes, it is true that some health insurance benefits (especially for retirees, for which this program should be of intense interest) from various countries do extend abroad, but try to keep it relatively simple: perhaps by simplifying to a high-deductible minimum coverage insurance policy by various ages.)

2. How does this compare the result to Tb 2000-2200 per year and a putative Tb30 per visit?

You can Google the answers! No need to speculate!

Edited October 24, 2013 by Mapguy

[harrry]

Here are a couple of questions to consider.

1. What is the availability and cost of health insurance abroad for foreigners living in Thailand? (I grant you that there are many, many factors that complicate such calculations --- and, yes, it is true that some health insurance benefits (especially for retirees, for which this program should be of intense interest) from various countries do extend abroad, but try to keep it relatively simple: perhaps by simplifying to a high-deductible minimum coverage insurance policy by various ages.)

2. How does this compare the result to Tb 2000-2200 per year and a putative Tb30 per visit?

You can Google the answers! No need to speculate!

What relevance does this have to the program.....

no need to speculate....NONE.

[Mapguy]

I disagree. It is most relevant. I am not interested in speculation. I suggest people need to understand the relative costs and benefits of such a program compared to what else might or might not be available to them. This will, I believe, lead to some usefui understanding of the implications of such a program.

Dare I say it!! Is this "Obamacare" for those lost in Thailand without insurance !!!!!

Edited October 24, 2013 by Mapguy

[Frank James]

If you are over 60 years of age, and enroll in a health insurance scheme in Thailand, the cost will rise significantly every year, and after age 70 they can refuse to insure you at any price. This has been my experience (using Bupa). I finally dropped it altogether, and just pay as I go for outpatient care and drugs at a local hospital. So far, so good, but any serious illness requiring hospitalization would be a major hit on scarce resources (mine).

If a plan is now made available to foreigners at such a reasonable cost, I am going to go for it. I know the care will be of the most basic kind, but it's better than being bankrupted. One shouldn't be made to feel like a lowlife leech for taking advantage of what is there. It's not taking anything away from anyone else.

I don't look at this as "Obamacare", and anyway, why is that now a dirty word to some? If you are fortunate enough to be retired here and have a good stack of money to live on, that's beautiful. Enjoy, enjoy, and God bless. But those who make snide comments about old guys hanging on by their fingernails, living in 40sm rooms, how we should all go back where we came from...that's a low shot, and you really need to look at yourself in the mirror. Live and let live.

[sailaway2000]

Anybody with experience applying in San Kampaeng?

Quite a few falang out here too.

[mccw]

I'm not against people getting a good deal btw. If people make a choice to come here with a bare mInimum , as I did when I first arrived, then up to the individual. Part of that arrival was accepting I was running certain risks for a better quality of life. It was a trade between nanny state and freedom really. Ij ust worry a bit about the mid to long term possible negative implications. Like starting off its cheap, then become compulory for all visa non immigrant visa holders and then becomes expensive, prohibitively expensive; so removes that freedom of choice wich was such a wonderful option in the first place. What a shame that would be. Like the circular 30day tourist visas was put an end to already and the big cash requirements must be stuck on the bank. I prefer freedom for everybody to live by thier own means rather than a nanny state and over regulation. Same argument applies to the over zealous work permit and biz policing etc etc

[Chiengmaijoe]

Dare I say it!! Is this "Obamacare" for those lost in Thailand without insurance !!!!!

Dare I say it? You seem to delight in saying such things. We got the message already.... Smug, arrogant , selfish and uncaring. You're just trolling now, which means we can add 'pathetic' too.

[Chiengmaijoe]

I'm not against people getting a good deal btw. If people make a choice to come here with a bare mInimum , as I did when I first arrived, then up to the individual. Part of that arrival was accepting I was running certain risks for a better quality of life. It was a trade between nanny state and freedom really. Ij ust worry a bit about the mid to long term possible negative implications. Like starting off its cheap, then become compulory for all visa non immigrant visa holders and then becomes expensive, prohibitively expensive; so removes that freedom of choice wich was such a wonderful option in the first place. What a shame that would be. Like the circular 30day tourist visas was put an end to already and the big cash requirements must be stuck on the bank. I prefer freedom for everybody to live by thier own means rather than a nanny state and over regulation. Same argument applies to the over zealous work permit and biz policing etc etc

It isn't necessary for people to come here with a bare minimum in order to find themselves in need of a social health system, just a change in circumstances, which can happen to anyone. I'm sure NancyL can confirm that. And while we're at it, I'd like to congratulate her and the others involved who are very kindly offering assistance to those expats in need. I'm highly impressed and immensely thankful for what these good people do, because a fair few people here give the impression that they wouldn't piss on you if you were on fire. "I'm alright Jack" could well be their motto.

[ataloss]

#53"...after age 70 they can refuse to insure you at any price. This has been my experience (using Bupa)...."

I'm surprised that, your having been a BUPA subscriber, do not understand that BUPA is one of the few insurance agencies that will ensure you for life; provided you enrolled before age 60(?) and continuously insured with them each year. Too late for you now FJ; but you are misleading those who, regardless of cost, want lifetime coverage.

For those that do, why not check their site or pay a visit to their Chiangmai office across from Wat Yed Yod.

I had BUPA coverage for years well into their lifetime coverage but threw in the towel at the growing expense of it all.

Try here:

http://www.thaivisa.com/forum/topic/625739-health-insurance-for-70-s/

[cmsally]

#53"...after age 70 they can refuse to insure you at any price. This has been my experience (using Bupa)...."

I'm surprised that, your having been a BUPA subscriber, do not understand that BUPA is one of the few insurance agencies that will ensure you for life; provided you enrolled before age 60(?) and continuously insured with them each year. Too late for you now FJ; but you are misleading those who, regardless of cost, want lifetime coverage.

For those that do, why not check their site or pay a visit to their Chiangmai office across from Wat Yed Yod.

I had BUPA coverage for years well into their lifetime coverage but threw in the towel at the growing expense of it all.

Try here:

http://www.thaivisa.com/forum/topic/625739-health-insurance-for-70-s/

I find it a bit of a foggy area with their policies over 60.

I inquired twice regarding foreign nationals and found it very hard to pin them down on specifics.

So I inquired regarding Thai national. They have a plan called the "Crystal Plan" (Thais only). You have to join at least a year before 60th birthday. I managed to get a specific reply on yearly cost for approx 68-69 yrs, which she said was approx 22,000 bt depending on exact package. Then I upped it to 75-76 yrs and she hummed and hahed and finally admitted they had no one on the books over 70 yrs so wasn't sure!

Not exactly reassuring!

[uptheos]

Dare I say it!! Is this "Obamacare" for those lost in Thailand without insurance !!!!!

Dare I say it? You seem to delight in saying such things. We got the message already.... Smug, arrogant , selfish and uncaring. You're just trolling now, which means we can add 'pathetic' too.

He was one of the first to sign up, just trying to put people off in case it gets too crowded in his hospital.