Private hospitals: Moves to control medical treatments and drug costs will be difficult

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PRIVATE HOSPITALS
Moves to control medical treatments and drug costs will be difficult
PUANGCHOMPOO PRASERT,
CHULARAT SAENGPASSA
THE NATION

BANGKOK: -- PRIVATE hospitals have warned that government attempts to control the cost of medical treatments and medicine will be difficult, as various facilities have different operational costs and private hospitals - unlike pharmacies - shoulder heavier costs in the dispersal of drugs.

They called on the government to study the facts before implementing any controls, saying it must be remembered that private hospitals in Thailand are up to 35 per cent cheaper than private hospitals in Singapore.

After meeting to discuss the matter at the Department of Health Service Support (DHSS) yesterday, Dr Chalerm Hanpanich, president of the Private Hospitals Association, said pricing at public and private hospitals was not comparable due to cost differences.

Private facilities had personnel and other costs, he said, such as building construction, land purchases and investment fund repayments - while public hospitals were funded by the state.

Affirming that private hospitals abided by the 1998 Sanatorium Act, he said: "All Thais have either one of three health security funds to cover medical bills anyway. And private facilities are just an alternative for people."

Chalerm said he would wait to see what a central committee set up by the Public Health Ministry last week to tackle the issue comes up with first before deciding whether to set a price ceiling on private hospital medicines.

The association's secretary-general, Dr Pongpat Patanavanich, said that while private facilities treated emergency patients in accordance with the policy of free treatment for life-and-death cases and referred such people to their subscribed hospitals, the government and the public should understand that private hospitals also shoulder expenses and costs.

"Such a policy should also be clear in terms of the expense range for emergency illnesses and treatments so the private hospitals won't suffer heavy losses," he said. "We don't want to make a profit from people's lives but we also want you to understand the investment [our members have made]."

Another meeting will be held today to discuss the urgent-treatment policy.

Negotiating medicine prices

The head of the National Legislative Assembly's subcommittee on the standard of medical treatment pricing, Dr Sarana Boonbaichaiyapruck, said an ongoing study on nine private hospitals had found that outpatients' flu treatment cost from Bt2,000 to Bt3,000 compared to Bt500 to Bt800 for public hospitals.

Dr Pratheep Sajjamit, a former expert on medical expenses at an insurance company, said the Food and Drug Administration could control central pricing for medicines at private hospitals and he called for the establishment of a central committee to set drug prices.

Pratheep cited his work experience in negotiating medicine prices, saying the cost of medicines varied depending on where they were purchased - a drug sold for Bt100 in a rural area could be sold for Bt80 in the city and Bt45 near a medical school.

"No place on Earth would let a hospital charge drug prices without controls," he said.

The cost of other expenses should not be included in a medicine's price, he added.

DHSS deputy chief Dr Thares Karasnairaviwong said it was initially agreed that private hospitals would clearly state treatment prices while a website (www.thailandmedicalhub.net) would show 80 medical treatment prices.

Public Health Minister Dr Rajata Rajatanavin agreed last week to address the problem of unreasonably high prices charged by some private hospitals at the request of Thai Medical Error Network president Preeyanan Lorsermvattana.

After accepting the network's petition, which garnered 33,000 signatures, Rajata moved to set up the central committee to probe the matter.

Source: http://www.nationmultimedia.com/national/Moves-to-control-medical-treatments-and-drug-costs-30260397.html


-- The Nation 2015-05-19

[EricBerg]

No way prices of treatments in private hospitals will be limited. It's too lucrative a business.

Mainly the "aliens" are the ones being ripped off, so there's no reason to limit that.

It only means the new kids on the block must be given brown envelopes.

[Bluespunk]

"We don't want to make a profit from people's lives but we also want you to understand the investment [our members have made]."

So you do want to make a profit from people's lives then?

[clockman]

The results of lack of transparency and corruption. Which runs through every sector of society

[janpharma]

Only erase corruption...simple as that...

[BKKBrit]

At Bumrungrad after surgery I was charged Bht500+ for ONE 4" x 5" waterproof dressing. I found the identical product made by 3M for Bht450 for a pack of 6 in my local pharmacy.

Funny how it seems men named Chalerm tend to speak out of the wrong orifice.

[Anthony5]

I wonder why simple regulations that are possible about everywhere in the world are never possible in Thailand?

Reeks of incompetence, isn't it?

[emilymat]

Please tell me what are the 'extra' costs in the 'dispersal' of aspirin between a private hospital and a pharmacy which justifies a mark up of around 200% minimum?.

Also, whilst posting, I remember being in Geneva a long time ago, and couldn't believe a cup of coffee cost the equivalent of 5 UK pounds. That was until I found out that the salary of a secretary in Switzerland was around 3 times the UK one, when doing a currency conversion.

So, if the cost of private hospitals in Thailand is 35% cheaper than Singapore, perhaps some of the well travelled TVF members could advise us how much is the minimum wage in Singapore, in relation to the Thai baht?. Just curious.

[Lupatria]

…will be difficult, as various facilities have different operational costs and private hospitals - unlike pharmacies - shoulder heavier costs in the dispersal of drugs.

If you need help, make this a project in an international school for 16 year old students and they will come up with a practical system to solve the "difficulties". The private hospitals should know from their experience it is as easy as to implement a scheme to cheat the patients,- it just goes in the opposite direction.

[trogers]

I like the title of this article, particularly the word 'Difficult'.

It means it is difficult, BUT NOT IMPOSSIBLE!

When there is a will, there is a way.

[jackanapes]

this doctor is making it patently obvious he is making a case for private hospital charges he also states they don't make a profit out of peoples lives a point I beg to differ putting people on life support systems till money has run out and I mean big money in some cases is a way of profiting from peoples lives.

[trogers]

Here is a suggestion - let the buyers of services decide.

Government hospitals shall publish a range of prices for their services, from brain surgery to dispensing flu medications.

This would be the measuring ruler.

The buyers are thus informed and decide if they want 35 baht somtum by the roadside or 200 baht for the same in a 5-star environment.

Edited May 19, 2015 by trogers

[TallGuyJohninBKK]

The government could easily adopt a mandate that private hospitals cannot discriminate in their pricing (whatever their individual pricing is) based on the type of patient -- Thai, farang expat, tourist, etc... But, they haven't done that, and I'm afraid they won't. Because the citizens group pushing the government on this is a Thai citizens group, so their agenda isn't going in that direction.

As for the hospital's prices for medications, it's been my impression here that doctors at private hospitals tend to get a cut of what they prescribe in the way of medications, so it becomes part of their compensation package. My guess is, that's one part of the reason why hospital pharmacy prices are higher, in addition to all the other reasons like facility overhead, etc etc.

[trogers]

The government could easily adopt a mandate that private hospitals cannot discriminate in their pricing (whatever their individual pricing is) based on the type of patient -- Thai, farang expat, tourist, etc... But, they haven't done that, and I'm afraid they won't. Because the citizens group pushing the government on this is a Thai citizens group, so their agenda isn't going in that direction.

As for the hospital's prices for medications, it's been my impression here that doctors at private hospitals tend to get a cut of what they prescribe in the way of medications, so it becomes part of their compensation package. My guess is, that's one part of the reason why hospital pharmacy prices are higher, in addition to all the other reasons like facility overhead, etc etc.

Maybe some hospitals giving their doctors a cut, but not from the hospital I frequent as my doctor told me to make subsequent purchases at the outside pharmacies.

[TallGuyJohninBKK]

Interesting re the www.thailandmedicalhub.net website mentioned in the OP...

There's already some medical cost info available there...but it's very sporadic and incomplete...

Still, the enormous pricing variations on already on display for anyone to see...

[elgordo38]

"We don't want to make a profit from people's lives but we also want you to understand the investment [our members have made]."

So you do want to make a profit from people's lives then?

Yes they do want to profit and profit big. That big boss the shareholder is waiting for his dividends and stock value to increase.

[Doc46]

At Bumrungrad after surgery I was charged Bht500+ for ONE 4" x 5" waterproof dressing. I found the identical product made by 3M for Bht450 for a pack of 6 in my local pharmacy.

Funny how it seems men named Chalerm tend to speak out of the wrong orifice.

You are right,,,it is only greed and corruption that needs to be nocked on the head,,,

[Prbkk]

The government could easily adopt a mandate that private hospitals cannot discriminate in their pricing (whatever their individual pricing is) based on the type of patient -- Thai, farang expat, tourist, etc... But, they haven't done that, and I'm afraid they won't. Because the citizens group pushing the government on this is a Thai citizens group, so their agenda isn't going in that direction.

As for the hospital's prices for medications, it's been my impression here that doctors at private hospitals tend to get a cut of what they prescribe in the way of medications, so it becomes part of their compensation package. My guess is, that's one part of the reason why hospital pharmacy prices are higher, in addition to all the other reasons like facility overhead, etc etc.

Agree but even with a % for the doctor, would not the economies of scale make drugs cheaper to dispense in a hospital than a pharmacy? I get treatment in a hospital with a specialist clinic and it dispenses the same medication all day every day ( but that medication is still cheaper at the local pharmacy which might see only a few people a week asking for it).

[Andreas2]

I wonder why simple regulations that are possible about everywhere in the world are never possible in Thailand?

Reeks of incompetence, isn't it?

I'm also surprised why it shouldn't be possible for the Thai authorities to (more) regulate the medical sector in its country.

But I'm happy about its "incompetence", as you call it. Why?

As it seems, the lack of further pricing regulations kept the prices lower compared to other, more regulated countries. Otherwise people wouldn't explicitly come to Thailand for medical treatments. It is obviously still cheaper and quite safe for some treatments here than compared to abroad, despite its other hidden costs here, be it supposed corruption or whatever. The market works.

One thing I have learnt in my life so far: The more regulated a market is, the more expensive and less available services and products are. I completely stopped my religious belief in governments. They are neither infallible nor benevolent, nowhere.

If someone approaches me and tells me: "I'm from the government and I'm here to help you", you see me run, run as fast and far as I can. Ok, that wouldn't be very fast and far but at least I would try hard .

Edited May 19, 2015 by Andreas2

[TallGuyJohninBKK]

Agree but even with a % for the doctor, would not the economies of scale make drugs cheaper to dispense in a hospital than a pharmacy? I get treatment in a hospital with a specialist clinic and it dispenses the same medication all day every day ( but that medication is still cheaper at the local pharmacy which might see only a few people a week asking for it).

I can only presume that the private hospitals here build some automatic overhead pricing unrelated to the medicines into their medicine charges.

Needless to say, a full-service hospital with all its associated buildings, equipment and staffing expenses has a much higher cost structure than a pharmacy private business operating out of some streetfront shophouse.

The private hospitals probably dispense a higher volume/quantity of their various medicines, but there's certain no volume discount benefits that they're passing along to their patients.

[metisdead]

A nonsense post has been removed.

[trogers]

I wonder why simple regulations that are possible about everywhere in the world are never possible in Thailand?

Reeks of incompetence, isn't it?

I'm also surprised why it shouldn't be possible for the Thai authorities to (more) regulate the medical sector in its country.

But I'm happy about its "incompetence", as you call it. Why?

As it seems, the lack of further pricing regulations kept the prices lower compared to other, more regulated countries. Otherwise people wouldn't explicitly come to Thailand for medical treatments. It is obviously still cheaper and quite safe for some treatments here than compared to abroad, despite its other hidden costs here, be it supposed corruption or whatever. The market works.

One thing I have learnt in my life so far: The more regulated a market is, the more expensive and less available services and products are. I completely stopped my religious belief in governments. They are neither infallible nor benevolent, nowhere.

If someone approaches me and tells me: "I'm from the government and I'm here to help you", you see me run, run as fast and far as I can. Ok, that wouldn't be very fast and far but at least I would try hard .

In the developed world, the high cost of medical services are largely due to two factors:

Higher cost of living, and

Price fixing by insurers, they insure both patients and medical staff and hospitals.

[Srikcir]

"We don't want to make a profit from people's lives but we also want you to understand the investment [our members have made]."

So you do want to make a profit from people's lives then?

Isn't making a profit from people in ANY free enterprise the point of a free enterprise? Investors who capitalize any business do so with expectation of recovering their capital investment and make a reasonable rate of return on their investment in proportion to business risks.

If you object to an investor making a profit from people, then the alternative is to have all private businesses (ie., hospitals) nationalized by the State.

Then in that way the cost of services and supplies for hospitals can be standardized because costs would be spread over all hospitals. Of course the consequence will be that costs will go up in large hospitals to cover costs in small hospitals because small hospitals lack an economy of scale. Or the State can simply close all small hospitals and just make hospital access much more difficult.

[ksamuiguy]

Looking into who the owners of these institutions are should be very enlightning.

[ksamuiguy]

Looking at thier tax records should also be very enlightning.

[xylophone]

The government could easily adopt a mandate that private hospitals cannot discriminate in their pricing (whatever their individual pricing is) based on the type of patient -- Thai, farang expat, tourist, etc... But, they haven't done that, and I'm afraid they won't. Because the citizens group pushing the government on this is a Thai citizens group, so their agenda isn't going in that direction.

As for the hospital's prices for medications, it's been my impression here that doctors at private hospitals tend to get a cut of what they prescribe in the way of medications, so it becomes part of their compensation package. My guess is, that's one part of the reason why hospital pharmacy prices are higher, in addition to all the other reasons like facility overhead, etc etc.

I like the idea of that suggestion with regard to "not being able to discriminate in their pricing on the type of patient", but as you say, it's highly unlikely that this will happen.

IMO it is greed and corruption which are major causes of the high cost/difference in cost for various procedures/treatment. For example the hospital knows that if an insurance company is paying for the operation, it can "Bump up" the costs and the insurer doesn't seem to mind. Of course this eventually means that the rates for insurance go up and the poor consumer has to pay more.

The experiences that I and a few friends have had with hospitals here also points to the fact that the final bill can be loaded with all sorts of extra and inflated costs, and one particular example quoted the surgeons costs twice, once under the "surgeons fees" heading and the other one under "surgeons costs" heading and when I queried this, there were some red faces amongst the nurses/administrators.

I suppose the overarching aspect is that we are in Thailand, where price gouging is common, especially in the case of treating farangs, and corruption is seen as nothing more than a normal way of conducting business, and hospitals seem no exception.

[Anthony5]

I wonder why simple regulations that are possible about everywhere in the world are never possible in Thailand?

Reeks of incompetence, isn't it?

I'm also surprised why it shouldn't be possible for the Thai authorities to (more) regulate the medical sector in its country.

But I'm happy about its "incompetence", as you call it. Why?

As it seems, the lack of further pricing regulations kept the prices lower compared to other, more regulated countries. Otherwise people wouldn't explicitly come to Thailand for medical treatments. It is obviously still cheaper and quite safe for some treatments here than compared to abroad, despite its other hidden costs here, be it supposed corruption or whatever. The market works.

One thing I have learnt in my life so far: The more regulated a market is, the more expensive and less available services and products are. I completely stopped my religious belief in governments. They are neither infallible nor benevolent, nowhere.

If someone approaches me and tells me: "I'm from the government and I'm here to help you", you see me run, run as fast and far as I can. Ok, that wouldn't be very fast and far but at least I would try hard .

If you look a bit further you will find that medical treatment prices in Thailand aren't that low anymore, and because TAT calls Thailand a medical tourism hub, doesn't mean that it also is in reality.

India is a hub of medical tourism, and even including the flight from Thailand to India, you will save money compared to the cost in Thailand.

Edited May 20, 2015 by Anthony5

[MaiChai]

I would observe that you will find the same doctors and specialists working at the government and private hospitals. Thus just go to the government hospital? Unless you are very rich, in which case you don't care?

Cost of treatment in the private hospitals is related to how rich they think you are! Its pretty much the mentally of a lot of Thai business folk; they will charge as much they can. Often they get away with it because folks don't know the going price for something. It affects Thais too; we bought an aluminium window for less than 2000 baht and had it fitted by our builder. A family relative got ripped off for 4 windows of the same size and quality; 37,000 baht! That person got ripped off because he didn't know the going rate or where to buy at reasonable prices. Some folks are fair game for being ripped off and some question/negotiate/work out the going price.

Thus you need to negotiate up front before treatment?

Edited May 20, 2015 by MaiChai

[TallGuyJohninBKK]

I agree that a lot of the doctors who work in government hospitals also spend part of their time in private hospitals.

I'm not sure it's equally true that a lot of the doctors who work in private hospitals also work in government hospitals, although some certainly do, and they may well have worked at government hospitals in the past. Rather, I think a lot of doctors who work in one private hospital work other days at other private hospitals. That certainly seems to be the case among the various doctors I have encountered at private hospitals here.

Also, at least with a lot of the larger private hospitals in BKK, you can check the experience and training of individual doctors on the hospital's website, and then select the doctor that seems to best fit you situation/desires. Whereas when you go to a government hospital, AFAIK, certainly initially, you're pretty much going to get randomly assigned doctor.

But either way, the choice of doctor isn't the only factor that goes into deciding where to seek treatment, though it's certainly an important one.

The level of medical equipment available may be different at government hospitals. The waiting times for appointments, and waiting times for procedures, may be different. And certainly the English speaking capability of the hospital staff may be different.

And, as has been pointed out here many times, there are quite widely varying qualities of facilities among the broad term government hospitals, ranging from the top-end facilities like Chula and Siriraj, down to local district hospitals in small cities. I've been in local government hospitals here where I wouldn't want to take my cat or dog for treatment.

So in sum, I guess what I'm saying it, government hospitals here certainly should be considered part of the available treatment options for farangs, especially if they look to the higher end government hospitals for quality of doctors and care/facilities. But there are lots of reasons that farangs will want to also use private hospitals here, especially if they shop wisely and are covered by private medical insurance.