Overpriced medical care could bring down Thai health system

[webfact]

HEALTH
'Overpriced medical care could bring down Thai health system'
PRATCH RUJIVANAROM,
PAKAWAN ROJANASINGSAWAD
THE NATION



Critics call for standardised fees at private hospitals, notably for drugs

BANGKOK: -- THOUSANDS of Thai patients are checking out of private hospitals with hefty bills - creating many doubters who blame the "medical tourism policy" which attracts a growing number of patients from higher-income nations.

The Medical Council, however, cautions critics to think twice before trying to disrupt Thailand's booming medical tourism sector.

Viroj Na Ranong, a public health economist with the Thailand Development Research Institute, said the major reason for soaring medical treatment prices at private hospitals was the medical hub policy.

And the government's move to control medicine prices and standardise private hospitals' medical care costs had yet to consider the effect of medical tourism.

"The arrival of medical tourists from abroad who are willing to pay high treatment costs allows private hospitals to make a profit from these rich customers by increasing treatment costs," Viroj explained.

Preeyanan Lorsermvattana, president of Thai Medical Error Network, said: "They [the hospitals] don't have to care if this expensive medical treatment will affect Thai patients because they still have rich foreign patients."

The medical hub policy should be reconsidered, she said, because private hospitals are focusing more on foreign customers who can be charged 50 per cent higher than Thai patients. As a result, the overall outlook for fees would be an increase for local patients in order to keep a balance.

Viroj suggested the government tackle the problem by implementing a medical tax on tourists to lower their purchasing power, forcing private hospitals to cut their treatment fees.

"The money from collecting this tax could also be spent on our medical system and invested in the training of new doctors," he said.

Medical Council secretary-general Dr Samphan Komrit had a different view.

"The medical hub policy is the only hope for Thailand to be among the world's best [for medical services]. [Medical tourism] is a very profitable business, which generates more than Bt1 billion in profit for the country annually. Would you just stop this policy because hospital costs were expensive?" Samphan said.

According to the Public Health Ministry and Kasikorn Research Centre, 2.5 million international patients received medical treatment in Thailand in 2012, generating up to Bt140 billion in income. Thailand claimed to be the world's first destination for medical tourism.

But Preeyanan has warned that the whole Thai healthcare system could collapse because of overpriced medical care in private hospitals.

Action needed to undertaken to save the health system, she said, such as the setting up of a central agency to be a clearing house, careful pricing for medicines and reconsidering the medical policy to ensure the problem is solved.

"If the problem [of overpriced healthcare] is not solved in time, this could be mark the end of the government medical system - because all kinds of charges including medical fees, services and for medicine would have to increase, according to private hospitals," she warned.

She suggested that a "price control panel" should limit medical fees at private hospitals to a fair price, and said they should separate fees for medicine from other services. Also, the price for medicines should not be more than 15 per cent above prices at state hospitals.

She emphasised the importance of setting prices for medical drugs. The central price for all drugs had to be carefully calculated according to the sale price at state hospitals nationwide and pharmacies, as well as the budget price of each drug. A possible obstacle may be if drug companies conspire with private hospitals to increase medicine prices.

The Medical Council's Samphan said substantial measures were required but warned that they could be harmful to private hospitals if efforts to tackle such problems were unclear.

He highlighted "free emergency healthcare", saying it was a good policy, but noted that definitions of "critical" or "emergency" were not clearly stated.

"This would cause a problem right after the policy is implemented. Some people could go to the nearest hospital, claim they have a serious health problem which indeed was not that serious - and the result would be wasted time for medical staff, the patients themselves and those really in a critical condition."

He said the medicine price control policy was good and quite fair to all stakeholders. However, the ministry had to be clear on how to set the price of each medicine because there was not only the cost of drugs - hospitals also had to pay for management and service costs too.

"People who go to private hospitals know they have to spend more money there than in a public hospital to receive better care. What we should do is to make sure private hospitals do not charge too much with unclear billing - and [we need to] strengthen our National Health Security system to let the people have access to quality but cheap healthcare," he said.

Source: http://www.nationmultimedia.com/national/Overpriced-medical-care-could-bring-down-Thai-heal-30262812.html

-- The Nation 2015-06-22

[clockman]

The Thai mantra, is greed.

[ezzra]

This is an open secrete that Thai private hospitals are fees gougers and some time to the extreme,

Most local business acumens is to milk the proverbial cow to it's last drop and milk and gut

the goose that lays the golden eggs, they don't know where to stop, and how much is too

ridiculously too much already, yes, they have fantastic facilities with fairly advanced good

care, but they make you sick again when you get the bill...

[Prbkk]

A 'medical tax' on tourists?. If there was a tax on economic lunacy this guy would be paying through the nose.

[Thian]

I know some practising chirugians in BKK who only work for farang in private hospitals and i agree they make a huge amount of money. Even their collegues from the West can only dream of that.

All medical staff deserves a proper salary in my opinion but the ones who want to become millionaires should have become bankers. I don't understand why medical staff in the West (and also in Thailand it seems) has become so greedy.

[UKCanuk]

The government is right to be looking into the issue of price gouging and should also be examining the relationship with the health care insurers. I recently had a small procedure done at a private hospital and the initial estimate was 75,000 baht. When they discovered I had insurance from BUPA the price dropped to about 45,000 baht (pay now, claim later). OK, I had the money to pay this and will be refunded, but someone without the insurance would be gouged 30,000 baht by the hospital.

As a business relationship I can see there would be a discount applied to an insurance company, but nearly 50% tells you something doesn't it?

[konying]

The Thai mantra, is greed.

That pretty much sums it up.

It use to be "cheaper " but from personal experience I find it is the same if not more expansive now.

Shoulder surgery Bkk Hospital- close to 500k

Shoulder surgery in Sydney Australia, private room -$16000,close to 500k

The only competitive prices remain is the physio and dental, everything else is about the price of Western countries

[SABloke]

From what I've read on here the costs here are sometimes 30% cheaper than the western equivalent and so foreigners think it's a good deal and we get lots of ''the hospital needs to make a profit aswell'' arguments. It makes sense since it is a business BUT the wages paid to staff here are 50 - 80% cheaper than in the west, operational costs are cheaper and propert prices are cheaper. So the hospitals are, discussed in terms of the country's economy and GDP per capita, relatively much more expensive and much more profitable than the western ones.

[Borzandy]

So many times I saw these incompetents overcharge Thais and as well farangs.

[AlQaholic]

I was in a private hospital and had an insurance policy. The insurance policy specified certain maximum fees for different medical services. As the service I was using then was according the Doctor (who by the way first thing he did before even talking about my conditions, was to check the policy in his computer) "Consultation", he advised me that maximum coverage for this was 2000 baht. So after consulting, which took about 5 minutes, he prescribed some medication that was not covered in the policy and then I asked how much the consultation was, he answered "2000 baht"....

[janpharma]

As long as Thai charge up to 400% of European treatments they can forget about medical tourism...

[chrissables]

The Thai mantra, is greed.

That pretty much sums it up.

It use to be "cheaper " but from personal experience I find it is the same if not more expansive now.

Shoulder surgery Bkk Hospital- close to 500k

Shoulder surgery in Sydney Australia, private room -$16000,close to 500k

The only competitive prices remain is the physio and dental, everything else is about the price of Western countries

Add to this their attitude when operations go wrong, at least in the West the will try to correct any issues, here they ask you to pay again for "their" mistake.

[biplanebluey]

I know some practising chirugians in BKK who only work for farang in private hospitals and i agree they make a huge amount of money. Even their collegues from the West can only dream of that.

All medical staff deserves a proper salary in my opinion but the ones who want to become millionaires should have become bankers. I don't understand why medical staff in the West (and also in Thailand it seems) has become so greedy.

Why cant you understand it.You are dangerously ill,or painfully hurt.You have not a lot of money but you do not want to suffer and die.Whats the next choice??

[utkb]

My wife's experience needing ESWL treatment for kidney stones was that the big American hospital in BKK was at least 6 times cheaper than what we would have paid in the US.

Two sessions of ESWL 80k THB for first session, 20k THB for second (plus some incidental's total 120k) In the US it would have easily cost over 500k THB for the same treatment.

We went to at least five different hospitals, some suggesting two nights stay, others suggesting treatment for over a month. We ended back at my first choice (wife had to shop around) and found it to be the best option.

The experienced Urologist we found laughed and said one treatment with a second follow-up in three days to ensure the stone was removed.

I would find it very difficult to believe the private hospitals in Bangkok come anywhere close to the US costs.

[Pib]

This article is trying to blame the wrong thing...that is, medical tourism/hub is causing the big price increase.

I expect the medical hub does significantly raise prices at private hospitals in certain areas which receive a lot of tourists....like Bangkok, Pattaya, Phuket, etc. And in using Bangkok as an example and since Bangkok is a large place where some parts of Bangkok have lots of tourists like central/highrise Bangkok, other places like western Bangkok where I live which have very few tourists, a person just can't say all private hospitals in Bangkok have overpriced their services. Now maybe hospitals well known in central Bangkok for medical tourism such as Bumrungrad have raised their prices big time...I do hear Bumrungrad is a pricey hospital compared to most other Thai private hospitals...but hey, in Bumrungrad-type hospitals you are also paying for the five star hotel type atmosphere. I sure know the private hospital I use in western Bangkok (Thonburi 2) has not rapidly raised/overpriced medical services for the almost 7 years I've been using them. When you look at Thailand as a whole as in the many, many private hospital all across Thailand's in the country's 78 provinces (counting Bangkok), medical tourism is probably a small factor in rising private hospital prices.

It's simply the private hospitals raising prices because they are able to based on their customer's willingness to pay higher pricese with inflation thrown in. The owners of the private hospitals are just pushing higher prices. Private hospitals are businesses and they will raise prices until their particular customer base starts declining or growing...I expect for many private hospitals in Thailand their foreigner/tourist customer base is very small to practically non-existent.

Viroj Na Ranong, a public health economist with the Thailand Development Research Institute, said the major reason for soaring medical treatment prices at private hospitals was the medical hub policy.

And the government's move to control medicine prices and standardise private hospitals' medical care costs had yet to consider the effect of medical tourism.

Edited June 22, 2015 by Pib

[cardinalblue]

How to deal with outpt drugs is very simple. The pt is allowed to fill that prescription anywhere they want so the hospital becomes just another supplier that must demonstrate price competition. Currently there is a huge conflict of interest when doctors writing prescriptions that i believe they are getting kickbacks for writing from the hospital..

The bill should not be tied to be paid before the pt is given drugs. The pt decides who and where to fill prescriptions...

Let them compete on the drug market with pharmacies like in the west...

CB

[Bob12345]

I know some practising chirugians in BKK who only work for farang in private hospitals and i agree they make a huge amount of money. Even their collegues from the West can only dream of that.

All medical staff deserves a proper salary in my opinion but the ones who want to become millionaires should have become bankers. I don't understand why medical staff in the West (and also in Thailand it seems) has become so greedy.

What stops you to become a surgeon yourself and become a millionair also?

Maybe the 6 years of medical school with 60+ hour work weeks followed by 4 years of specialisation with 80+ hour workweeks (I know one doctor who is currently specializing to become a surgeon and he makes 20 hour workDAYS regularly). If you can get in at least, as they do require you to be at the top of your class to even be considered to enter.

And the pay during those 10 years? Most get paid so little that they need to find side jobs during that period if their parents don't send money (taking shifts in the hospital where they study or a nearby hospital).

[soalbundy]

Is the over charging only prominent in tourist areas such as BKK or Pattaya ? I live out in the sticks in the Surin area and have never felt over charged at the private hospital in Surin which mainly has Thai people ( they don't look like high so's ) as patients. I have been in hospital there for dengue fever, a hernia operation, and a lung infection, my wife had an appendix op with private room ( 28,000 Baht ) My son has been there twice for viral infections, never has a stay resulted in a bill of more than 40,000 Baht.

[konying]

The Thai mantra, is greed.

That pretty much sums it up.

It use to be "cheaper " but from personal experience I find it is the same if not more expansive now.

Shoulder surgery Bkk Hospital- close to 500k

Shoulder surgery in Sydney Australia, private room -$16000,close to 500k

The only competitive prices remain is the physio and dental, everything else is about the price of Western countries

Add to this their attitude when operations go wrong, at least in the West the will try to correct any issues, here they ask you to pay again for "their" mistake.

Funny you mention it, this was the case with me.

They were nice enough though to offer 5 % discount

[circusman]

I know some practising chirugians in BKK who only work for farang in private hospitals and i agree they make a huge amount of money. Even their collegues from the West can only dream of that.

All medical staff deserves a proper salary in my opinion but the ones who want to become millionaires should have become bankers. I don't understand why medical staff in the West (and also in Thailand it seems) has become so greedy.

Many years of difficult study and high university fees is maybe one reason don't you think ?

[Emster23]

"government tackle the problem by implementing a medical tax on tourists to lower their purchasing power, forcing private hospitals to cut their treatment fees."

Let me see if I get this right: perhaps a 20k tax on a 70k procedure for total of 90k. This is such a warped view of how to apply econ 101.... Hospital at least gives treatment, whereas government may even be reason had to go to hospital (lack of traffic law enforcement led to accident). This is so odd.... do they see medical care like a pack of cigarettes, trying to lower consumption with a tax.... It boggles my mind.... medic!

[cardinalblue]

utkb...

The issue is not whether the thai HC system is cheaper than the US. It's apples and oranges. It's much cheaper - the issue is whether the Thai hospitals are charging a fair market value compared to their profit margin...

Give you some perspective. A Thai nurse makes 100B an hour - his/her counterpart makes $30 - $50 an hour in the USA....Labor. legal and regulatory costs are huge expenses in the US HC system; very small in the thai HC system...

CB

[razer]

Controlling hospital costs would certainly be a qualifier for Thailand to be a retirement destination.

[Bob12345]

This article is trying to blame the wrong thing...that is, medical tourism/hub is causing the big price increase.

...

It's simply the private hospitals raising prices because they are able to based on their customer's willingness to pay higher pricese with inflation thrown in. The owners of the private hospitals are just pushing higher prices. Private hospitals are businesses and they will raise prices until their particular customer base starts declining or growing...I expect for many private hospitals in Thailand their foreigner/tourist customer base is very small to practically non-existent.

Agree with you there.

Idea for the government:

If you think private hospitals are making too much money, maybe you should open your own "private hospital"?

That way you can offer more convenience and better care to patients, and charge them accordingly.

Your government budget should be able to easily cover the setup costs, and if you charge fair prices for good service and good treatments I am sure you will steal away many, if not all, customers from private hospitals.

See Ramathibodi hospital as an example (government hospital which set up a hi-so clinic area where patients pay for their care but do get better facilities/treatment/customer care).

That way you actually solve the problem by competing! Private hospitals will be forced to lower their prices to stay competitive and instead of disrupting the market (which always comes at a high price in the end) you are turning this into a big win for the country as a whole (lower prices in private hospitals, extra income for the government, more choices of medical care for everybody, better opportunities for medical staff, etc).

[StephGo]

The very real risk with "have access to quality but cheap healthcare" is that it becomes "cheap quality healthcare"

[chrissables]

The Thai mantra, is greed.

That pretty much sums it up.

It use to be "cheaper " but from personal experience I find it is the same if not more expansive now.

Shoulder surgery Bkk Hospital- close to 500k

Shoulder surgery in Sydney Australia, private room -$16000,close to 500k

The only competitive prices remain is the physio and dental, everything else is about the price of Western countries

Add to this their attitude when operations go wrong, at least in the West the will try to correct any issues, here they ask you to pay again for "their" mistake.

Funny you mention it, this was the case with me.

They were nice enough though to offer 5 % discount

The t##t shouted at me and demanded 100,000 and come tomorrow so he could "fix" it! I went elsewhere. Total cost 700,000 baht and loss of an eye.

[mihalis]

The Thai mantra, is greed.

Really, so in your country greed doesn't exist.....

[Hans vliege]

Hij,

My Thai wife have a gouvernement card for 30 Baht, and we go to a hospital in Hua Hin, the Hua Hin Hospital. Excellent treatment, doctors are very friendly and take there time for us when we come for controle my wifes her pragnecy. He explane everything in Thai and in Emglish.

About 2 years before, a dog bite me, the ambulance bring me to Bangkok Hospital, the dog make terible wounds on different places of my body. They give me about 120 injections becourse they where afraid for crazy dog disseas.

Price more than 120.000 baht!!!!!!!! YES i Wright ONE HONDERD TWENTY THOUSAND BAHT.

Next time I know if I need a hospital what hospital I am going to!

Same medicine I need for my hart and sucker, in Bangkok hospital alway have to check by a doctor before I can get my medicine, and I have to pay the doctor as well. If I go to a medicine store in Hua Hin and I ask for the same medicine I have to pay 3500 Baht, the same medicine they send me by post from the village of my wife I Pay only 2500 baht.

So I think it's just shopping for good care and a good price.

Last thing is the enormous price you have to pay af a foreigner when you want assurance for your healt. About 370 - 450 euro a month and they don't pay for things you had before? Mister president, Falangs bring a lot of money to Thailand, every month again, why can't you make a good offer for assurance for them??????

[mathias67]

The Thai mantra, is greed.

My thought on those coming purely for treatment from abroad know in advance the type of cost involved so it is there choice. On the other hand most ferang living in Thailand are on pensions of limited funds and should be treated as Thai's. I have told my partner that if I need to go to hospital I want to be taken to either Banglamung or Sattahip where they have prices I can afford. Example 7 yeas ago I was quoted 50,000Bt for a hernia op at Pattaya Memorial and ended up paying Bt7,800 and Sattahip for the same op and that I could afford

[Keesters]

The government is right to be looking into the issue of price gouging and should also be examining the relationship with the health care insurers. I recently had a small procedure done at a private hospital and the initial estimate was 75,000 baht. When they discovered I had insurance from BUPA the price dropped to about 45,000 baht (pay now, claim later). OK, I had the money to pay this and will be refunded, but someone without the insurance would be gouged 30,000 baht by the hospital.

As a business relationship I can see there would be a discount applied to an insurance company, but nearly 50% tells you something doesn't it?

That wasn't a discount offered to the insurance company. That was the correct price and the price that the hospital knew the insurance company would pay. And the power price was clearly profitable enough as they went ahead with the procedure didn't they.