A Monday morning experience in the Thai health care system

[mzuri]

Disclaimer: [These are observations and a narrative of my experience; surprising and occasionally aggravating but not necesarily judgmental. There are differences in health care protocols, procedures& billing systems between cultures, countries, hospitals, specialties and individual practitioners.]

I had an appointment to have a dental crown inserted (very satisfied with my dental appliance and its cost). Since I had been have urinary symptoms that most likely required treatment I requested to be seen in the general medical clinic the same morning and was expediently worked into their schedule.

After a nursing check in (weight, BP which had an elevated reading, never subsequently commented upon & temperature documentation) I was ushered into the physician's office. The doctor was sitting at a computer monitor, never looked up nor made eye contact. No greeting, no small talk beyond "speak English slowly". I related the history of the current illness and he made entries into the computer. There was no physical exam or laying on of hands. He (or the computer) suggested a urinalysis and a urine culture. I waited in the hallway for 45 minutes for the results and was told "infection". More computer entries and was asked whether I wanted to be admitted to the hospital for care. I said that I would prefer out-patient treatment. He suggested administering an IV antibiotic daily for several days and using several oral medications as well. I responded that daily visits to the hospital were very inconvenient (distance) but that I would like to start with an intravenous dose and continue with out-patient medications. If there was no improvement in 48hrs I would return. I made written note of the 3 antibiotic drugs recommended. In addition he recommended another drug which he said was for urinary discomfort. This drug's actual indication is relief of prostatic blockage to urine flow. Perhaps indicated for my age group but I was not given an honest explanation for its use.

We proceeded with an IV placement and administration of the antibiotic over one hour. At the conclusion I asked the nurse for prescriptions for the additional oral medications. I intended to fill these at an outside pharmacy. After a conference with the physician (in my absence) I was told that there were no prescriptions and that the medicines would be filled by the hospital. I objected, another conference between doctor and nurse and I was told that it was policy to have all prescriptions filled by the hospital pharmacy. I again declined and was asked to sign an AMA (against medical advice) document. When signing I added a note that it was not my intention to go against the advice but that I only preferred to obtain the meds at my own pharmacy. When I asked whether they could phone or e-mail the results of the culture (requires 48 hrs) I was told that was not possible and I would have to schedule another appointment to obtain lab results.

I was then ushered to the payment desk. There was a nursing and midwifery fee that seems to be a universal cover charge. In addition there were medical supply fees that were not itemized. I asked for a breakdown and received information that I purchased, among other things, an IV needle for 65 baht, an alcohol swab for 9 baht and a band aid for 11 baht. Ala carte medicine. I subsequently purchased my outpatient medications at an outside pharmacy for 40% of what I would have paid at the hospital. I was able to obtain the culture result 3 weeks later after numerous phone calls and e-mails and threats.

In retrospect It is probable that my questions, requests and preferences were probably a threat to the physician and that my desire to have opinions and options in my health care were contrary to his elitism as well as the financial bottom line of the hospital. Not sure whether I will have the similar experiences in future medical encounters but perhaps I should alert the practioner that I am there for advice and opinion and not dictum.

[pigeonjake]

well last week i had a chest infection, i new what it was ive had asthma all my life and many chest infections,

so the wife and i jumped in the truck, drove to our local clinic, the young lady doctor there listened to my chest and breathing, and said chest infection with a cold,

went and got me the medication and cough mixture and dint charge me 1 bht,

thats my experience of the thai medical care i have had from them a few times, allways been very good to me

[lopburi3]

Was this a government or private hospital?

Bill will not include details unless you ask for a detail receipt at any hospital I have used so that was normal.

How do you know you purchased medications for 40% of what hospital would have charged?

This is Monday but appears you are talking about something from the past?

[DirtyDan]

Welcome to TV. If you ever feel the need to just rant via a keyboard, let 'er rip! We're here for you.

Family in Canada could not have their medical test results delivered without being there in person... and I guarantee the (hidden) cost was a lot more than what you paid here.

I've had nothing but good treatment here - sometimes over treatment!

Edited August 17, 2015 by DirtyDan

[cloudos]

In Australia it's the same, need to get the results in person and not over the phone. About the issue with the drugs needing to be administrated in the hospital, I don't have much experience with that but in many other Asian countries getting medicine from the hospital is the norm.

[Sheryl]

A few observations:

1. This appears to have been a private hospital, so what you are describing is not an experience "with the Thai health care system" but with "private medical care in Thailand". And with a specific doctor and hospital at that. At least of few of this issues would have differed, right in the same hospital, with a different doctor. I know you mention that at the start but your thread title implies otherwise. Experience with the Thai public health system would have been completely different - beter in some respects but much worse in others; whole different set of issues.

2.I don't think your issues with the doctor were due to elitism on his part, and rather than threatened I suspect he was utterly baffled by you. I think the problems were: (1) poor English on his part; (2) lack of socialization to western patients (including not only their expectations of care but also their level of sophistication in understanding medical matters -- most Thais truly would not have a clue how to understand a culture result given to them on the phone or even know what a culture and sensitivity test was) (3) differing expectations due to cultural difference: the concept of patients taking an active role in their health care is not part of medical culture here, to put it mildly. Except with doctors trained in the west, a patient acting as you did would be a complete shock and they'd have no idea at all what the behavior meant/was about. They might well misinterpret it as deliberate rudeness; and (4) hospital policies you were asking him to bend.

It does not sound like you selected a particular doctor. One should always do so, researching qualifications first (most private hospitals list them online) and if possible choosing someone with training in a western country - that assures excellent English and familiarity with western patients. Also usually implies an above average level of skill. For a urinary problem I would also have opted not for the medical clinic but the urology clinic and a urologist. Not only better trained to handle the problem but more odds of their being one trained in the west, since generally it is only specialists who ever are.

3.Getting meds at hospital pharmacy rather than outside pharmacy: There is talk of some reforms in the works around this issue but at present, this is indeed a problem with private hospitals and what I find works is as follows: Tell the doctor, quietly during the consultation, that you want to buy the meds at an outside pharmacy and ask for the names and dosages (there is never any writing of "prescriptions"). Depending on the hospital and the doctor's spine, s/he may be fine with doing that, or may tell you that the hospital frowns on this and suggest that they prescribe a day or two dose to be filled at the hospital and you can then buy the rest, or s/he may just say they can't. In that case, smile and wait till you reach the cashier, then refuse the medications (having noted the names and doses) and have them struck off your bill. I do this all the time, and find it simpler and less contentious to just smile and say I already have the drug rather than make an issue about planning to buy it myself.

Bear in mind the doctor does not benefit from this, it is the hospital that does, and s/he may be under some pressure to toe the line. Do not under any circumstances discuss the problem with the nurses or within hearing of many other people as that just pushes the doctor further into a corner and makes it harder for them to bend the rules.

3. Nursing and medical supplies charge: this is standard in all private hospitals. What is sometimes called "nursing/midwifery fee" is actually just the hospital fee. The consultation fee goes straight to the doctor. This (as well as mark up on drugs and supplies) is what the hospital gets - a mix of recouping actual costs for providing the facility (record keeping, reception, appointment booking and all the staff and equipment required for same; electricity, furnishing, physical upkeep of the offices etc) and yes, on top of that, a profit margin for them.

4. Medical supply/equipment costs: padded, no question, just like the meds at the hospital pharmacy. But unlike the latter nothing you can do about it. This too is the subject of discussion for possible government regulation but who knows if it will materialize.

5. Getting lab results by email or phone: In cases where result is expected to be negative I find this is usually easily arranged especially if you are dealing with a western-trained doctor. But the arrangement has to be made with the doctor, don't wait to discuss it with the nurse. Thai hospital nurses tend to be rigid sticklers for form/routine. During the consultation with the doctor, explain that you live far away and ask if the results can be sent by email or phone, then later on just tell the nurse the doctor agreed and presto, no problem.

In cases where the result indicates a need for change of treatment it is usual , not only in Thailand but in most countries, to have the patient come back so all can be explained and also additional information about the effects of treatment so far obtained to help guide the doctor in his advice. Culture and sensitivity results are not black and white, they are graduated; for example, the drugs you are on may show only partial effectiveness against the organism, or be effective but less so that a drug you are not on. Whether or not to change therapy based on this would depend on whether your symptoms were improving - so some dialogue is required. A doctor can, at his discretion and as an exceptional case, do this by phone or email but is only going to do so if he is really convinced that the patient has sufficient understanding already of the situation, the possible need for a change in treatment and why, etc. This will only happen with a doctor who has worked in the west and further gotten the impression during the consultation that the patient has a fairly sophisticated understanding of matters, and who was able during the discussion to outline a decision tree to the patient about what will be done based on the test reports, which the patient fully understood.

In regard to which, you don't mention what the culture results were nor if your symptoms have cleared. If you are at all symptomatic, you should arrange to see a urologist, bringing the results with you.

[JaiLai]

well last week i had a chest infection, i new what it was ive had asthma all my life and many chest infections,

so the wife and i jumped in the truck, drove to our local clinic, the young lady doctor there listened to my chest and breathing, and said chest infection with a cold,

went and got me the medication and cough mixture and dint charge me 1 bht,

thats my experience of the thai medical care i have had from them a few times, allways been very good to me

I find that hard to believe, diagnosis and medication for free??

That must be a very busy clinic?? Can you pls send me doctors name and address pls.

[kannot]

well last week i had a chest infection, i new what it was ive had asthma all my life and many chest infections,

so the wife and i jumped in the truck, drove to our local clinic, the young lady doctor there listened to my chest and breathing, and said chest infection with a cold,

went and got me the medication and cough mixture and dint charge me 1 bht,

thats my experience of the thai medical care i have had from them a few times, allways been very good to me

I find that hard to believe, diagnosis and medication for free??

That must be a very busy clinic?? Can you pls send me doctors name and address pls.

He said "clinic" probably the local vets after all if the pigs are ill etc?

[Sheryl]

well last week i had a chest infection, i new what it was ive had asthma all my life and many chest infections,

so the wife and i jumped in the truck, drove to our local clinic, the young lady doctor there listened to my chest and breathing, and said chest infection with a cold,

went and got me the medication and cough mixture and dint charge me 1 bht,

thats my experience of the thai medical care i have had from them a few times, allways been very good to me

I find that hard to believe, diagnosis and medication for free??

That must be a very busy clinic?? Can you pls send me doctors name and address pls.

He said "clinic" probably the local vets after all if the pigs are ill etc?

Probably the local government health center or maybe a small community hospital. Definitley not a private clinic.

They should have charged him but as services to Thais are free and hardly any foreigners ever come to these facilities, many most have no system in place to do so and to set one up would be more hassle than it's worth.

[slapout]

Some of the doctors expect people to treat them like a prima donna, same with some teachers, policemen, politicians, military personal and civil servents. It depends on the upbringing they had as children in most cases When I meet these types I have actually excused myself and walked out of their office, and told them why.

As I am leaving I just point out that I am not willing to use nor pay the servives of someone who is rude. I have seen some schocked looks by nurses who overheard but have never been apologized to by those rude people, but i always felt better. Its only happen twice, i teacher and i civil servent at a land office.

[mogandave]

Remember, every time you point a finger, three more point back.

If I meet more than one a-hole in a day, it's a good bet it's not them.

I try to treat everyone with respect, and I seem to get along with most everyone.

[slapout]

Well I treat everyone as an equal and get along quite well. if I say so myself. Respect I give/ gave to those holding rank above me and those who had earned the right to have/ be respected by some action on their part. But then everyone does not see the same morals to the same story about others.

have a good day now

[little mary sunshine]

You sound like one of the cheapest people on TV...not one

Remark on how you are doing, did the meds work, only

Complaints about the bed side manner of doctor and

Cost....you know so much, you should treat yourself and save

The physician's fees.

I to have had an experience with a private hospital, Pattaya

Memorial, excellent doctor, IV antibiotic for five days as

An outpatient and everything, lab fees, x-rays, follow up

Meds and I feel wonderful. With all that treatment the cost

Was 1/20th of what it would have been in the US, and I

Didn't tell the doctor how to,treat me or where to buy my

Meds. And, by the way , I am a retired Med Tech, and

Appreciate the physicians and nurses care.

[h90]

A few observations:

1. This appears to have been a private hospital, so what you are describing is not an experience "with the Thai health care system" but with "private medical care in Thailand". And with a specific doctor and hospital at that. At least of few of this issues would have differed, right in the same hospital, with a different doctor. I know you mention that at the start but your thread title implies otherwise. Experience with the Thai public health system would have been completely different - beter in some respects but much worse in others; whole different set of issues.

2.I don't think your issues with the doctor were due to elitism on his part, and rather than threatened I suspect he was utterly baffled by you. I think the problems were: (1) poor English on his part; (2) lack of socialization to western patients (including not only their expectations of care but also their level of sophistication in understanding medical matters -- most Thais truly would not have a clue how to understand a culture result given to them on the phone or even know what a culture and sensitivity test was) (3) differing expectations due to cultural difference: the concept of patients taking an active role in their health care is not part of medical culture here, to put it mildly. Except with doctors trained in the west, a patient acting as you did would be a complete shock and they'd have no idea at all what the behavior meant/was about. They might well misinterpret it as deliberate rudeness; and (4) hospital policies you were asking him to bend.

It does not sound like you selected a particular doctor. One should always do so, researching qualifications first (most private hospitals list them online) and if possible choosing someone with training in a western country - that assures excellent English and familiarity with western patients. Also usually implies an above average level of skill. For a urinary problem I would also have opted not for the medical clinic but the urology clinic and a urologist. Not only better trained to handle the problem but more odds of their being one trained in the west, since generally it is only specialists who ever are.

3.Getting meds at hospital pharmacy rather than outside pharmacy: There is talk of some reforms in the works around this issue but at present, this is indeed a problem with private hospitals and what I find works is as follows: Tell the doctor, quietly during the consultation, that you want to buy the meds at an outside pharmacy and ask for the names and dosages (there is never any writing of "prescriptions"). Depending on the hospital and the doctor's spine, s/he may be fine with doing that, or may tell you that the hospital frowns on this and suggest that they prescribe a day or two dose to be filled at the hospital and you can then buy the rest, or s/he may just say they can't. In that case, smile and wait till you reach the cashier, then refuse the medications (having noted the names and doses) and have them struck off your bill. I do this all the time, and find it simpler and less contentious to just smile and say I already have the drug rather than make an issue about planning to buy it myself.

Bear in mind the doctor does not benefit from this, it is the hospital that does, and s/he may be under some pressure to toe the line. Do not under any circumstances discuss the problem with the nurses or within hearing of many other people as that just pushes the doctor further into a corner and makes it harder for them to bend the rules.

3. Nursing and medical supplies charge: this is standard in all private hospitals. What is sometimes called "nursing/midwifery fee" is actually just the hospital fee. The consultation fee goes straight to the doctor. This (as well as mark up on drugs and supplies) is what the hospital gets - a mix of recouping actual costs for providing the facility (record keeping, reception, appointment booking and all the staff and equipment required for same; electricity, furnishing, physical upkeep of the offices etc) and yes, on top of that, a profit margin for them.

4. Medical supply/equipment costs: padded, no question, just like the meds at the hospital pharmacy. But unlike the latter nothing you can do about it. This too is the subject of discussion for possible government regulation but who knows if it will materialize.

5. Getting lab results by email or phone: In cases where result is expected to be negative I find this is usually easily arranged especially if you are dealing with a western-trained doctor. But the arrangement has to be made with the doctor, don't wait to discuss it with the nurse. Thai hospital nurses tend to be rigid sticklers for form/routine. During the consultation with the doctor, explain that you live far away and ask if the results can be sent by email or phone, then later on just tell the nurse the doctor agreed and presto, no problem.

In cases where the result indicates a need for change of treatment it is usual , not only in Thailand but in most countries, to have the patient come back so all can be explained and also additional information about the effects of treatment so far obtained to help guide the doctor in his advice. Culture and sensitivity results are not black and white, they are graduated; for example, the drugs you are on may show only partial effectiveness against the organism, or be effective but less so that a drug you are not on. Whether or not to change therapy based on this would depend on whether your symptoms were improving - so some dialogue is required. A doctor can, at his discretion and as an exceptional case, do this by phone or email but is only going to do so if he is really convinced that the patient has sufficient understanding already of the situation, the possible need for a change in treatment and why, etc. This will only happen with a doctor who has worked in the west and further gotten the impression during the consultation that the patient has a fairly sophisticated understanding of matters, and who was able during the discussion to outline a decision tree to the patient about what will be done based on the test reports, which the patient fully understood.

In regard to which, you don't mention what the culture results were nor if your symptoms have cleared. If you are at all symptomatic, you should arrange to see a urologist, bringing the results with you.

I would expect that the Doc get some commission on the sale of meds. No?

[elgordo38]

Welcome to TV. If you ever feel the need to just rant via a keyboard, let 'er rip! We're here for you.

Family in Canada could not have their medical test results delivered without being there in person... and I guarantee the (hidden) cost was a lot more than what you paid here.

I've had nothing but good treatment here - sometimes over treatment!

Key words "over treatment" but at a price in most cases maybe not yours. I had a friend just tell me about his experience at a well known Chiang Mai hospital and I have had the same experience in their dental clinic. I disagree with the fellow quoting (hidden) costs in Canada and also that they would be a lot more there. I know for a fact that when it comes to cataract surgery at a private hospital here it would be more than 4 times more than the amount OHIP would pay a surgeon in Canada. OHIP pays a surgeon $397.97(this figure is under attack by OHIP because cataract surgery has become an assembly line process thus takes less time)times 4 equals $1591.88 times 27 bahts(a little high) equals 42980.76 bahts. Private hospitals are 50,000 bahts and up here. My friend just had it done and that is the price he paid. Public hospitals are about 30,000 bahts my g/f's mother just had it done. If you do not want to queue up and have the 30 baht card cover it that is the price YOU pay. Queuing up is 20,000 bahts a year or more wait. I almost fell over when my insurance provider told me this about OHIP. The rest of the world like Thailand is catching up fast. Medical hub hmm. In full disclosure after getting a 2nd opinion I did not need cataract surgery yet. The first quote I received was from well I cannot name names but they were out and out thieves with a quote of over 250,000 bahts including glaucoma surgery(which I did not need) They told me I was at stage 4 and they like to operate at stage 3. My eyes were perfectly OK I was just going in for a test before ordering new glasses. Today I had another ripoff attempt but its off topic.

Edited August 18, 2015 by elgordo38

[maderaroja]

I have been to the government hospital many times for various reasons. I have always been treated well and fairly. The charges have never been excessive for the medical treatment or for drugs (when necessary).

On the last occasion, I was charged 50 baht for the doctor, 45 baht for the nurse, and 55 baht for the medications; there was a 15-minute wait. At home, I could not see the doctor for less than $50 and I would have to wait at least one month for an appointment.

My congratulations to the Thai government medical system. It works for me.

[little mary sunshine]

Of course physicians receive "incentives" for the number of "private pay"

Patients the admit into the hospital, as well as the well insured. They

Also receive "incentives" for the types and brands of medications

They prescribe.......It all part od "The business of medicine".

[lopburi3]

Welcome to TV. If you ever feel the need to just rant via a keyboard, let 'er rip! We're here for you.

Family in Canada could not have their medical test results delivered without being there in person... and I guarantee the (hidden) cost was a lot more than what you paid here.

I've had nothing but good treatment here - sometimes over treatment!

Key words "over treatment" but at a price in most cases maybe not yours. I had a friend just tell me about his experience at a well known Chiang Mai hospital and I have had the same experience in their dental clinic. I disagree with the fellow quoting (hidden) costs in Canada and also that they would be a lot more there. I know for a fact that when it comes to cataract surgery at a private hospital here it would be more than 4 times more than the amount OHIP would pay a surgeon in Canada. OHIP pays a surgeon $397.97(this figure is under attack by OHIP because cataract surgery has become an assembly line process thus takes less time)times 4 equals $1591.88 times 27 bahts(a little high) equals 42980.76 bahts. Private hospitals are 50,000 bahts and up here. My friend just had it done and that is the price he paid. Public hospitals are about 30,000 bahts my g/f's mother just had it done. If you do not want to queue up and have the 30 baht card cover it that is the price YOU pay. Queuing up is 20,000 bahts a year or more wait. I almost fell over when my insurance provider told me this about OHIP. The rest of the world like Thailand is catching up fast. Medical hub hmm. In full disclosure after getting a 2nd opinion I did not need cataract surgery yet. The first quote I received was from well I cannot name names but they were out and out thieves with a quote of over 250,000 bahts including glaucoma surgery(which I did not need) They told me I was at stage 4 and they like to operate at stage 3. My eyes were perfectly OK I was just going in for a test before ordering new glasses. Today I had another ripoff attempt but its off topic.

I had cataract IOL on both eyes this year at Vejthani Hospital here in Bangkok and package cost was 35k each plus 1k for IOL measurement exam. Public hospitals are much cheaper - nothing near 30k.

[RedQualia]

well last week i had a chest infection, i new what it was ive had asthma all my life and many chest infections,

so the wife and i jumped in the truck, drove to our local clinic, the young lady doctor there listened to my chest and breathing, and said chest infection with a cold,

went and got me the medication and cough mixture and dint charge me 1 bht,

thats my experience of the thai medical care i have had from them a few times, allways been very good to me

I find that hard to believe, diagnosis and medication for free??

That must be a very busy clinic?? Can you pls send me doctors name and address pls.

I've been given free medication at a clinic in the past, along with like an 80 Baht fee for the consultation. I suspect it might have been a come-on for me to visit the doc's private hospital, where fees would be quite high. Whatever the problem was at that time, it wasn't critical for me, hence, clinic.

Scraped my foot pretty badly a couple of months ago, and was happy to visit the local Thai government hospital for treatment. Initial treatment and cost of antibiotics, etc., was about 400 Baht as I recall. Thereafter it was daily trips to the emergency room to have the wound cleaned and dressed. 70 Baht per day for the next four weeks or so, for which fee I got to flirt with almost the entire Thai ER staff. All very pleasant and friendly. Wound looks quite good at this time.

I also visited the local Thai government hospital a few years ago. Had traveled to Cambodia, and came back sick. Docs in Cambodian clinics didn't fix it. Private hospitals in both BKK and Chiang Mai just pushed antibiotics at me, and didn't fix it either. One day when I was about 3/4 dead, went to the Thai hospital. Doc said "Hmmm... I think I know what it is." Did a blood test, and then gave me appropriate drugs for typhus. The highly rated private hospitals had missed it completely. Cost was negligible again. Maybe 200 Baht, with drugs.

I love Thai government hospitals! That said, there are things best treated by private hospitals. A private hospital/urologist removed a kidney stone for me a few years ago using a fiber optics scope with a claw on the end of it. The Thai government hospital would probably have removed the same stone with a scalpel.

Also just had some skin cancer stuff removed by a plastic surgeon, who repaired the damage nicely. I don't know for sure, but suspect the Thai government hospital might well have cut out the cancer and left big holes in my head with no repair.

The cost of the skin cancer removal, complete with doctor, operating room, anesthesiologist, an overnight stay in the hospital, and drugs from the hospital pharmacy, was about 55,000 Baht, or maybe $1500-1600US. The cost to do that in the US would probably be closer to $8,000-10,000US. Can't remember what the kidney stone removal cost, but remember doing cost comparisons with the US, and it was about 1/10th - 1/7th or so of what such procedures are said to cost in the US.

Generally, extremely satisfied with healthcare in Thailand. Probably more than I would be were I in the US, actually. Different doctors do have different personalities and bedside manners, of course. I've run into at least one here who I will not be seeing again, if I can help it at all.

[Sheryl]

I would expect that the Doc get some commission on the sale of meds. No?

Not to my knowledge, no - not in a private hospital. The doctor's income is the consultation fee, which they themselves set, and which is more than adequate to produce a good income.

Doctors who run their own clinics and dispense their own meds (more often found in small towns than big cities) add a mark up to the meds which goes to them, and often the consultation fees are small with most of the profit made on the meds (a bad arrangement as it can bias prescribing patterns). But in a private hospital where doctors have a private contractual arrangement to use the facilities, the doctors earnings are from the consultation fee. Mark up on drugs goes to the hospital.

[Sheryl]

Of course physicians receive "incentives" for the number of "private pay"

Patients the admit into the hospital, as well as the well insured. They

Also receive "incentives" for the types and brands of medications

They prescribe.......It all part od "The business of medicine".

Actually no, it is not.

In the case of public hospitals doctors receive a flat salary and nothing else. And the last thing the hospital administration would want is to incentivize admissions or prescriptions since the hospitals are already over capacity and under-reimbursed for care they provide. They'd just lose more money.

In private for-profit hospitals, doctors are not employed by the hospital, they just have an arrangement allowing them to use the facilities. They charge a direct and substantial fee for their services and this is clearly reflected in the billing, as are the other items charged by the hospital itself. It is quite clear which payments go to whom (and both do quite well). The part that is less transparent is how much of what the hospital charges (room, lab fees, meds, etc) is profit for them. Some of it obviously goes to pay for the actual cost of providing these items, some of it is obviously a profit margin for them, but how much is not made clear. This is one of the things that has been under discussion by government lately especially regarding meds.

[shaurene]

I have had very good treatment in Khon Kaen private hospitals. The doctors were very good. I suffer with chest problems, 3 times in 3 yrs I had Pheumonia I had drips with antibiotics. The only thing I said to the nursing staff was do not come to take my temp or blood pressure after 10pm come back at 8am in the morning. They are instructed to do these tests every 4 hrs or so at a nice charge.

On my prescription the do gave me a breather puffer, one from Sweden it was 2,500 a go. I refused this at the medication desk and said I have this at home. From the previouse time I went and bought one from the outside pharmacy and I go 3 for 2,100 at 70 Baht each. Other stuff you can get from the pharmacy is more than 50% less than the hospital. But the treatment always cured me.

[ggt]

"laying on of hands"...is not likely to happen...Thailand is 95% Buddhist...Christians do "laying on of hands"...if you need this to feel better...go to a massage parlor...

[sammygood]

A few observations:

1. This appears to have been a private hospital, so what you are describing is not an experience "with the Thai health care system" but with "private medical care in Thailand". And with a specific doctor and hospital at that. At least of few of this issues would have differed, right in the same hospital, with a different doctor. I know you mention that at the start but your thread title implies otherwise. Experience with the Thai public health system would have been completely different - beter in some respects but much worse in others; whole different set of issues.

2.I don't think your issues with the doctor were due to elitism on his part, and rather than threatened I suspect he was utterly baffled by you. I think the problems were: (1) poor English on his part; (2) lack of socialization to western patients (including not only their expectations of care but also their level of sophistication in understanding medical matters -- most Thais truly would not have a clue how to understand a culture result given to them on the phone or even know what a culture and sensitivity test was) (3) differing expectations due to cultural difference: the concept of patients taking an active role in their health care is not part of medical culture here, to put it mildly. Except with doctors trained in the west, a patient acting as you did would be a complete shock and they'd have no idea at all what the behavior meant/was about. They might well misinterpret it as deliberate rudeness; and (4) hospital policies you were asking him to bend.

It does not sound like you selected a particular doctor. One should always do so, researching qualifications first (most private hospitals list them online) and if possible choosing someone with training in a western country - that assures excellent English and familiarity with western patients. Also usually implies an above average level of skill. For a urinary problem I would also have opted not for the medical clinic but the urology clinic and a urologist. Not only better trained to handle the problem but more odds of their being one trained in the west, since generally it is only specialists who ever are.

3.Getting meds at hospital pharmacy rather than outside pharmacy: There is talk of some reforms in the works around this issue but at present, this is indeed a problem with private hospitals and what I find works is as follows: Tell the doctor, quietly during the consultation, that you want to buy the meds at an outside pharmacy and ask for the names and dosages (there is never any writing of "prescriptions"). Depending on the hospital and the doctor's spine, s/he may be fine with doing that, or may tell you that the hospital frowns on this and suggest that they prescribe a day or two dose to be filled at the hospital and you can then buy the rest, or s/he may just say they can't. In that case, smile and wait till you reach the cashier, then refuse the medications (having noted the names and doses) and have them struck off your bill. I do this all the time, and find it simpler and less contentious to just smile and say I already have the drug rather than make an issue about planning to buy it myself.

Bear in mind the doctor does not benefit from this, it is the hospital that does, and s/he may be under some pressure to toe the line. Do not under any circumstances discuss the problem with the nurses or within hearing of many other people as that just pushes the doctor further into a corner and makes it harder for them to bend the rules.

3. Nursing and medical supplies charge: this is standard in all private hospitals. What is sometimes called "nursing/midwifery fee" is actually just the hospital fee. The consultation fee goes straight to the doctor. This (as well as mark up on drugs and supplies) is what the hospital gets - a mix of recouping actual costs for providing the facility (record keeping, reception, appointment booking and all the staff and equipment required for same; electricity, furnishing, physical upkeep of the offices etc) and yes, on top of that, a profit margin for them.

4. Medical supply/equipment costs: padded, no question, just like the meds at the hospital pharmacy. But unlike the latter nothing you can do about it. This too is the subject of discussion for possible government regulation but who knows if it will materialize.

5. Getting lab results by email or phone: In cases where result is expected to be negative I find this is usually easily arranged especially if you are dealing with a western-trained doctor. But the arrangement has to be made with the doctor, don't wait to discuss it with the nurse. Thai hospital nurses tend to be rigid sticklers for form/routine. During the consultation with the doctor, explain that you live far away and ask if the results can be sent by email or phone, then later on just tell the nurse the doctor agreed and presto, no problem.

In cases where the result indicates a need for change of treatment it is usual , not only in Thailand but in most countries, to have the patient come back so all can be explained and also additional information about the effects of treatment so far obtained to help guide the doctor in his advice. Culture and sensitivity results are not black and white, they are graduated; for example, the drugs you are on may show only partial effectiveness against the organism, or be effective but less so that a drug you are not on. Whether or not to change therapy based on this would depend on whether your symptoms were improving - so some dialogue is required. A doctor can, at his discretion and as an exceptional case, do this by phone or email but is only going to do so if he is really convinced that the patient has sufficient understanding already of the situation, the possible need for a change in treatment and why, etc. This will only happen with a doctor who has worked in the west and further gotten the impression during the consultation that the patient has a fairly sophisticated understanding of matters, and who was able during the discussion to outline a decision tree to the patient about what will be done based on the test reports, which the patient fully understood.

In regard to which, you don't mention what the culture results were nor if your symptoms have cleared. If you are at all symptomatic, you should arrange to see a urologist, bringing the results with you.

in my home country, a doctor can diagnose a urinary problem and give the right medication for it

you don't go to a specialist for everything & nothing

you go see your "house" doctor first and when needed, he will tell you to go see a specialist in the hospital

my home doctor also takes blood or piss or stool and send it to the lab

when I have a cut in my let's say finger, do I go see the normal doctor or a bone pr platisc surgeon ?

[bil2054]

I appreciate the views and experiences related in this topic.

I intend to retire in LOS, and as a diabetic, cardiac patient, etc., this is all near and dear.

Does anybody have experience with the variety of expat insurance programs, and how they work with the Thai health system?

Also, any advice on where to go for medical attention in Ubon Ratchathani?

I had been pondering the whole subject, as I mentioned to a couple of Thai friends that I was going to see my doctor

yesterday, just a periodic check and to get my prescriptions up to date, etc. They both seemed a bit alarmed; "What is wrong?", "You sick?"?"and so on. Preventative or ongoing care seemed to not be part of their expectations.

I found in the course of my two month visit last year that I can walk ok, due to a mile lower elevation than here on the Colorado Plateau, and the abundance of fresh fruit and vegetables also were a great advantage health wise.

[Sheryl]

in my home country, a doctor can diagnose a urinary problem and give the right medication for it

you don't go to a specialist for everything & nothing

you go see your "house" doctor first and when needed, he will tell you to go see a specialist in the hospital

my home doctor also takes blood or piss or stool and send it to the lab

when I have a cut in my let's say finger, do I go see the normal doctor or a bone pr platisc surgeon ?

Obviously for a simple cut, one sees a GP (or any other available doctor).

But this is Thailand, not your home country, and (1) medical care is very specialized/siloed; (2) quality of GPs is generally not very good, though there are exceptions; (3) many things that in the west would be considered normal to be handled by a GP are viewed as the sole province of specialists here; and (4) there tends to be a feeling that it is a "loss of face" to refer patients elsewhere with the result that it is not done when it should be in many cases, to the patient's detriment.

I am trying to give advice specific to the reality of how it is in Thailand. Which differs from how it is in western countries in many, many ways.

BTW even in the west, urinary problems are frequently referred to specialists. Depends obviously on the nature of the problem.

[fred Kubasa]

As, in Thailand, truth is not a requirement for a slander suit to be filed I, also will not identify the hospital he describes but am certain, due to treatment ? similarities, they are one and the same. I HAD been a ckient for10 years and, now realize I was more impressed by perception due to amenities, staff, ( very competent), surroundings, etc., and hadn't until a recent disasterous visit wherein I realized the Doctors appear to be more concerned

with billings, ( aka Laywers billed hours ),and

repeated appointments then actually diagnosing accurately and following up results via phone/Email. You simply cannot

get a Doctor to receive or return a call - you must make another appointment. I have, since, found that some of the Doctors

at govt, hospitals are just as competent, maybe more, and don't require you make a loan to pay their bills. I'd say be

more concerned by results then perceptive appearences and advertiising, ( which you pay dearly for ).

[NickJ]

There are a vast number of problems that can arise with the urinary system. Certain drugs are better matched for diffrent pathogens. Chronicity also plays a keen part. Drug type and schedule. Many patients here self medicate and think they are free and clear when the symptoms subside.....Better see the correct Dr. And follow up with tests to really make sure the problem is resolved.

[Sheryl]

I appreciate the views and experiences related in this topic.

I intend to retire in LOS, and as a diabetic, cardiac patient, etc., this is all near and dear.

Does anybody have experience with the variety of expat insurance programs, and how they work with the Thai health system?

Also, any advice on where to go for medical attention in Ubon Ratchathani?

I had been pondering the whole subject, as I mentioned to a couple of Thai friends that I was going to see my doctor

yesterday, just a periodic check and to get my prescriptions up to date, etc. They both seemed a bit alarmed; "What is wrong?", "You sick?"?"and so on. Preventative or ongoing care seemed to not be part of their expectations.

I found in the course of my two month visit last year that I can walk ok, due to a mile lower elevation than here on the Colorado Plateau, and the abundance of fresh fruit and vegetables also were a great advantage health wise.

There are both locally issued insurance policies and internationally issued ones aimed at expats living abroad. All will exclude from coverage pre-existing conditions so as a diabetic with cardiac problems you face having to pay out of pocket for quite a bit and costs could reach 6 figures in US$. So think carefully about whether you can afford to self-insure for this. It is still worth getting insurance as it will cover you for other things (accidents, medical problems not related to your pre-existng conditions). Best to consult an insurance broker for guidance. Most companies have age limits beyond which they will not enroll people. Thai issued policies tend to have a low cut off (e.g. 55 or 60 yrs), international policies go up much higher.

Another point to be aware of is that health insurance is not well regulated in Thailand and companies are legally able to do things that would not be permitted in the west. For example, they can drop you, or raise your premiums (beyond normal age bracket increases) if you have had large claims, even though you have paid premiums regularly. Insurers are governed by the laws of the country where they are based so an internationally-issued policy that includes coverage in Thailand will not be able to do that.

As to how insurance policies relate to the Thai "system" (there is indeed a public health system; care in private facilities is much more ad hoc and unregulated), some have direct pay arrangements and some do not, meaning you would have to pay first and get reimbursed afterwards. That is highly undesirable: not only does it require you to have potentially large amounts of money ready to hand but it means any issues/hassles/paperwork with the insurance company will be totally your headache rather than that of the hospital billing dept.(And hospitals will often prove less than helpful in providing the documentation you need in that scenario), So a very important question to ask of any insurance policy under consideration is whether they have direct billing arrangements with Thai hospitals and if so, which ones/how many.

Ubon is an OK location for routine problems (provided you are in or near the city) but not IMO a very good choice for someone with your medical problems. I would recommend instead, if you want to be in Issan, Khon Kaen which has a large teaching hospital.

In either place -- and indeed in most upcountry locations -- for anything major you are best off avoiding private hospitals in favor of government hospitals that are either provincial or regional level facilities, or else the military hospitals (which will also treat civilians). Good quality care can be had in private hospitals in Bangkok and CM but beyond there tends to be rather mediocre.

Quality of care in higher level government hospitals is usually good but amenities/conveniences few or none and waits and red tape considerable. A Thai speaker needed to help navigate as well, at least on initial visits.

[Si Thea01]

Here's my experience. Diagnosed with nasal polyps, went to a large private hopsital, checked out and agreed to do operation the same night. Told them I had insurance coverage but wanted me to guarantee payment if not covered by insurer. I agreed and was given an estimate of between B150k to B200k, which not knowing costs, seemed reasonable. They then asked for B100k deposit, told I'd give B20k, as by this time they had determined insurer would meet certain costs. Later found out this was $100k. The costs charged ended up being B153k, which turned out to be B53k over what the insurer paid. I was also advised that the fees charged were B53k over what two other hospitals would charge. My mistake for not getting another quote.

Anyway, that aside, I was operated on the same night, woke up the next day and looked like I had done 20 rounds with Mohammad Ali. Complained to ENT specialist about extreme headaches and eye pain and later was taken down and had nose packing removed. Pain stopped within 10 minutes. Was then checked by eye specialist who told me they had instructed specialist to remove packing as it had been packed too tightly. I also complained about pain in eyes and the eye specialist checked and gave me medication but made no mention of any other problem. The ENT specialist wanted to discharge me on the Saturday but I asked to stay another day as I was concerned abut my eyes. Stayed another day and was discharged and returned home the same day. My head during the night and next morning swelled like a football and later the following evening I went to local clinic and was rushed from there to the ER of the local hospital with post op complications.

Admitted and remained there for 3 days and was advised that they did not know what was causing the problem and advised to go to a larger hospital. This happened and after being discharged I was taken to a major government hospital, where, after an examination I was admitted and remained for two weeks. Here it was determined that I had suffered major trauma to the intraocular muscles in one eye, which cause me to have double vision and would require further surgery in an attempt to rectify the problem. I was also told that it was highly likely that the damage occurred during the nasal operation.

As a result I informed the ENT doctor, who after speaking with doctors at this hospital, although not admitting to causing the problem, undertook to meet some extra costs that had been incurred and also indicated that this had never happened before in respect of his competing similar operations. Over the next 1o months I had two operations which, unfortunately, did not rectify the problem caused to my eye and now I have to wear a patch over the damaged eye as if I don't I become disorientated and lose my balance when walking. I was also told that the damage occasioned was a complication that could occur, along with a number of others. I was initially told that complications that could arise was excessive bleeding and infections but never told about what could occur to my eye, as had I, I would never have undergone the surgery.

I later did a search of the internet and found out that although the surgery could cause this particular complication, it was rare. Seeing I wasn't told, it may well be that they doctor didn't know either. I later returned to the hospital and obtained a copy of my medical records, where it was discovered that following my initial operation, the eye specialist had examined my eyes the next morning and had recorded that muscle damaged had been occasioned to my right eye. Yet no one ever told me of this and I only found out about this after I was admitted to the third hospital.

So now I am stuck with ruined eyesight, cannot drive, have trouble getting around and my wife has to take time off work to take me to the last hospital for regular examinations. Since this I have had a meeting with the medical board of the initial hospital, in relation to compensation but they have tried to stretch out the time it takes them to do their investigation so as to run the time over 12 months, which is the time factor that I have to sue. Fortunately for me, I was able to find an experienced lawyer, who has since lodged a civil claim against the hospital and doctor, as a well as a criminal charge against the doctor for a wrongful act (medical negligence) a few days prior to the 12 month expiry.

For obvious reasons I have not mentioned the names of the hospitals or medico's involved but the second and third hospitals provided excellent treatment, despite the second hospital not being able to diagnose what had caused the post op complications. The initial hospital and third hospital are both well known, the first being a private establishment, thethird a large government hospital. The care given at the latter was just as good, if not better, than the private establishment, with the costs being one fifth of those charged at the private hospital. So now, besides having had two additional operations, I now have to go through a legal battle, which will take god knows how long, and even then there is no guarantee that I will be compensated but I do have the guarantee that my eyesight cannot be returned to normal and will have the use of just one eye for the rest of my life.