overcharging by BGH

[gamini]

The orthopaedic specialist at BGH gave me an epidural steroid injection in my right shoulder for pain. He spent sometime trying to find the right spot. He charged Bt2600 for the injection. It did not give me any reliel. A few months later a freind reccomended a specialist at a government hospital. He knew exactly where to give me a steroid shot and the bill including the injection was Bt 360. It worked and the pain is much less.

[Singerman]

An Epidural injection in the shoulder ?

Are you sure about that ?

[Sheryl]

This is not "overcharging" in that there is no indication you were charged more than the official price.

Prices at private hospitals are always much higher than at government hospitals. By a factor of 3-6 times.

(and indeed, it could not have been an "epidural" injection since by definition that is an injection into the epidural space of the spinal cord.).

[thaiduncankk]

And the specialist in the private hospital most probably practices in Government hospitals too. You are paying for the beautiful surroundings, and a marginally better command of the English language.

[fstarbkk]

Epidural injections are, by definition, administered to the spine, not the shoulder. The current state of practice is to give them using imaging guidance, using fluoroscopy or a radio contrast agent. "Blind injections" have a high risk of missing optimum placement, even with good knowledge of the anatomical landmarks.

As for the cost of the procedure, it is clear that private healthcare has become a free-for-all for hospitals and their practitioners in Thailand. Despite some recent rumblings from the government, there is no effective consumer protection in sight.

[Sheryl]

This is true. However, use of government hospitals is not without its disadvantages -- especially for non-Thai speakers and for anyone who lives far away and/or for whom time is money.

1. Red tape and Long waits (really long - often needing several days to accomplish what you can in a single in and out appointment at a private hospital). For some people, myself included, this is enough to make govt hospitals actually more expensive once costs of travel and lost work time are factored in.

2. Inability to choose your doctor (govt hospitals with an after hours private channel excepted) - this is a BIG drawback especially when combined with #3:

3. Much of the care -- and this includes surgery -- is provided by interns and residents in training. Under supervision of course but the level of supervision is not always as intensive as it needs to be.

A good Cambodian friend recently underwent spinal surgery at a government hospital, because there was no way they could afford private (They couldn't afford the govt hospital either, I had to pay half for them outright and let them borrow the other half. Due to need for a lot of titanium rods, cost was about 150,000 baht despite being a govt facility. With the imported hardware accounting for most of that).

The attending physician was fine, but a team of interns and residents did most of it and they were a sorry bunch of incompetents. Worse yet, they did some or most (perhaps even all, who knows) of the actual surgery and left a bleeder open. She returned to the room pale as a ghost having lost huge amounts of blood and complaining of severe pain and numbness in her legs (due to the rapidly forming hematoma) and her blood count continued to spiral down. Despite these obvious signs the residents & interns insisted it was all "normal" and would improve with time. Kept transfusing her but never looked into why her blood count continued to drop. In vain I told them I though there was a hematoma; in vain I and her family complained that something was wrong. This went on for a full 3 days, finally I got so desperate I staged a sit in demanding to speak to the Professor in charge. Sat there 14 hours with no luck, turned out he was off in Chiang Mai and relying on his "team" to let him know if there were any prioblems....they of course were telling him everything was fine. I finally prevailed on one of them to call him (day 4 at this point) and tell him that her legs were numb and blood count still dropping. He immediately left the conference, flew back and had her in the OR that night where they evacuated a large hematoma...but not before some nerve damage had occurred. It is now 2 months later and she can walk but with a walker and a limp, still not sure if complete function will be regained.

I am 80-90% sure the problem stemmed from a mistake in the OR by the resident and 100% sure that, regardless, obvious signs of a problem were ignored for 4 days, jeopardizing her ability to walk.

I don't think this would have happened in a private hospital with a good surgeon. In this case the doctor in charge (the professor) was indeed quite capable but being a government teaching hospital, it was the interns and residents who did everything and due to work overload they were not sufficiently overseen. (I later learned that the chart consistently stated that the patient had no complaints and everything was normal -- totally untrue. This "team" of miscreants not only ignored what they were repeatedly told but lied about it in documentation, ensuring that their superior would not think anything was wrong.

Now this does not happen in every case, of course..but it can. And this was I think an unusually poor crop of residents/interns...but that happens sometimes.

Unless there is really no choice, I can't advise undergoing a major surgical procedure or other risky treatment at a government hospital unless there is a private channel whereby you can select the doctor and be assurred he will personally perform it.

[shirtless]

Mate its all hit and miss your lucky your cured ,

[14 the other side]

^^^ Sheryl's post above ... respect ...

[Issangeorge]

Sheryl, perhaps there is s better chance of this happening in a Thai government hospital, but malpractice and incompetence, can happen in any hospital anywhere in the world. I live in the North East and have far more faith in say KK University Hospital, than any private North East Hospital. When I'm sick I'm sick, and have no need for five star facilities. The only private hospitals over the KK University Hospital I would have confidence in are in Bangkok and as far as I'm concerned over priced. I want a hospital that will treat me efficiently and competently, not a five star hotel. Perhaps after I recovered I'd go to a 5 star hotel to celebrate, but after I have recovered.

[thaiduncankk]

I am only commenting on personal experience, usually a visit to A&E or a follow up appointment.

Apart from a broken finger 10 years ago, I have never needed surgery. Ironically, I paid at the RAM then, and it was not a perfect job. The operated little finger sticks out, away from the other fingers when I hold my hand out.

I have been hospitalised, for things such as asthma and a few infections, and although I am by no means fluent in Thai, I have always been able to communicate.

Your friend's predicament is on a far larger scale, and, without a doubt, the private hospital would be the better option.

[BKKdreaming]

are most Thai government hospitals also teaching Hospitals ?

[Sheryl]

The large tertiary ones, yes.

Small upcountry hospitals no, but largely staffed by recent graduates.

Issangeorge - quite agree with you re KKU. In Issan as in virtually all upcountry areas (not counting major city like Chiang Mai) the private hospitals are best avoided and the best option is the nearest large, preferrably tertiary level, government hospital. Upcountry private hospitals have a great deal of trouble attracting good doctors, the best specialists are disproportionately found in Bangkok and in large government teaching hospitals.

In Bangkok the situation is very different, with lots of top notch doctors to be found in private hospitals provided one takes the time to do a bit of research and select one. (There are also mediocre doctors, in larger numbers than the good ones, so the "pot luck" approach that for some reason many people take of just going to a hospital and letting the clerk behind the counter select their doctor is a really, really bad idea.)

I believe KKU may have a private channel, if so well worth using it for anything serious so that you can select your doctor and be cared for by one of the attending doctors rather than the residents.

I should add I worked in teaching hospitals for many years, and not all residents are bad by any means...but they are certainly less experienced and expert than their teachers, and there are always some bad apples. In my friend's case unfortunately the entire lot seem to have been bad apples (and the nurses not much better).

Since all this occurred, ever since the second surgery (which the Professor personally performed), he has not let his "team" near her. Even routine follow up visits go directly to him and him only. Unfortunatley the damage has already been done.

[thaiduncankk]

Sheryl, perhaps there is s better chance of this happening in a Thai government hospital, but malpractice and incompetence, can happen in any hospital anywhere in the world. I live in the North East and have far more faith in say KK University Hospital, than any private North East Hospital. When I'm sick I'm sick, and have no need for five star facilities. The only private hospitals over the KK University Hospital I would have confidence in are in Bangkok and as far as I'm concerned over priced. I want a hospital that will treat me efficiently and competently, not a five star hotel. Perhaps after I recovered I'd go to a 5 star hotel to celebrate, but after I have recovered.

I use the main hospital on Srichan Road as opposed to the University alternative, mainly because of it's location, but also, they have my full medical history on record.

I notice, when I have been admitted there, that a lot of the other inpatients are from outside of the actual city boundaries, and live further afield within the KK province, having been transferred from their local smaller hospital, due to the better equipment and facilities at the larger hospital.

[gamini]

An Epidural injection in the shoulder ?

Are you sure about that ?

My mistake. It was not an epidural but both procedures were exactly the same, using the same medication. betamethasone

[gamini]

This is not "overcharging" in that there is no indication you were charged more than the official price.

Prices at private hospitals are always much higher than at government hospitals. By a factor of 3-6 times.

(and indeed, it could not have been an "epidural" injection since by definition that is an injection into the epidural space of the spinal cord.).

My mistake. It was not an epidural. But the cost was not 3 to 6 times, but 10 times. I have not found private hospitals having official prices unless it's a standard procedure. I have often been in charged much more by one Dr than another one at the same hospital for the same consultation. I know for sure that doctors decide how much the patient should be billed for. I have been charged from 300 bt to 1500 at private hospitals

[gamini]

This is true. However, use of government hospitals is not without its disadvantages -- especially for non-Thai speakers and for anyone who lives far away and/or for whom time is money.

1. Red tape and Long waits (really long - often needing several days to accomplish what you can in a single in and out appointment at a private hospital). For some people, myself included, this is enough to make govt hospitals actually more expensive once costs of travel and lost work time are factored in.

2. Inability to choose your doctor (govt hospitals with an after hours private channel excepted) - this is a BIG drawback especially when combined with #3:

3. Much of the care -- and this includes surgery -- is provided by interns and residents in training. Under supervision of course but the level of supervision is not always as intensive as it needs to be.

A good Cambodian friend recently underwent spinal surgery at a government hospital, because there was no way they could afford private (They couldn't afford the govt hospital either, I had to pay half for them outright and let them borrow the other half. Due to need for a lot of titanium rods, cost was about 150,000 baht despite being a govt facility. With the imported hardware accounting for most of that).

The attending physician was fine, but a team of interns and residents did most of it and they were a sorry bunch of incompetents. Worse yet, they did some or most (perhaps even all, who knows) of the actual surgery and left a bleeder open. She returned to the room pale as a ghost having lost huge amounts of blood and complaining of severe pain and numbness in her legs (due to the rapidly forming hematoma) and her blood count continued to spiral down. Despite these obvious signs the residents & interns insisted it was all "normal" and would improve with time. Kept transfusing her but never looked into why her blood count continued to drop. In vain I told them I though there was a hematoma; in vain I and her family complained that something was wrong. This went on for a full 3 days, finally I got so desperate I staged a sit in demanding to speak to the Professor in charge. Sat there 14 hours with no luck, turned out he was off in Chiang Mai and relying on his "team" to let him know if there were any prioblems....they of course were telling him everything was fine. I finally prevailed on one of them to call him (day 4 at this point) and tell him that her legs were numb and blood count still dropping. He immediately left the conference, flew back and had her in the OR that night where they evacuated a large hematoma...but not before some nerve damage had occurred. It is now 2 months later and she can walk but with a walker and a limp, still not sure if complete function will be regained.

I am 80-90% sure the problem stemmed from a mistake in the OR by the resident and 100% sure that, regardless, obvious signs of a problem were ignored for 4 days, jeopardizing her ability to walk.

I don't think this would have happened in a private hospital with a good surgeon. In this case the doctor in charge (the professor) was indeed quite capable but being a government teaching hospital, it was the interns and residents who did everything and due to work overload they were not sufficiently overseen. (I later learned that the chart consistently stated that the patient had no complaints and everything was normal -- totally untrue. This "team" of miscreants not only ignored what they were repeatedly told but lied about it in documentation, ensuring that their superior would not think anything was wrong.

Now this does not happen in every case, of course..but it can. And this was I think an unusually poor crop of residents/interns...but that happens sometimes.

Unless there is really no choice, I can't advise undergoing a major surgical procedure or other risky treatment at a government hospital unless there is a private channel whereby you can select the doctor and be assurred he will personally perform it.

Having lived in Thailand many years, and now quite old with plenty of medical problems I have to admit that if anything is seriously really wrong with me. I will always go to Bumrungrad. The charges might be slightly higher than other private hospitals, but at least they don't pad the bills, which in the end makes them actually cheaper. Most other private hospitals add a lot of extras. It might be interesting to know that this hospital charges far less for cataract treatment than most other private hospitals. Most of my friends know this and have been treated at Bumrungrad.

In my opinion, one of the best hospitals in Thailand is Siriraj. Many of the best doctors from private hospitals practice there. I go there for specialised skin treatment and again it's about one 10th of the price of private hospital. But I'll admit I have to wait a long time for treatment. And have to make appointments a long time in advance. I found some excellent doctors at private hospitals and some pretty awful ones too. It is a question of finding the best doctor. For my orthopaedic problems I use a government hospital. I have an excellent cardiologist at BGH. My cancer specialist works at Bumrungrad. And I have excellent radiologists at another government hospital. I avoid being admitted to any of these hospitals because of the high price of treatment as an inpatient. So I will travel to Chiang Mai and go to siripat hospital . Should I need an operation. My wife has diabetes and has had very disappointing treatment and advice from several specialists. She now goes to Bumrungrad and has found a really excellent and caring doctor.

[never me]

This is true. However, use of government hospitals is not without its disadvantages -- especially for non-Thai speakers and for anyone who lives far away and/or for whom time is money.

1. Red tape and Long waits (really long - often needing several days to accomplish what you can in a single in and out appointment at a private hospital). For some people, myself included, this is enough to make govt hospitals actually more expensive once costs of travel and lost work time are factored in.

2. Inability to choose your doctor (govt hospitals with an after hours private channel excepted) - this is a BIG drawback especially when combined with #3:

3. Much of the care -- and this includes surgery -- is provided by interns and residents in training. Under supervision of course but the level of supervision is not always as intensive as it needs to be.

A good Cambodian friend recently underwent spinal surgery at a government hospital, because there was no way they could afford private (They couldn't afford the govt hospital either, I had to pay half for them outright and let them borrow the other half. Due to need for a lot of titanium rods, cost was about 150,000 baht despite being a govt facility. With the imported hardware accounting for most of that).

The attending physician was fine, but a team of interns and residents did most of it and they were a sorry bunch of incompetents. Worse yet, they did some or most (perhaps even all, who knows) of the actual surgery and left a bleeder open. She returned to the room pale as a ghost having lost huge amounts of blood and complaining of severe pain and numbness in her legs (due to the rapidly forming hematoma) and her blood count continued to spiral down. Despite these obvious signs the residents & interns insisted it was all "normal" and would improve with time. Kept transfusing her but never looked into why her blood count continued to drop. In vain I told them I though there was a hematoma; in vain I and her family complained that something was wrong. This went on for a full 3 days, finally I got so desperate I staged a sit in demanding to speak to the Professor in charge. Sat there 14 hours with no luck, turned out he was off in Chiang Mai and relying on his "team" to let him know if there were any prioblems....they of course were telling him everything was fine. I finally prevailed on one of them to call him (day 4 at this point) and tell him that her legs were numb and blood count still dropping. He immediately left the conference, flew back and had her in the OR that night where they evacuated a large hematoma...but not before some nerve damage had occurred. It is now 2 months later and she can walk but with a walker and a limp, still not sure if complete function will be regained.

I am 80-90% sure the problem stemmed from a mistake in the OR by the resident and 100% sure that, regardless, obvious signs of a problem were ignored for 4 days, jeopardizing her ability to walk.

I don't think this would have happened in a private hospital with a good surgeon. In this case the doctor in charge (the professor) was indeed quite capable but being a government teaching hospital, it was the interns and residents who did everything and due to work overload they were not sufficiently overseen. (I later learned that the chart consistently stated that the patient had no complaints and everything was normal -- totally untrue. This "team" of miscreants not only ignored what they were repeatedly told but lied about it in documentation, ensuring that their superior would not think anything was wrong.

Now this does not happen in every case, of course..but it can. And this was I think an unusually poor crop of residents/interns...but that happens sometimes.

Unless there is really no choice, I can't advise undergoing a major surgical procedure or other risky treatment at a government hospital unless there is a private channel whereby you can select the doctor and be assurred he will personally perform it.

Sheryl, That is disgusting what happen to your friend from Cambodia.

Is there any recourse at that hospital or the Ministry of health?

I hope your friend gets better.

[Sheryl]

We were seriously thinking of suing (not an easy thing to do with a government hospital) but the attending doctor, at his own initiative, got all the additional costs waived so we did not have to pay anything for the second surgery or extended hospital stay (a difference of more than 100,000 baht). And he has expressed so much sincere anguish over what happened that we are not inclined to do anything, even though at best she will have had months of preventable suffering and disability. We would also in any case have to wait until the final outcome is known (since suits have to show lasting damage). At this point we are still hoping for an eventual return to normal as there is still slow improvement taking place. Nerves regenerate very slowly.

Gamini -- Siriraj now has a private wing where you can circumvent the long waits. Of course, costs more but I think still a bit less than Bumrungrad et al. http://www.siphhospital.com/

[NancyL]

Sheryl, do you think some of what happened to your friend was because she was Cambodian and thus treated as being not as important as a Thai person?

[Sheryl]

Possible. Not so much that she was not considered important -- this care was at a government hospital, the Thai patients there were hardly VIP class -- but they may have been more dismissive of what she said than they would have been with a Thai, and certainly neither the doctors nor (especially) the nurses made much effort to understand when she tried to communicate. However they also had me there piping in.

Frankly I think this was just a really, really substandard group of interns/residents receiving insufficient supervision.