Health insurance for Thai with lupus possible?

[Moldybread]

I'm asking this for a Thai lady who's been diagnosed with SLE (lupus).

She would like to have some type of health insurance but the insurer she contacted declined her application because of her pre-existing condition.

Is it possible for someone with SLE to have health insurance in Thailand? She's particularly worried about the fact that certain DMARD and biological drugs used for SLE may cause cancer and she'd like to be covered for that.

[Sheryl]

Any insurer will at a minimum exclude not just the SLE but all complications associated with it as pre-exisitng condition.

 

Why does she, as a Thai, need or want private health insurance? She already has access to free care through either the Soc Sec system (if she is employed) or the universal access (AKA 30 baht or cold card) system.

[Moldybread]

Doesn't private health insurance give a better coverage in terms of hospitals? She's being treated at bumrungrad and doesn't want to be treated at a government hospital, knowing how bad some doctors there are.

 

She's a business owner, what are her options? I guess the soc sec system is out then?

 

P.s. Do you Sheryl, or anyone else know where to find more information about the options of Thai health insurance? Being the free ones you mentioned or private health insurance.

 

Edited December 9, 2016 by Moldybread

[Moldybread]

After a little bit more research it indeed sounds like it's unnecessary for a Thai to take private health insurance.

A friend of her is an accountant and explained that by paying 432 baht (social security?) she's covered and able to visit hospitals in Bangkok.

With the 30 baht scheme she'll have to travel to her changwat to see a doctor in the local government hospital, who then might refer her to a better hospital in Bangkok like Chula.

 

Is that about right Sheryl?

 

Edited December 9, 2016 by Moldybread

[Sheryl]

Yes. She doesn't need to get private insurance to have coverage, though I am not certain if as business owner, rather than employee, she can get under Soc Security. However, the Soc Security office can certainly advice her.

 

However neither the Soc Sec system nor the universal system will cover her at Bumrungrad or other very high priced private hospital. The priciness of a hospital does not correllate to the quality of medical care, by the way, though it does bring more comforts and conveniences

 

Under Soc Sec one must chose a singe hospital to register at, the choice includes some private as well as government hospital but not usually very good private ones; one is generally best off choosing a large government hospital from those on the list. Note that most of the doctors at Bumrungrad also work in a government hospital. And many government hospitals have an after hours channel where one can see top doctors by appointment for just a small extra fee.

 

Private health insurance operates on the principal of risk pooling, it is set up to protect people against what might occur but probably (in their individual case) will not. It is not set up to enable people to get care they already need (or are already clearly likely to require) at a lower price. Pre-existing conditions are always excluded. Unfortunately in the case of SLE, the disease is so far reaching and affects so many body systems, that about the only thing that would not be excluded in her case should she manage to get a policy would be accidents.

 

Many, many people -- including TV members and their immediate family -- have had cancer treatment at government hospitals. So can she, should the need arise (though in my experience the health problem people think, in advance, will strike them is usually not what does.).

[Moldybread]

Thanks for the excellent info Sheryl, I feel less worried now if something happens to her. For a long time I believed it was everybody for themselves in Thailand, no money, no treatment.
 

She'll give the social security office a call.
 

Do you perhaps know which hospital in Bangkok has the best doctors in rheumatology and oncology?

 

One thing I worry about though is that she will not get the best treatment under soc sec or the 30baht scheme. For example, for SLE there's a drug called belimumab, a biologic which target's the BlyS enzyme. It's new and patented so quite expensive, but it has one of the highest remission rates. It costs around 1 to 1.5 million THB per year. Under the 30baht scheme they will probably put her on high dose prednisolone + hydroxychloroquine or one of the cheaper DMARD's like azathioprine.

[JoePai]

As a business owner(?) with a company she would already be paying the SS so no need to pay again

[Sheryl]

I don't know what drug the government hospitals use for SLE, but the condition is quite widespread in Thailand and there is an abundance of doctors with experience in managing it.. 

 

If they do not supply belimumab for free, an option would be for her to pay for that out of pocket while getting the rest of the treatment (doctor visits, lab tests etc) free.

 

She would be best served by being registered at a large government hospital such as Chulalongkhorn. However, she has to see which hospitals in her area are accepting new Social Security enrollments. There will be a list. If covered under the "30 baht" scheme, she does not have a choice of hospital, has to be  the one that covers the place where she lives or a higher level facility they refer her to.

 

Again, I am not certain a business owner  qualifies for Soc Sec, it might be limited to employees. (recording her as an employee may be what the accountant she spoke to had in mind). Normally the company's HR department will have a list of eligible hospitals under Soc Sec, if not, she can get it from the SS office.