Thailand ‘has potential to be medical tourism leader’

[madmitch]

Do the numbers include "accidental" medical tourists: just regular tourists who end up getting treatment in Thai hospitals? It wouldn't surprise me knowing the way numbers are manipulated here.

[JSixpack]

27 minutes ago, retarius said:

Dubai is light years ahead and has real doctors in the hospitals....dream on.

 

How's Dubai doing on the medical tourism front? For some reason I don't see it in the lists. And is that why Bumrungrad is full of those Middle Easterners?

Edited July 24, 2017 by JSixpack

[gamini]

3 hours ago, jaltsc said:

"Thailand can emerge as the region’s top medical tourism hotspot..."

 

First they need to develop an education culture based on achievement and not based on social status. 

 

I don't think medical tourists will feel too confident knowing that the person who is treating them had his degrees purchased by his family. 

Since most of the best private hospitals here employ doctors who are trained abroad in the US,  you claim they bought thier medical degrees there. Why do you post such nonsense?

[Jimbo in Thailand]

Thailand vying to be a regional 'medical tourism leader’ is horrible news for we expats (and Thai nationals).  Bumrungrad International Hospital facilities have already increased their medical fees/rates exponentially just during the past few years, and I'm sure some other private Thai hospitals are following Bumrungrad's lead.  Here in Isaan, private hospital healthcare is still very reasonably priced but I'm sure it won't be much longer as the inevitable greed factor kicks in nationwide.  Like I said, terrible news for all of us living here.

[YetAnother]

2 hours ago, connda said:

Yep.  All they need to do is stop enforcing a xenophobic immigration policy.

altho i agree with you, it appears the newest murmurings have immigration getting Worse; note the health insurance....

[JAG]

After being a leading hub for all kinds of things since a long time, it is time for Thailand now to move up and assert its rightful position as an emerging leader amongst nations?

Be patient, they're waiting for Thai to replace English as THE international language, then...

[smileydude]

1 hour ago, JSixpack said:

 

And for all those working in them, right down to the maids, and their extended families upcountry.

 

 

Many of the docs in private hospitals work in public also. Even in your own country the average person isn't going to have access to the top notch hospitals. If I get cancer, no way the Mayo Clinic is going to be treating it. Public hospitals, such as Chula, can be excellent and are affordable for expats. But of course the definition of affordable varies and for many an expat here really means pittance "free" as in "back home" free where they've paid many millions of baht in taxes for the "free." This would fit the pension and lack of savings. Nor would our expats be happy about helping to fund the public healthcare system themselves with a rise in visa fees. We remember the last time in 2003.

 

 

Despite the chorus of doomsters here, the economy is growing, as you may verify with a modicum of research. If you compare public healthcare in Thailand w/ what it was 20 years ago I think you'll find it much improved. Not to say it doesn't have far to go, esp. in rural areas. 

 

Valid points all of them but first let me clarify that I am a thai physician and have worked in both private and public healthcare for 20+ years and I'd like to add some points:

 

Yes I agree, not everyone in the US will have access to Mayo Clinic, MD Anderson or Cleveland clinic.  These speciality clinics were often started as non-profit organizations but they are not charities.  Private hospitals exists for a reason and that is to provide quality healthcare to those who can afford it.  Many US citizens who are not affluent do STILL have access to quality healthcare if they can afford insurance.

In the UK, the NHS basically ensures access to everyone who is a resident albeit the waiting list for elective surgeries such a hernia's is long due to the limitations, thus private hospitals are an option.  There is no free meal but the situation in Thailand has much to be improved.

 

The situation for the 3 public healthcare system in Thailand, Universal coverage scheme (UCS), Civil Servant Medical Benefit Scheme (CSMBS) and Social security scheme (SSS) is such that the UCS is paying much less per case to the provider (majority of government hospitals under the Ministry of Public health) such that many are losing money and accounts are in the red.  As for the SSS, many private hospitals participate, but most members feel they are treated to sub par treatment due to the paradox of fixed capitation/per head (2200 baht/patient/year) and the hospitals trying to make a profit.  Everybody in the CSMBS is generally satisfied because it pays higher per service relative to the UCS.  An example, the UCS reimburses a hospital around 1 RW (relative weight) = 9800 baht per appendectomy.  The CSMBS reimbursement rate is about on average 30,000/ appendectomy case.  You'd probably pay for an appendectomy anywhere between 50,000- 200,000 at a private hospital.  No hospital can provide an appendectomy for 9800 baht.  True, government hospitals objectives are not to make a profit but they are not built as charities either.

Right now many university hospitals such as Chula, Siriraj and most public hospitals are playing a game of Robin Hood.  They prefer and take enough money from CSMBS patients to subsidize the loses incurred from treating UCS patients.  I don't know if you are aware but universities hospitals are NOT REQUIRED to accept UCS and SSS patients in primary and secondary care (where most of the loses occur) but mainly accept tertiary care (advanced case such as heart surgery and catherization) for purposes of training and humanity.  

 

Now here are some facts.  UCS has 42 million members with costs subsidized from taxes.  CSMBS has 5 million members with costs subsidized from the government budget. SSS has approx 10 million members with their budget from employers, employees and the government.  The budget per head for CSMBS is 10 times that for UCS.  The disparity is appalling and is apparent in the quality of healthcare each group is receiving as economics rules. Moral hazards abound.  Does a doctor want to use a different treatment protocol for a patient with the same disease from each type of healthcare group?  No, but the reality is they must otherwise the hospital they work for will incur heavy loses, again moral hazards and economics at play that shape the current healthcare system in Thailand today.

 Private hospital patients feel first class.  CSMBS feel 2nd class.  SSS feel 3rd class and UCS patients feel like they are at the bottom without choice.  JCI ensures you are getting quality service at private hospitals.  Hospital accreditation (HA) ensures that most SSS and UCS hospitals must maintain their basic standards so we DO still have standards but the variation between hospitals is more then outsiders will ever know.

 

The solution is currently being debated between the payers and providers of the 3 healthcare systems.  Co-payment schemes for those who are actually earning income like farmers, hawkers and all those in the non-formal workforce but don't pay taxes and are using the UCS system are trying to be enacted for some self-responsibility.  Research from all around the world has proven that if anything is free and co-payment is non-existent will result in 3 problems that will bankrupt the system:  

First many unnecessary visits to the hospital and subsequent burden and costs incurred by providers when in fact patients you could stay home, drink lots of fluids and get well after a few days of rest without the need of over-prescription of antibiotics.

Second:  Free medication often results in less patient compliance to take your medication on time as instructed.  Free medication is less valuable then if you have to pay for it.  Disease progresses when it should not, complications arise and costs too, again.

Third:  Patients often do not have any behavioral incentive to take care of themselves if free medical care is available.

 

There are other solutions such as registering those WHO are truly in poverty to receive healthcare free of charge.  Currently 12 million are registered but academics debate that many times the income of those in the non-formal workforce alternate between sufficient and insufficient each year.  Where do we draw the line?

 

All in all the disparity between the 3 healthcare systems in Thailand has much to be addressed before it all collapses due to the unsustainable nature of each.

Edited July 24, 2017 by smileydude

[JSixpack]

1 hour ago, smileydude said:

Valid points all of them but first let me clarify that I am a thai physician and have worked in both private and public healthcare for 20+ years and I'd like to add some points:

 

Yes I agree, not everyone in the US will have access to Mayo Clinic, MD Anderson or Cleveland clinic.  These speciality clinics were often started as non-profit organizations but they are not charities.  Private hospitals exists for a reason and that is to provide quality healthcare to those who can afford it.  Many US citizens who are not affluent do STILL have access to quality healthcare if they can afford insurance.

In the UK, the NHS basically ensures access to everyone who is a resident albeit the waiting list for elective surgeries such a hernia's is long due to the limitations, thus private hospitals are an option.  There is no free meal but the situation in Thailand has much to be improved.

 

The situation for the 3 public healthcare system in Thailand, Universal coverage scheme (UCS), Civil Servant Medical Benefit Scheme (CSMBS) and Social security scheme (SSS) is such that the UCS is paying much less per case to the provider (majority of government hospitals under the Ministry of Public health) such that many are losing money and accounts are in the red.  As for the SSS, many private hospitals participate, but most members feel they are treated to sub par treatment due to the paradox of fixed capitation/per head (2200 baht/patient/year) and the hospitals trying to make a profit.  Everybody in the CSMBS is generally satisfied because it pays higher per service relative to the UCS.  An example, the UCS reimburses a hospital around 1 RW (relative weight) = 9800 baht per appendectomy.  The CSMBS reimbursement rate is about on average 30,000/ appendectomy case.  You'd probably pay for an appendectomy anywhere between 50,000- 200,000 at a private hospital.  No hospital can provide an appendectomy for 9800 baht.  True, government hospitals objectives are not to make a profit but they are not built as charities either.

Right now many university hospitals such as Chula, Siriraj and most public hospitals are playing a game of Robin Hood.  They prefer and take enough money from CSMBS patients to subsidize the loses incurred from treating UCS patients.  I don't know if you are aware but universities hospitals are NOT REQUIRED to accept UCS and SSS patients in primary and secondary care (where most of the loses occur) but mainly accept tertiary care (advanced case such as heart surgery and catherization) for purposes of training and humanity.  

 

Now here are some facts.  UCS has 42 million members with costs subsidized from taxes.  CSMBS has 5 million members with costs subsidized from the government budget. SSS has approx 10 million members with their budget from employers, employees and the government.  The budget per head for CSMBS is 10 times that for UCS.  The disparity is appalling and is apparent in the quality of healthcare each group is receiving as economics rules. Moral hazards abound.  Does a doctor want to use a different treatment protocol for a patient with the same disease from each type of healthcare group?  No, but the reality is they must otherwise the hospital they work for will incur heavy loses, again moral hazards and economics at play that shape the current healthcare system in Thailand today.

 Private hospital patients feel first class.  CSMBS feel 2nd class.  SSS feel 3rd class and UCS patients feel like they are at the bottom without choice.  JCI ensures you are getting quality service at private hospitals.  Hospital accreditation (HA) ensures that most SSS and UCS hospitals must maintain their basic standards so we DO still have standards but the variation between hospitals is more then outsiders will ever know.

 

The solution is currently being debated between the payers and providers of the 3 healthcare systems.  Co-payment schemes for those who are actually earning income like farmers, hawkers and all those in the non-formal workforce but don't pay taxes and are using the UCS system are trying to be enacted for some self-responsibility.  Research from all around the world has proven that if anything is free and co-payment is non-existent will result in 3 problems that will bankrupt the system:  

First many unnecessary visits to the hospital and subsequent burden and costs incurred by providers when in fact patients you could stay home, drink lots of fluids and get well after a few days of rest without the need of over-prescription of antibiotics.

Second:  Free medication often results in less patient compliance to take your medication on time as instructed.  Free medication is less valuable then if you have to pay for it.  Disease progresses when it should not, complications arise and costs too, again.

Third:  Patients often do not have any behavioral incentive to take care of themselves if free medical care is available.

 

There are other solutions such as registering those WHO are truly in poverty to receive healthcare free of charge.  Currently 12 million are registered but academics debate that many times the income of those in the non-formal workforce alternate between sufficient and insufficient each year.  Where do we draw the line?

 

All in all the disparity between the 3 healthcare systems in Thailand has much to be addressed before it all collapses due to the unsustainable nature of each.

14

 

Good, thoughtful analysis, thanks for taking time to write it, not that many here besides me will read it. FWIW (not much) I thought the 30-baht scheme was crazy when they implemented it and never thought it could be sustainable. It will be interesting to see how it all plays out. 

[sawadee1947]

8 hours ago, webfact said:

 

“Rehabilitative care and connected healthcare

yes, that is starting already. There are several nursing homes for disabled/Parkinson/Alzheimer in this country. One got even an International Award in London.

But.....to get something from the pot of surgery (100 Bill) I think it's too late. Other countries as Korea e.g. are famous and docs are well trained, whereas in Thailand foreigners are not allowed to work, not even for training Thais.

[smileydude]

20 minutes ago, JSixpack said:

 

Good, thoughtful analysis, thanks for taking time to write it, not that many here besides me will read it. FWIW (not much) I thought the 30-baht scheme was crazy when they implemented it and never thought it could be sustainable. It will be interesting to see how it all plays out. 

I appreciate that you took the time to read it and agree not many would care enough to read about it either.

I wrote it because there are always 2 sides to a story and wanted to share a bit of information about Thailand's healthcare system.

As we speak the debate between healthcare providers, payers and NGO's rages on with each side calling the other either unreasonable or protective of their self-interests.  I hope they find a compromise otherwise many will find themselves without coverage if the system collapses.

[Lingba]

OH PLease...!!!...enough of this nonsense...Thailand doesn't come close to being a medical hub...They have hospitals that are either ancient or disquised as hotels...but medical knowledge is lacking by far...plus all they want is your money

[Jimbo2014]

There certainly seems to be enough corpses to experiment on!