· In this exclusive report, we look at ways the government is curbing excessive charges for locals and foreigners
· Only two hospitals have dual pricing for COVID-19 tests
By MAXMILIAN WECHSLER
Sooner or later most of us enter the hospital system, and in Thailand it’s a lot easier to seek treatment in a private hospital than a government facility, especially for foreigners.
Even though it comes at a much higher cost, many expats and tourists still consider medical care here a bargain compared to their own countries. And despite some criticism, most are impressed with the quality of care they receive.
The Health Care Index is a statistical analysis of a country’s overall healthcare system that includes infrastructure, competence of health care professionals, availability of quality treatments and medicines and government commitment. The index also takes into consideration environmental and social factors in individual countries including access to clean water, sanitation, overall obesity rates, tobacco use and government readiness to enforce health measures, for example by imposing fines on people who violate restrictions on tobacco use.
Public Health Minister Anutin Charnvirakul hailed the CEOWORLD ranking, announced in August 2019, as confirmation that the determined efforts Thailand has made toward developing its healthcare sector have paid off. In September last year Minister Anutin said the government must not rest on its laurels, as mere rankings do not matter as much as how well the ministry performs its duty of maintaining public health. “It was a collective effort that got us here,” he added.
There is general agreement among patients that the accolades are well deserved, but on the home front it’s not all bouquets for Thailand’s hospitals and overall health care system. Locals often complain of waiting for hours at government hospitals when they have a health problem. The waiting period for further medical tests or surgery in non-emergency cases might be weeks up to a few months.
Expats complain they are charged more at government hospitals and some private hospitals, while others say they’ve been scheduled for unnecessary and costly procedures.
Universal health coverage
An article published by Krungsri Research in June 2019 says: “Access to medical services and public healthcare is a fundamental necessity of life and the state has an important role to play in facilitating this. In light of this, the World Health Organization (WHO) has stated that Thailand’s universal health coverage (UHC) is one of the best models available for low-cost healthcare systems, even though per capita income in Thailand is relatively low when compared to other countries that provide UHC.
“Thailand instituted its system of universal healthcare in 2002 with the enactment of the National Health Security Act. The most recent data indicates that 66.05 million people, or 99.94% of those with a right to universal healthcare, are now covered. Three funds are available through which Thai citizens are able to access healthcare: (1) the Universal Coverage Scheme (UCS); (2) the Social Security Scheme (SSS); and (3) the Civil Servants Medical Benefit Scheme (CSMBS).”
Krungsri Research also reported in 2019 that Thailand had 38,512 facilities providing some form of healthcare provisions. Of these, 34.7% are state-funded healthcare providers (public health centers, district public health offices, and community and general hospitals), while the remaining 65.3% are private sector ventures (private clinics and hospitals).
Divided according to size and the range of medical services they offer, 98.3% are classified as primary healthcare providers (9,800 public health and district health promotion centers and approximately 24,800 private clinics). The remainder is comprised of 641 secondary and tertiary healthcare providers, split between 294 (45.9%) hospitals under the management of the government, the MOPH, local administrative bodies, state enterprises or the Bangkok Metropolitan Administration (BMA). The remaining 347 hospitals (54.1%) are in the private sector.
Private vs public
The drawback to government hospitals is the tremendous volume of patients. This makes long queues inevitable. Patients may have to wait several weeks or even months before they can see a specialist or get a specific test. The workload also means that customer service can be limited, if
not abrupt. Unless they have a good level of spoken and written Thai, most expats find it daunting to navigate a government hospital without a Thai relative or good friend.
Even at King Chulalongkorn Memorial Hospital there are usually few if any Western faces in the large waiting rooms. Some government hospitals in the provinces do see more foreign patients, in part because access to private hospitals and medical care in general is still behind the cities.
Private hospitals are an important component of the national healthcare system, especially in Bangkok and other large urban areas. Foreigners almost always prefer to be treated at private hospitals and they are usually the choice of Thai nationals who can afford them as well. There is very little wait and generally better facilities all around. Administrative staff and nurses usually have adequate English language abilities and they have more time to answer patients’ questions.
According to Thailand Medical News there are 1,373 public and private hospitals throughout the country. In Bangkok alone there are at present reportedly 92 private and 41 public hospitals, with a capacity of about 14,000 and 18,000 beds respectively. The latest addition to the array of private hospitals is MedPark Hospital on Rama IV Road, which saw a limited opening in September. When fully operational the hospital will have 550 available beds.
It should be pointed out that often statistics on the number of hospitals and other healthcare facilities as reported in the Thai media are outdated, incorrect and sometimes contradictory. Thailand Medical News appears to be the most reliable and accurate.
Dual pricing at public hospitals now legal
The new system prescribes limits Thai hospitals under the MOPH are allowed to charge foreigners, but the limits are different for each of three categories, or tiers, of foreigners:
Tier 1: Those coming from neighboring countries like Cambodia, Laos and Myanmar.
Tier 2: Those working and paying taxes in Thailand with the appropriate visas and work permits.
Tier 3: Retired expats and tourists.
Apparently hospitals are given some leeway in setting up their pricing schemes, but these must be submitted to the MOPH to finalize. The MOPH says the new system provides uniformity in prices for services and procedures, and in some cases foreigners will actually be paying less than before
Overpricing at private hospitals
Some complain about unnecessary tests and medical procedures prescribed by doctors to jack up the price. This can be difficult to prove since it involves questioning a doctor’s professional judgment.
While not addressing the issue of whether foreigners are specifically targeted, the government last year bowed to public pressure to do something about overpricing at private hospitals. This came after it was reported in Thai media that an April 2019 survey by the Thai Ministry of Commerce showed many private Thai hospitals were overcharging between 30% and 300% on a range of more than 10,000 medical products and services. New regulations controlling the price of medicines, medical supplies and medical services were announced and put into effect the following month.
The Nation reported on May 30, 2019 that legal measures had been introduced to prevent private hospitals from hitting patients with huge, and in many cases unexpected, bills for services rendered. Earlier this year, Foundation for Consumers Secretary-General Saree Ongsomwang said that in one case a patient’s medical bill at a private hospital was calculated at over 23 million baht.
“If hospitals involve many specialists when a patient shows simple symptoms like a headache or stomach ache, and then charge the patient a hefty fee, then that can be grounds for complaint and legal action,” Internal Trade Department Director-general Wichai Phochanakit said shortly after announcement of the regulations. He added that any hospital or executive officer found guilty of delivering unnecessary treatment and overcharging patients faces the risk of seven years in jail and/or a fine of 140,000 baht.
The new rules stipulate that hospitals join importers, exporters, manufacturers and distributors in having to declare the purchase and selling price of their medicines and medical equipment. Initially the regulations cover 3,892 medicines, medical supplies and medical services listed in the Universal Coverage for Emergency Patients.
“We intend to significantly expand the number of medicines, medical supplies and medical services covered under the new regulations. Failure to disclose purchase and selling price will result in a jail term of up to one year and/or a fine of 20,000 baht, plus a 2,000 baht daily fine throughout the period of delay,” said Mr Wichai, adding that the prices declared by hospitals will be displayed on the website of his department’s and the hospitals’ websites.
“Private hospitals are also required to display a QR code on their websites so patients can conveniently check prices. Our new rules aim to ensure fair prices,” Mr Wichai said. He also disclosed that if asked, private hospitals must now inform patients of the estimated cost of their treatment.
“Also, under the new regulations, prescriptions must include the generic and trade names of a medicine, what form the medication is in, the amount and consumption instructions,” he said.
“Bills should also specify the per-unit price of the medicine. Hospitals failing to comply with these stipulations can face up to five years in jail and/or a fine of 100,000 baht,” Mr Wichai added.
It was reported on July 15, 2019 that the Ministry of Commerce’s Department of Internal Trade would establish a center the following month to hear complaints about private hospitals overcharging patients. Prayot Pensut, the department’s deputy director-general, said the aim was to assure fair pricing for consumers.
He also said the Central Committee on Prices of Goods and Services will set price ceilings for medical services. It’s anticipated that many people will come forward with grievances related to overpricing. According to a press release the center will be located within the department’s compound in the Sanam Bin Nam area in Nonthaburi.