Hospitals count cost of foreigners' bills

[PeteC]

After 3 readings, I'm still trying to get my head around the real purpose and meaning of this article. Is it really a growing concern here to the extent that an article like this is needed? Is it simply another pop at the foreign community here in accenting a very small problem in comparison to total foreign population, the great majority of which pay their bills responsibly? Their example of 1.3 m for 17 patients averages $2,500 apiece, 1,600 in 2009 and 1,500 in 2008. Yes, a growing number but a pittance in the overall scheme of things. I reserve judgement whether I should take this article at face value, or read between the lines. If bothers me when a person says the words "lots of" and "some of" and doesn't quantify what that means. Lists "377 patients" but gives the impression that all were penniless by the paragraphs above and below the statement. Pete

Hospitals count cost of foreigners' bills
Elderly patients often can't pay for treatment

http://www.bangkokpost.com/news/local/2 ... ners-bills

* Published: 20/01/2011 at 12:00 AM
* Newspaper section: News

PHUKET : State hospitals in the southern province are shouldering a heavy burden for treating elderly foreigners who cannot afford to pay their medical bills.

Many retired foreigners who came to Thailand with the hope of settling down here are now struggling after spending their pensions wastefully and marrying Thai women, some of whom left them after their money ran out.

Lots of foreigners have fallen ill and been admitted to local hospitals. Their relatives back home refuse to pay for their treatment on being contacted by the embassy, Vachira Phuket Hospital's public relations centre said.

The embassies regard the matter as personal. They will provide help to their nationals only in cases of emergency or disaster.

"So we've treated these patients based on professional ethics until the last moments of their lives. Funeral rites and merit-making ceremonies are held for them," a source at the centre said.

The state-run Vachira Phuket Hospital admitted a record 377 foreign patients, mostly Britons, in the 12 months to Sept 30, 2010.

There were also cases of foreigners who died outside of hospital but were brought in for autopsies. They died of causes ranging from road accidents to drowning and suicide.

The hospital last year spent 1.3 million baht treating 17 penniless foreigners. It was the third consecutive year that the hospital had logged unpaid bills.

The hospital bore costs of more than 1.2 million baht in 2009 for 22 foreign patients, a 50% rise from the 800,000 baht in costs to treat 17 patients in 2008, the centre said.

"These patients are mostly European men," the source said. "They didn't take out health insurance. They renew their visas every year and have no savings."

Some of them produced fake financial statements to have their visas renewed. Each foreign national seeking the renewal of his or her retirement visa must have at least 800,000 baht in their bank account or show they have earnings of at least 65,000 baht a month.

The source said foreigners' savings often were quickly used up on entertainment and women.

Some who wanted to build families in Phuket married Thai women who later took off with their money.

In a lot of cases, the patients require long-term treatment for chronic illnesses such as alcoholism and liver and heart diseases.

The source said the government should review its policy and focus on quality tourism.

Stricter screening of visa applications was needed. Foreign residents must be required to have health insurance.

The government should even set up a fund to help foreign patients with some of their financial costs, the source said.

[dozer]

Making health insurance a requirement for a retirement visa is the next reasonable step.
The problem with that is if you take the UK as an example where most rely on the National Health Service, which is paid for by compulsory national insurance contributions, is that many of these retirees will have pre-existing conditions which will make it either very expensive or impossible to get insurance.

[lomuamart]

Jeez, the hospital went down for about 27,000 GBP last year and they're suggesting a change to visa regulations and that "a lot" of us are degenerate, alcoholic, sex crazed, bar girl marrying scum of the earth. Talk about stereotypes.
What about these stories I hear of where hospitals won't treat you for major complaints unless you can produce health insurance? Sure, there will be instances when someone's life needs to be saved immediately and there's no time to get a certificate and maybe the patient can't communicate, but the hospital also seems to be referring to cases when treatment is ongoing. And they don't check a patient's ability to pay? Seems to me that they are the ones who should tighten up their practices or even take out their own insurance to protect themselves from this eventuality. How they know that the farang's savings are quickly spent on wine, women and song? I won't write what I think of this hospital. The words would only be automatically edited out by our swear word filter.
dozer make a valid point though.

[Johan]

My wife was admitted at the hospital in Bangkok, they asked for full cash money FIRST (80 000 bahts), she needed really urgent care. My credit card was stolen few days before (my wife had it and she was robbed in Hua Hin with all the others cards) and i needed 3-4 days to get the money in full, they also didn't accepted a wire transfer from my bank because they needed to be sure about the payment.

We got the money from friends of her and had to repay few days later, well, without this people she would be dead now.

So, my advice, always have cash to pay the hospital in case of an emergency.

[PeteC]

Yes, you hit it spot on Lomu. The title includes the following; "Elderly patients often can't pay for treatment". The word OFTEN connotes most of the time, a majority. This is clearly not the case and is prejudicial rubbish.

As you stated, I wonder how many people he talked to and how many months he spent in the field studying the subject before arriving at the conclusion...."The source said foreigners' savings often were quickly used up on entertainment and women." That word OFTEN again.

The entire article is sour grapes. Pete

[Nereus]

Hospital debt crisis could have been avoided

By The Nation

Our public health system is stretched because of a lack of planning; new emphasis should be on creating health providers at the village level

More than 300 state hospitals are facing a financial crisis, with total debts of more than Bt4 billion, Public Health Minister Jurin Laksanawisit told the public recently. The Health Ministry estimates that 77 state hospitals face a serious problem, with their combined debts adding up to Bt1.3 billion, while 227 other hospitals are shouldering moderate debts, worth about Bt2.7 billion in total. Most of the affected institutions are general hospitals, central hospitals and rural hospitals. There are over 900 government hospitals in Thailand.

If anything, we can be certain that this financial crisis in the public health system will definitely take its toll on management and medical services. And it goes without saying that these shortfalls are the result of a short-sighted policy. The concept of universal healthcare is a good one, but the planning has been poor. This is typical of Thailand, indeed, where elected officials do whatever they can to make a name for themselves but care little about really improving standards for the future.

The Bt30 healthcare scheme was supposed to be a service to the public, but bad planning and short-sightedness have placed the country's public hospitals in their current predicament. Voters need to think beyond what's in it for them in the immediate term. They need to look at the long-term consequences and think about how their children and their children's children will have to pick up the tab when the coffers run dry.

It's not too late to think outside the box and come up with solutions. From the look of it, too many people who can afford to pay for hospital treatment are getting a free ride. In the past there was the concept of the "health card", where the village chief or kanman played a part in determining which individuals living under his jurisdiction were entitled to this free medical scheme. But to go back to such a method to determine who is entitled to free medical care would be difficult given the movement of people in and out of cities and villages, as well as other factors such as the absence of an effective way to determine one's financial worth.

In Thailand, corporate employees are required to contribute to a social security fund that will pay off their hospital bills in times of need. Civil servants and their immediate family members are entitled to state privileges, and workers at state enterprises are entitled to similar benefits.

But the Bt30 scheme has soaked up all the money in the public health system, and something urgent has to be done to save the patient. Besides exploring the concept of cost co-sharing, the government should look for ways to prevent the over-stretching of provincial hospitals by strengthening and beefing up local health centres at the tambon and district level.

In some cases, where a local health centre is unavailable, mobile medical centres should be utilised. Moreover, educating local people on health issues, especially in remote areas, should in line with the government's idea of prevention and promotion.

One of the most visible projects that is often billed as a success story is the use of the Or Sor Mor healthcare volunteers. These volunteers are literally walking databases of information, since the patients in their villages are very well known to them. These volunteers are not certified as nurses, but they can administer first aid. It was not until this administration that these Or Sor Mor volunteers were paid Bt600 per month. Perhaps such a scheme could be an entry point to a professional health career for individuals in rural areas who are unable to afford to attend nursing or medical school otherwise.

In short, we need to think about investing in our people. Public health should not be narrowly defined as just medical services and promotion-preventive measures. It should also be about nurturing future doctors and nurses and healthcare providers, as well as empowering ordinary people so that they feel they have a stake in the system.

As of now, too many of us are too willing to take advantage of the system, as in the Bt30 universal healthcare scheme. What we don't realise is that such action comes at the expense of someone else.


-- The Nation 2011-01-18

...........................................................................
Those pesky foreigners strike again.

[Nereus]

Foreigners owe Coventry University Hospital £28k from unpaid operations

http://www.coventrytelegraph.net/news/c ... -27929270/

FOREIGN patients owe Coventry’s University Hospital thousands of pounds after failing to pay for expensive treatment.

The overseas debt bill includes one patient from India who fled after knee reconstruction surgery costing £6,000. Another from Nigeria vanished after a hip replacement costing £3,000 without paying up.

The figures, released following a Freedom of Information Act request, show that University Hospital at Walsgrave is owed a total of £28,857.37 in unpaid fees by patients from countries around the world, including the USA, Saudi Arabia, Thailand, Tanzania.

Patients from India owe the most, with the hospital chasing them for nearly £12,000.

The revelation has led to the Patients Association – a charity campaigning for patients’ rights – to call for more to be done to track down bill cheats.

Katherine Murphy, the charity’s chief executive, said: “It’s down to the trust to make sure they have got all the relevant measures in place.

“You shouldn’t be able to walk into a hospital and expect treatment if you have no intention of paying up.

......................................................................

Maybe they can arrange a trade off.

[HAPPYGOLFER]

Making health insurance a requirement for a retirement visa is the next reasonable step.
Why not, staying in Thailand , for me it means being a guest in a friends house.
I work in a hospital in Norway, and every year we got a lot of patient from abroad with no insurance and no cash, should we not treat them? I just ask, for me that,s an impossible problem. I have an education and a way of thinking that means, health and treatment first , money afterwards.
What,s money, it,s just something you need for buying, living is something quite different

[Dr Mike]

Most of the Thai govt hospitals are deeply in debt--because of that there is a fear of restricted services and naturally there is a feeling of resentment about farangs who are treated and the hospital not paid.
When a poster says that $2500 is a pittance, his definition of a pittance is very different from a Thai hospital finance dept short of money to pay the staff.
Frequently tourists, ex-pats, retirees here who have medical bills that they cannot pay ask the hospitals to contact the relevant Embassy. In 14 years in Asia I have NEVER seen an Embassy pay or even show much interest in this problem. They have no funds for this.
CUBA has instituted a policy that any foreigner entering must have medical insurance--hard to enforce for long term residents but it could happen.
One piece of advice for those with insurance. If you do not have a card in your wallet with the policy details, write them down and keep it in your wallet and make sure your wife/live in lady/ best buddy have a copy too.

[silverbird]

Making health insurance a requirement for a retirement visa is not fair to a lot of expatriates staying in Thailand. Some of us 65+ are prepared to pay the cost for any hospital bill but are not in a position to get any insurance at a fair price due to previous health history. I am not willing to sign up for an insurance unless the small print does not exclude all stuff most of them do exclude.

[pharvey]

Most of the Thai govt hospitals are deeply in debt--because of that there is a fear of restricted services and naturally there is a feeling of resentment about farangs who are treated and the hospital not paid.
When a poster says that $2500 is a pittance, his definition of a pittance is very different from a Thai hospital finance dept short of money to pay the staff.
Frequently tourists, ex-pats, retirees here who have medical bills that they cannot pay ask the hospitals to contact the relevant Embassy. In 14 years in Asia I have NEVER seen an Embassy pay or even show much interest in this problem. They have no funds for this.
CUBA has instituted a policy that any foreigner entering must have medical insurance--hard to enforce for long term residents but it could happen.
One piece of advice for those with insurance. If you do not have a card in your wallet with the policy details, write them down and keep it in your wallet and make sure your wife/live in lady/ best buddy have a copy too.

Fair comments Dr Mike, and I tend to agree. Why should Thai (or for that matter any other country's) hospitals foot the bill unnecessarily for foreigners? Certainly, those in need of treatment should not be turned away, but I would agree that certain conditions should be met/requirments put in place.

Making health insurance a requirement for a retirement visa is not fair to a lot of expatriates staying in Thailand. Some of us 65+ are prepared to pay the cost for any hospital bill but are not in a position to get any insurance at a fair price due to previous health history. I am not willing to sign up for an insurance unless the small print does not exclude all stuff most of them do exclude.

Sorry silverbird, and zero disrespect - whilst I have a great deal of sympathy for what you're saying re: health insurance and the small print, I have to disagree. That issue is simply not Thailand's problem. Thailand's problem is that a fair few expats do not/cannot pay, are not covered by insurance, or are simply unwilling. IMHO the majority of whom will tend to be tw@ts on holiday or ''finding themselves'' , with little or no consideration for the country or people they are visiting. Zero respect for the laws ( ) or safety of themselves or more to the point, of others.

If Thailand make it a condition that holders or applicants for Retirement Visas, Employment Visas, Student Visas etc. need medical insurance, then so be it and IMHO rightly so - we certainly should have the same in the UK.

If you want to really have a bitch about it, direct that bitch at the brain dead tw@ts visiting Thailand and ****ing it up for the majority of others.

[Super Joe]

Making health insurance a requirement for a retirement visa is not fair to a lot of expatriates staying in Thailand.

And it certainly isn't fair that Thai nationals, or foreigners who do pay, see their services and costs affected by those who can’t be ar$ed to sort their live out. If the qualifying criteria of my visa/stay was having a detrimental affect on hospitals and healthcare for others, I'd fully expect it be changed. I'm sure the government will do the right thing in the end and fail to care less that foreigners are unhappy paying a bit more

Jeez, the hospital went down for about 27,000 GBP last year and they're suggesting a change to visa regulations

What then, wait until it becomes a big problem before suggesting a solution is found? I would have thought it fairly likely from events of recent years, ie: pensions crashing, the global recession, then our exchange rates falling through the floor that this is one of the things that is going to get even worse. They’re the ones that have suffered from it increasingly over the last 3 years, they’ve got every right in the world to ask for it to stop.

and that "a lot" of us are degenerate, alcoholic, sex crazed, bar girl marrying scum of the earth. Talk about stereotypes.

They only said that their patients savings had been used up on entertainment and women, hardly a stretch is it, and it reads to me like these were the reasons given by the patients themselves. And their comment about alcoholism seems to be their medical opinionn based on their own patients. We don’t really need a hospital to tell us this is an issue among us do we, I know a lot of people who fit your descriptions let alone theirs, but I am trying to slow down


Mandatory health insurance for retirees would seem a logical step, and not only benefit the foreigner in the long run, but also any wives and kids. Insurance is mandatory for applicants and their dependants under that Malaysian program that people like to hold up as an example of what Thailand should do. Interestingly, in relation to this subject Malaysia has recently increased the qualifying show money due to the financial climate to 3.5M Baht, of which 1M Baht has to stay in the bank account at all times

If we stopped complaining about hospitals complaining and had a look outside our little box, we'd realise just how good we have it here

SJ

[Super Joe]

The title includes the following; "Elderly patients often can't pay for treatment". The word OFTEN connotes most of the time, a majority. This is clearly not the case and is prejudicial rubbish.
I wonder how many people he talked to and how many months he spent in the field studying the subject before arriving at the conclusion...."The source said foreigners' savings often were quickly used up on entertainment and women." That word OFTEN again.
The entire article is sour grapes.

Why focus on the irrelevance of one individuals views, rather than the detrimental affect some foreigners are having on our hosts' healthcare facilities. Sounds like sour grapes

I wonder how many people he talked to and how many months he spent in the field studying the subject before arriving at the conclusion...."The source said foreigners' savings often were quickly used up on entertainment and women

It seems obvious to me that his team talked to EVERY ONE OF THEM that couldn't pay, and that these were the reasons most of THE FOREIGNERS GAVE. It's not clear though is it... so we're both just having a stab at it really... but don't let that stop you attacking the bloke

SJ

[Big Boy]

SJ,

I don't know you personally, but I'm guessing that you're reasonably young and in good health. Health insurance shouldn't be a problem. You also seem to be fairly settled, and bringing up a family in Thailand.

What happens if you get to 60, and your health significantly deteriorates? Your insurance will increase substantially, and no longer cover you for pre-existing conditions.

- Are you going to pay inflated prices for an insurance policy that barely covers you?

- If one of those 'new' pre-existing conditions problems was a heart attack, what would the hospital do if you went to them with chest pains? You're no longer covered for heart related problems, so will they actually admit you for fear of not getting their money?

- If you can no longer get comprehensive cover for all conditions, does Thailand deport you? What happens to your family? Do you live out your days alone in your country of origin?

Maybe my imagination is running away with me and/or my understanding of such insurance policies is incorrect - I certainly hope I'm way off track. However, if my conception of such insurance policies is even 50% correct, I see this as a very worrying development for a mainly ageing expat population in Hua Hin.

It could be a case of retiring to Thailand until your first medical crisis, and then being deported because you can't meet the visa renewal conditions.

[Super Joe]

Maybe my imagination is running away with me and/or my understanding of such insurance policies is incorrect - I certainly hope I'm way off track.

Yes possibly a little off-track based on what other countries do, here's Malaysia for example which provides for exemptions:
Approved participants and their dependants must possess valid medical insurance coverage that is applicable in Malaysia from any insurance company. However, exemptions may be given for participants who face difficulty in obtaining a medical insurance due to their age or medical condition.


From my own persepctive I would say I was quite an unhealthy person, and would welcome mandatory healthcare for foreigners and their Thai families, because it would force me to get it where otherwise I can't really be bothered as yet.

But whatever happens to me cost-wise, failing to qualify for my extension-wise, or lack of cover for my money-wise, I will not be blaming anyone other than myself, because I know I should have got cover earlier in life and kept it going. And I certainly wouldn't complain when my visa/stay requirements are changed because those requirements are having a detrimental affect on the healthcare of others because of non-payers.

SJ