Shortcomings of Health Care in Thailand

Thailand is a healthcare destination and there is an active policy promoting the country for medical tourism. The question is : what are the flaws in Thai hospitals and health care facilities, for medical tourists, and foreigners residing in Thailand.

Shorthcomings of the health care system :

1) Specialized Medicine prioritized - Primary Healthcare less developed

Thai health care is medical-specialist oriented, certainly in Bangkok. General practioners are hard to find, though most hospitals may have one or two around the premises. There is a need to self-diagnose a bit, and choose a specialist most likely capable of addressing your medical problem. There are some specialized clinics around town, but no well established primary care system.

So if you have any relevant medical problem, you will end up going to a hospital.

2) Most Thai doctors working in hospitals do not do so fulltime.

With working schedules in different hospitals and clinics around Bangkok, will your physician be available when a problem arises during your admission? Busy schedules and commutes can result in little 'quality' time with your doctor.

You can maybe prevent this to some extent by checking a physician's qualifications and clinic schedules at the website of the hospital. Look for doctors that have clinics every day, they are more likely to be working most of the time at the same hospital, and be more readily available, if you are hospitalized.

3) Emergency transport and treatments not developed?

Most major hospitals have ambulances. Will they be able to reach you during an emergency? Traffic in Bangkok, and little reaction by car drivers to emergency sirens, limit timely response to medical emergencies. If you have a heart attack, or a stroke, likely a lot of time will be lost getting you to the hospital, preventing timely treatment.
A corollary is that there is less experience with medical emergencies in emergency rooms, which sometimes rather function as after-hours clinics. For traffic injuries, we suggest you head for the Police Hospital at Ratchaprasong Intersection.

The 'lobby' of Bumrungrad Hospital, located between Soi 1 and Soi 3 on Sukhumvit Road.

4) Money matters.

Thai private hospitals are a bit notorious for almost wanting money upfront. Show (and give) them the money, or have your insurance documents with you. Having local insurance may facilitate this proces, since you can show your insurance card, and things will likely be handled between the hospital and the insurance company. Reports sometimes surface of foreigners stranded in hospital with serious conditions or after an accident, and not being able to come up with the necessary funds. It looks like they are getting treatment but run up substantial debts (reports of refused treatment are not present for quite a few years now). One reason why health insurance kind of became obligatory, is that there were a number of foreigners that accumulated hospital costs, and were not able or willing to pay.

5) Language Issues.

In our experience, especially nursing staff sometimes have only basic command of the English language. Major hospitals employ translators for different languages, but you can not expect them to be lingering around your hospital room at all times. For surgical and emergency treatment, language issues are less important. But for medical conditions with a long history, and many symptoms, it is quite relevant to be able to communicate properly.

6) Pitfalls of being assertive.

Being assertive may be a Western characteristic. However, it may backfire if hospital staff (especially nursing staff) cave in to your every demand. Possibly because you are a foreigner (maybe Thai doctors do not behave the same way with Thai patients), the staff intends to take your objections and opinions too much into account. Then again, we noticed on occasion that Thai doctors can get a bit miffed, if you have the attitude of knowing things better than they do.

7) Limited nursing staff.

We noticed that many wards do not have that much staff around 'after sunset'. It seems that family members are expected to take over some of the nursing care at night. This may be one reason for the usually large rooms you get for a very reasonable price at most hospitals. There needs to be place and a sofa for visitors to stay overnight.

Foreigners may not have close relatives around, and are not used to this setup. A friend of mine, needing continuous care, also at night, had to hire a nurse (from outside the hospital!) for additional care.

We established that nurses actually are in high demand in Thailand, are relatively well paid, and are sometimes moving to one hospital after another if they can get a better salary. There is a lack of nurses (and also doctors upcountry).

If you need a nurse or care after leaving the hospital, do not expect it to be such a bargain.

8) Medical reporting.

We have yet to receive a medical report after any kind of treatment. To be honest, we never asked for one. If you visit different medical facilities, you will have to explain your medical history yourself.

9) Insurance.

Especially if you come from Europe, you will have some insurance issues. If you still keep your insurance from 'home' in some form or another, expect to pay a multiple of what you used to pay at home. This while treatment in Thailand (still) incurs less costs. Costs can become exorbitant. We recently met a 77 year old, who while being very health conscious otherwise, had to give up his insurance because they were going to charge him about 20,000 US Dollar a year for coverage.

When getting a local insurance, you will often pay not very much, but coverage can be limited. Quite a few people like to have insurance for major health problems, not to cover everything from a common cold to some bruises. Expensive treatment, like major heart surgery, and long stays in hospital, may reach your spending limit before you realize.

An even more serious issue is the problem of 'preexisting conditions'. Most local insurance, or newly purchased international insurance policies will not cover preexisting conditons. So if you had knee surgery before, do not expect coverage for new problems in your knees etc.

9) Quality care

Do you get adequate medical care. This is a very difficult question to answer. When going to a hospital and getting an appointment, you likely meet with a physician or surgeon you have never seen before, and you are not exactly in a position to quality his medical knowledge or capabilities. This of course, is a comment we also may give regarding doctors in other countries.

We can give you some general advice : 1) Are you being listened to ? You should be able to figure this out during a conversation with your doctor. Does he remember things you told him or her ? Does he or she asked relevant questions or just brushes over things you think are important ? 2) Do you get a medical examinations. Nowadays it seems to become more an more common for doctors to just give a summary exam, and then proceed to tell you about all the laboratory and X-ray exams they have lined up for you. We know of a case where a patient was advised to have neck surgery after an accident, based on results of an MRI. The doctor in question never examined the neck of the patient, and did only a minimal neurologic examination.

If one of the above happens to you, and you are in a condition to go elsewhere, we suggest you do. Hospitals in Bangkok are not digitally connected, so they will not know anything about your exams, if you go to another hospital. However, be aware that you can get copies of relevant exams, like lab work, and also CD-copies of X-rays, CT-scans, MRI etc. So you can get these, and look for another health care provider, or get a second opinion about your condition, without having to go through all the exams again (doubling the costs).