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[Jingthing]

jazzbo, on 2009-11-26 05:45:41, said:

Thailand is a case where it appears that the private insurance companies are not mandated to offer coverage to sick people. which is why it is important to start to buy insurance when you are young and healthy; in arrears, other than in a large non-underwritten group plan, it does not exist... and on these pages you often read about young guys bragging they they are 'self-insured'.

Not going to argue with you about the US system (obviously I disagree with you but why bother debating that here?).

This issue came up when a poster suggested it was silly to suggest that people getting insurance through their employers in THAILAND reject the employer based insurance and try to get PRIVATE insurance instead and ideally money from their employer to help pay for it. I agree that they should do that if they can even though most won't, because employment doesn't last for life, but your life lasts for life. If you develop a health condition during your employment, there is a good chance you won't be able to cover it if you want to apply for private insurance after your employment ends.

Edited by Jingthing, 2009-11-26 11:09:43.

[jazzbo]

obviously I disagree with you but why bother debating that here Kuhn JT -- I do not see that we are in any disagreement..  you are describing the way -- whether in Thailand or the USA -- you would like things to be... I am trying to analyze things as how they exist today and how best one can work within those obvious constraints.

[Jingthing]

jazzbo, on 2009-11-26 12:16:25, said:

obviously I disagree with you but why bother debating that here Kuhn JT -- I do not see that we are in any disagreement..  you are describing the way -- whether in Thailand or the USA -- you would like things to be... I am trying to analyze things as how they exist today and how best one can work within those obvious constraints.

Completely off base, sorry.
Don't even begin to presume the ways in which I actually do disagree the way in which you characterized the US situation. I am not going to discuss the US part of it further, except if it directly relates to illustrating issues with the Thai private insurance system. As both countries rely on private insurance and employer bought insurance for better quality care, they do have a lot in common. Cheers.

[jazzbo]

Don't even begin to presume the ways in which I actually do disagree the way in which you characterized the US situation. How presumptuous of me to characterize anything... especially the Thai private health insurance system for which I am entirely grateful and about which I will no further characterize... especially as whether they should be compelled to take on sick people as new subscribers.

[Jingthing]

jazzbo, on 2009-11-26 14:41:20, said:

Don't even begin to presume the ways in which I actually do disagree the way in which you characterized the US situation. How presumptuous of me to characterize anything... especially the Thai private health insurance system for which I am entirely grateful and about which I will no further characterize... especially as whether they should be compelled to take on sick people as new subscribers.

It seems you have misunderstood the intent of my posts on this subject. Another poster asserted insurance companies BY DEFINITION will not accept new sick members (or at best exclude the conditions). Of course. I just contested that this was BY DEFINITION, as there is an option to regulate such companies so that they do invite sick people into the pool. Its hard to imagine they would do that without being forced to do that by law and/or promised a much larger pool to work with. I am not saying should or shouldn't, just contesting the definition. My personal opinion is that private health insurance companies and employer based insurance is a bad model. The best systems in the world have government run universal coverage for all citizens and offer a buy in option for expats. My understanding is that Thailand has a kind of universal coverage but the cost structure is so low they can't really deliver good care, so it isn't something expats would usually be interested in participating in anyway. Of course Thailand is a poor country and that is not too shocking. However, I know some expats in Mexico who are on the Mexican government health care system and they find it not perfect, but very useful.

Edited by Jingthing, 2009-11-26 19:43:58.

[jazzbo]

The Topic herein is Expats, how do you handle health insurance in Thailand? So I guess I misunderstood as the topic is not Expats, how in a perfect world would you like to have health insurance handled in Thailand? It is my understanding that in UK and other countries with universal coverage the delivery rates are so poor that that their citizens travel all over the world to obtain major services so that they don't die during the waiting period.

[Jingthing]

jazzbo, on 2009-11-27 02:26:53, said:

The Topic herein is Expats, how do you handle health insurance in Thailand? So I guess I misunderstood as the topic is not Expats, how in a perfect world would you like to have health insurance handled in Thailand? It is my understanding that in UK and other countries with universal coverage the delivery rates are so poor that that their citizens travel all over the world to obtain major services so that they don't die during the waiting period.

No, you've got it right. The topic is indeed about how expats handle their health care needs in Thailand, whether through insurance or not. Otherwise, I ain't taking the bait. Cheers.

Edited by Jingthing, 2009-11-27 11:59:12.

[jazzbo]

Jazzbo -- The topic is not Expats, how in a perfect world would you like to have health insurance handled in Thailand?

JT -- Thailand is a case where it appears that the private insurance companies are not mandated to offer coverage to sick people... Its hard to imagine they would do that (accept new sick members and/or with chronic conditions) without being forced to do that by law and/or promised a much larger pool to work with. I am not saying should or shouldn't, just contesting the definition. My personal opinion is that private health insurance companies and employer based insurance is a bad model...

Otherwise, I ain't taking the bait. Cheers.

You already took it..

[Jingthing]

You win the prize.   Back to topic.

Edited by Jingthing, 2009-11-27 12:35:44.

[jazzbo]

The topic was always how expats can handle health insurance in Thailand... You took it into the realm of how you would like insurance to be handled in Thailand... and then you resort to insult by emoticon... maybe you should join the "Where is gold headed" crowd as that is their modus operandi as well.

[Jingthing]

Note -- I have put the above poster on permanent ignore. I am posting this publicly so people understand why there won't be any further replies to him by me.

[jazzbo]

Fine with me... In the USA, and I guess the UK as well, they have Fantasy Football. I guess Kuhn JT is off playing Fantasy Insurance where the HealthCare Universe - and maybe other parts of the Universe -- is as he thinks it should be.

[Wolfie]

I will ask you both to stop the bickering and petty arguments - you can either both put each other on ignore or simply actually ignore each other - failing that we can give you both a cooling off period, but i would rather it didnt come down to that to be honest.

[Lite Beer]

Post discussing a Moderation issue deleted.

[jazzbo]

Pending Legislation H.R. 3962 ‘Affordable Health Care for America Act’.

EC. 211. PROHIBITING PREEXISTING CONDITION EXCLUSIONS.
A qualified health benefits plan may not impose any preexisting condition exclusion (as defined in section 2701('b') (1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any of the following: health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, disability, or source of injury (including conditions arising out of acts of domestic violence) or any similar factors.

2701 subject to definitions in 2702 Public Health Service Act (1946 as amended)

SEC. 2702. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS.

      (a) In Eligibility To Enroll-

    (2) NO APPLICATION TO BENEFITS OR EXCLUSIONS- To the extent consistent with section 701, paragraph (1) shall not be construed--

  (' to prevent such a plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage so long as--

                        (i) such limitations and restrictions are explicit and clear;

                        (ii) in the case of such limitations and restrictions in health insurance coverage offered in connection with the group health plan, such limitations and restrictions have been disclosed in writing to the plan sponsor in advance of the point of sale to the plan;

                        (iii) the plan sponsor and the issuer of the group health insurance coverage make available, to participants and beneficiaries in the plan in advance of the point of their enrollment under the plan, a description of such limitations and restrictions in a form that is easily understandable by such participants and beneficiaries; and

                        (iv) the plan sponsor and the issuer of the coverage provides such description to participants and beneficiaries upon their enrollment under the plan at the earliest opportunity that other materials are provided..

[dsfbrit]

soundman, on 2009-11-18 09:06:16, said:

Self insured - that way I'm not wasting 80% - 90% of my money on Insurance Sales commissions, Executives Salaries, Large Flashy Building, Expensive Advertising campaigns, internal beaurocracy etc, etc - all paid to a large company that usually won't pay up for the full amount of the medical bill anyway.

My feelings exactly. Then there is a big chance that when you try to claim - they say it was a pre-existing condition or whatever. Mind you 'accident insurance' may be of some benefit. It seems to be relatively cheap compared to a lot of medical insurance - so if I do get run over by a car whilst I am walking on the pavement (not that unlikely where I live in Pattaya) then I could get medical treatment OK.

I decided years ago that I will fund 'minor' operations like hip etc... myself. If it gets really 'bad' - cancer etc... then I will return to the UK and get some of the benefits from the NHS I paid into for 30 years and never used   seems fair!

[dsfbrit]

Jingthing, on 2009-11-18 14:18:54, said:

In retrospect, based on the anemic response to this poll so far, it seems titling this  "Grand" was a tad bit presumptuous. I am curious to know roughly what percentage of expats here carry ANY kind of health insurance good in Thailand. If I had to guess I would say under 50 percent.

I know about 10 farang very well. Of those 2 have medical cover from their 'Thai/International' company - not sure how it works though or what it covers. The other 8 just pay as they go. Recently one non-insured Brit - aged 52 - had a motorbike accident and was taken to the local Thai hospital at his request and the overnight stay and medical treatment was not that expensive. I dont have the figures, it was a few thousand baht or so, but nothing like as expensive as the International Hospitals such as Bangkok Pattaya charges.

I think for road accidents like this - if you can get taken to a Thai hospital first then it may be a lot cheaper than going to an 'International Hospital' for effectively the same treatment.

I would not fancy more major ops - like cancer surgery as a local Thai Hospital though. My gut reaction is that if its that serious, then best to return to the UK and use the services of the NHS - which as I posted above - I have paid a lot into and never used.

A lot of people often say the NHS is 'free' - it isn't. Its only free at the point of delivery - in other words people get the treatment free, but some of us have paid a LOT of money for then to have this 'free' service - I can assure you

Edited by dsfbrit, 2009-11-27 18:34:29.

[jazzbo]

If it gets really 'bad' - cancer etc... then I will return to the UK

What if the nature of really 'bad' is a heart attack, or brain aneurysm, or some serious injury or other illness that prevents you from traveling back to the UK for an extended period of time?

[dsfbrit]

jazzbo, on 2009-11-27 18:40:24, said:

If it gets really 'bad' - cancer etc... then I will return to the UK

What if the nature of really 'bad' is a heart attack, or brain aneurysm, or some serious injury or other illness that prevents you from traveling back to the UK for an extended period of time?

yes - and thats how the insurance people sell it to you. 'What if a meteor falls on your head?' etc... the probability of a 'brain aneurysm' (whatever that is) occurring to me is miniscule - if it does I will fund it myself. I could fund the cancer operation myself as well - but the thought of returning to the UK to get some of the 'free' NHS service seems fairer to me as I have paid so much into it.

At least if I have a heart attack I will be sure that the cost will be covered by me - I know of many many stories (I suspect you do as well) where insurance companies have refused to pay up when they 'should'. Pre-exisitng condition blah blah...

I may need a minor hip operation soon and even for that I have considered returning to the UK and have it done privately - since the pound/baht exchange rate nose-dived - paying for an operation in the UK is not so expensive nowadays...and perhaps I have more confidence in the hospital system in the UK - not sure of that one!!

edit: come to think of it - even if the treatment is free in the UK - the reason I would rather have any operation in Thailand - is because the nurses are much cuter!!! pretty basic really!

Edited by dsfbrit, 2009-11-27 19:11:07.

[jazzbo]

refused to pay up when they 'should'. Pre-existing condition blah blah... Mostly when you have mis-represented something on your application 'What if a meteor falls on your head?' the probability of xxx occurring to me is minuscule If you walk into any hospital critical care ward it will be full of people who thought that it could not happen to them. if it does I will fund it myself. I guess that is why wealthy people never purchase health insurance.

Am I a health insurance representative or broker? No..just a former systems design guy who specialized in probability / logic analysis.

BTW What is a Brain Aneurysm?
A brain aneurysm, also called a cerebral or intracranial aneurysm, is an abnormal bulging outward of one of the arteries in the brain. It is estimated that up to one in 15 people in the United States will develop a brain aneurysm during their lifetime. ( www.brainaneurysm.com )

[dieter1]

I did write it before:

limited health insurance (be it 500.000 or 5 Mill) is just bull-shit. It is just good for the insurance company !

The biggest costs  for "normal" insurance companies ( like in my home-country, where there is at least some control by the state) is for long intensive care in hospital. And it is not (!) real cheaper, if you get this treatment in one of the best/most expensive hospitals in Thailand.

You may need some very expensive treatment, costs can be easy above 10.000 Baht a day. And having 2 big OP´s (surgical treatments) could easily cost up to 2 mill. And you could need that treatment for a very long time ! You, like most of us, will not totally recover from our last diseases we will have in our last years (on earth). We would need expensive care all the time.

I think, in western countries, these limited insurance are not allowed. Think about that: You get intensive care for one year and after this, the money (limited) is all used up. You are warned ! Here in Thailand, they will not care for you any more. They will let you die !

So if you have some money to pay for treatment (for smaller bills, that would mean less then 200.000/year), it would be much wiser, to have an insurance which would pay everything ABOVE 500.000 baht !!! and not for the small bills! Insurance is only necessary for the worst case ! And you can be sure (!!!) This case will come in the last 5 years of your live ! 100% But it could even be the case before !

And it is not that important, what you have to pay(for insurance) when you are less then 60 years old ! You need to know, what you have to pay, when you are beyond 60 !

And the contract:

Believe me:

Even in my homecountry, it´s normal that these shitty companies do write a lot in these contracts, but when you need them, they do everything to avoid to pay. And think about it: In what state you are (lets say you are 80 years old, just had a big surgery, handicapped ...) and need to have a lawsuit (for some years) to make them pay ! You will die before the case will be come to an end.

[dieter1]

I got the feeling, it is preaching to the pigs ....

sorry ..

[jfchandler]

Dieter, what you're really talking about is the potential for people incurring LONG-TERM CARE expenses later in life that can be very expensive because of their duration.

Those could be incurred in hospitals. But I think just as, or maybe even more likely, those can be incurred outside of hospitals where people may need supportive nursing or other care at home, which regular health insurance policies generally won't cover.

In the U.S., coverage for such care is provided by separate LTC (Long Term Care) policies... I've inquired about those kinds of policies offered by companies here in Thailand. So far, I haven't found any.

There are international companies that do provide LTC coverage to people living outside the U.S., but I haven't narrowed down the field on those as yet. It's easy to find and purchase an LTC policy for a U.S. person living in the U.S. It's not so easy to find such a policy when you're living outside the U.S., such as in Thailand.

I presume the reason for that situation in Thailand is society here still thinks of those kinds of care obligations being handled by relatives (or simply not being provided at all).
However, not everyone living here has family/relatives who would be capable of providing that kind of care.

If anyone has info on suitable LTC policies that would cover people living in Thailand, I'd appreciate hearing about those here.

[jazzbo]

from Gallup.com September 23, 2009

Cost Is Foremost Healthcare Issue for Americans / But public largely skeptical that healthcare reform will bring relief
by Lydia Saad

PRINCETON, NJ -- Americans are broadly satisfied with the quality of their own medical care and healthcare costs, but of the two, satisfaction with costs lags. Overall, 80% are satisfied with the quality of medical care available to them, including 39% who are very satisfied. Sixty-one percent are satisfied with the cost of their medical care, including 20% who are very satisfied.

There is a clear gulf in these perceptions between the health insurance haves and have-nots. According to a Sept. 11-13 USA Today/Gallup poll, the 85% of Americans with health insurance coverage are broadly satisfied with the quality of medical care they receive and with their healthcare costs. At 79%, satisfaction with costs among Medicare/Medicaid recipients is particularly high.

The 15% who are uninsured are far less satisfied with the quality of their medical care (50% are satisfied), and only 27% are satisfied with their healthcare costs. (Sixty-nine percent are dissatisfied with their costs.)

So I guess there are a lot of pigs out there that need some preachin'. (Palin-ese)

And it is not that important, what you have to pay (for insurance) when you are less then 60 years old ! You need to know, what you have to pay, when you are beyond 60 ! At least in Thailand that is an easy answer: If you do not become a subscriber before the age of 60, you will pay the Insurance company ZERO Baht per year after the age of 60 because they will not take you as a new subscriber.

[jazzbo]

Kuhn JFC -- from Wikipedia:

Long-term care insurance generally covers home care, assisted living, adult daycare, respite care, hospice care, nursing home and Alzheimer's facilities. If home care coverage is purchased, long-term care insurance can pay for home care, often from the first day it is needed. It will pay for a visiting or live-in caregiver, companion, housekeeper, therapist or private duty nurse up to 7 days a week, 24 hours a day (up to the policy benefit maximum).

The cost of such benefits, while prohibitive in the USA or UK, are relatively inexpensive in Thailand to the point that structuring a bank annuity (not life insurance annuity as you probably do not need the tax benefits) starting at your current age would most likely cover those expenses in the Kingdom for as long as you would need them...