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BANGKOK 17 November 2018 13:43
Guderian

Thai national asked to pay for an operation in a government hospital

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My Thai lady friend had a major operation on her face around 18 months ago. When she was a child she got hit in the face and suffered a fractured eye orbit. Nobody knew about this until, as she got older, it was causing her a lot of problems that were getting more and more serious. She eventually had it diagnosed properly and the corrective surgery was carried out in Chula hospital in Bangkok.

 

It was a big operation lasting around 12 hours and involved lifting the face off the skull so they could get at the eye socket and repair it. The surgeon made a mistake and didn’t reconnect one of her tear ducts so since the operation her eye has been dry and she’s had to use artificial tears.

 

She’s been going back to Chula every three to six months since then but has only had one minor surgery to correct an asymmetry in her eyes (I couldn’t even see it!). Of course, she very much wants the operation to fix her tear duct but this has not been forthcoming.

 

She was in Chula again this week and apparently she was told that the surgery to fix the tear duct will cost her 10K Baht. I’m currently back in the UK so don’t know more than this, which she’s written to me in Thai and I’ve tried to translate it. I asked her why she now has to pay when everything so far has been free, and she just said something like, “Ask the Prime Minister”.

 

Can anybody shed light on why she’s now being asked to cough up what is, for her, quite a lot of money? The operation is scheduled for August 27th apparently. I thought the Thai medical system was free at the point of use nowadays. Since it was a surgical error during the original procedure that left the tear duct useless I don’t see why she (read: me) should have to pay anything. I know it’s not a vast sum, but I’m wondering why there’s any need to pay at all?

 

Thanks for any info or insights.

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Just an afterthought, she's renewed her registration cards at Chonburi and Chula hospitals, I remember her showing me them a while back, so it's not because she's fallen out of the Thai system.

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If the hospital is unable to explain it to her she should call the government hotline 1111 to ask for information. She has to make this call, not tell you to make these enquiries (ie "ask the Prime Minister")

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If your lady friend has moved to a new abode she is obliged to register at the nearest hospital to her registration in the blue book. By moving she probably has negated the right to use the previous hospitals. It's normal for Thais to be charged for treatment if they do not use the hospital to which they are registered. If she has moved then all she needs to do is start the whole thing over again and get a referral letter from her hospital she's now registered at. That's how I see it.

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Co-pay is becoming more common in many government hospitals in Thailand, my Thai wife experienced similar three years ago at the Provincial Hospital in Chiang Mai following a gallbladder removal op.

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The government system is free only for care at the hospital that services the area where the person is listed in a  tabian ban (if under the "30 baht" or "universal scheme) or, in the case of people with jobs covered under Social Security, the hospital they are registered for under Social Security....or, in either instance,  a higher level facility that the primary hospital  refers her to. 

 

 The original surgery was highly specialized and presumably she got a letter of referral from whatever hospital covers her (under either 30 baht scheme or SS, whichever she is in)  to Chula. She will need the same for the second operation and as it is nto quite as specialized it is possible they would not refer to Chula but somewhere else, or even be able to do it at her primary hospital whatever that is.

 

To make any sense out of this you need to know:

 

Is she under Social Security or the "gold card" AKA "30 baht" scheme?

 

If under SS, what is her SS hospital? Has it given her a referral to Chula for this tear duct surgery?

 

If under gold card/30 baht" where is she listed in a tabian ban? What hospital covers that district? Has she gotten a letter for referral from it?

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1 hour ago, Guderian said:

 ... I asked her why she now has to pay when everything so far has been free, and she just said something like, “Ask the Prime Minister”...

Sounds like something said out of frustration. I expect this has been a stressful time for her.

 

You said that she has waited a long time for this op and she very much wants/needs it. Maybe the 10,000 baht isn't an "compulsory" fee but will help cut through the red tape, or get her to the front of the queue, or a choice of surgeon.

 

Just my 2d worth.

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2 hours ago, Sheryl said:

The government system is free only for care at the hospital that services the area where the person is listed in a  tabian ban (if under the "30 baht" or "universal scheme) or, in the case of people with jobs covered under Social Security, the hospital they are registered for under Social Security....or, in either instance,  a higher level facility that the primary hospital  refers her to. 

 

 The original surgery was highly specialized and presumably she got a letter of referral from whatever hospital covers her (under either 30 baht scheme or SS, whichever she is in)  to Chula. She will need the same for the second operation and as it is nto quite as specialized it is possible they would not refer to Chula but somewhere else, or even be able to do it at her primary hospital whatever that is.

 

To make any sense out of this you need to know:

 

Is she under Social Security or the "gold card" AKA "30 baht" scheme?

 

If under SS, what is her SS hospital? Has it given her a referral to Chula for this tear duct surgery?

 

If under gold card/30 baht" where is she listed in a tabian ban? What hospital covers that district? Has she gotten a letter for referral from it?

 

She's on the 30 Baht scheme. She's registered in Pattaya but the hospitals there couldn't deal with the original problem so she had to be referred to the Chonburi provincial hospital for further diagnosis. To be able to use that hospital she had to go through another registration process and get a second card (still under the 30 Baht system I assume?). Everybody knew that she would have to go to Chula for the operation but it seems it was only the provincial hospital that could refer her there. So she didn't receive any treatment in Chonburi, just the referral to see a doctor in Chula and to use their facilities she had to register again and get another card. As I said in post#2, she's recently re-registered in all the places so as far as she's aware should be able to continue getting free treatment for her condition. However, it's all in Thai and I don't really understand the system so I can't be any more specific I'm afraid. The follow-up operation to fix the tear duct in August is in Chula, but she said something about "needing to find a big doctor". How can they make an appointment for her if she doesn't even have a surgeon lined up yet, or did I misunderstand what she was saying?

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3 hours ago, simoh1490 said:

Co-pay is becoming more common in many government hospitals in Thailand, my Thai wife experienced similar three years ago at the Provincial Hospital in Chiang Mai following a gallbladder removal op.

I must be honest and admit that I've never heard of co-pay in Thailand. I get the impression it's a mystery to my lady friend too. But it might explain what's going on.

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1 hour ago, chickenslegs said:

Sounds like something said out of frustration. I expect this has been a stressful time for her.

 

You said that she has waited a long time for this op and she very much wants/needs it. Maybe the 10,000 baht isn't an "compulsory" fee but will help cut through the red tape, or get her to the front of the queue, or a choice of surgeon.

 

Just my 2d worth.

Possible, I guess. She said something twice about needing to 'find a big doctor'. I don't see, though, how they've already booked an appointment for the surgery in August if she doesn't even have a surgeon lined-up yet?

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6 hours ago, Guderian said:

I must be honest and admit that I've never heard of co-pay in Thailand. I get the impression it's a mystery to my lady friend too. But it might explain what's going on.

In the case of my partner, she needed to have her gallbladder removed and was referred to the District Hospital in Chiang Mai, we paid an additional 1,000 baht for a room upgrade which was optional but then at the time of discharge we were presented with a bill for 14,000 baht to pay for items not covered under the health scheme. We paid the bill because it was excellent value, we'd earlier been discussing having the op. privately which would have cost 100k or thereabouts.

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1 hour ago, simoh1490 said:

In the case of my partner, she needed to have her gallbladder removed and was referred to the District Hospital in Chiang Mai, we paid an additional 1,000 baht for a room upgrade which was optional but then at the time of discharge we were presented with a bill for 14,000 baht to pay for items not covered under the health scheme. We paid the bill because it was excellent value, we'd earlier been discussing having the op. privately which would have cost 100k or thereabouts.

1,000 Baht is about normal in a government hospital upgrade from a public ward to a private room. But 14,000 Baht in extras on top? I wouldn't mind knowing what those extras were?

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14 minutes ago, Rally123 said:

1,000 Baht is about normal in a government hospital upgrade from a public ward to a private room. But 14,000 Baht in extras on top? I wouldn't mind knowing what those extras were?

I was given a quick verbal translation at the time but didn't pay much attention, I was just relieved to be getting away so cheaply, it was also about three years ago now so it's not exactly fresh. But as I recall the amount covered items that the health scheme didn't cover, I'll see if my wife still has the paperwork and let you know. The op was a Laparascopic (minimally invasive) removal of the gall bladder.

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She's on the 30 Baht scheme. She's registered in Pattaya but the hospitals there couldn't deal with the original problem so she had to be referred to the Chonburi provincial hospital for further diagnosis. To be able to use that hospital she had to go through another registration process and get a second card (still under the 30 Baht system I assume?). Everybody knew that she would have to go to Chula for the operation but it seems it was only the provincial hospital that could refer her there. So she didn't receive any treatment in Chonburi, just the referral to see a doctor in Chula and to use their facilities she had to register again and get another card. As I said in post#2, she's recently re-registered in all the places so as far as she's aware should be able to continue getting free treatment for her condition. However, it's all in Thai and I don't really understand the system so I can't be any more specific I'm afraid. The follow-up operation to fix the tear duct in August is in Chula, but she said something about "needing to find a big doctor". How can they make an appointment for her if she doesn't even have a surgeon lined up yet, or did I misunderstand what she was saying?
She might neef to get a new referral from the Pattaya hospital to Chonburi provincial hospital and (if necessary, might not be) a new letter of referral from Chonburi to Chula. Each referral is for one procedure or condition only, it is not permanent. So possibly this is the idsue.

However 10k is surely less than the actual cost of the surgery so might also be that there is something specific involved that is not covrred though I have trouble imagining what it would be, usually that occurs if there is special supplues or disposable equipment required. Or, as other poster suggested, it might be something paid to expedite the timing.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

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6 hours ago, Sheryl said:

She might neef to get a new referral from the Pattaya hospital to Chonburi provincial hospital and (if necessary, might not be) a new letter of referral from Chonburi to Chula. Each referral is for one procedure or condition only, it is not permanent. So possibly this is the idsue.

However 10k is surely less than the actual cost of the surgery so might also be that there is something specific involved that is not covrred though I have trouble imagining what it would be, usually that occurs if there is special supplues or disposable equipment required. Or, as other poster suggested, it might be something paid to expedite the timing.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Thanks, it's nothing terribly obvious then. I'm back in Thailand on Tuesday so maybe I can figure it out better talking to her than I can from using Google Translate. If she was outside the necessary chain of referrals then I shouldn't have thought they'd have booked her a slot for the surgery would they? Maybe she's upgraded herself to a private room for the op and the 10K Baht is the cost, who knows?

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