Medical treatment costs

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I was asked by one of the Chambers of Commerce for guidance on how individuals and families may secure the best possible medical treatment (and insurance cover) at a sensible and affordable cost.

Having been involved in health care for more years than I wish to remember, and having worked in the UK, Europe, Australia and Thailand, I believe I am qualified to comment on this.

However, this is a vexed question. Just what do people consider to be “sensible and affordable” costs? What is affordable for some people, may not be as affordable for others. A comparison can be drawn between private international school fees and “ordinary” private Thai school fees. Everything is relative, surely?

And then there is the question of insurance cover. I have always adhered to the dictum that medical insurance is a contract between the patient and the insurance company. It is not a contract between the insurance company and the healthcare provider, even though some private hospitals (mine included) do assist the patient with the transaction. However, I do not believe I am qualified to comment on medical insurance cover, I leave that to the individual, but I do counsel that one should always work through a reputable agent. I realize that a small saving on premiums may be available by purchasing direct from the insurance company, but in the event of a difference in opinion (for say is the ailment a pre-existing condition or otherwise) who will go to bat for you? The insurance company most certainly will not fight itself. That’s why you should have an agent as your representative! I believe that is actually very important.

Back to the Chamber’s question regarding “best possible medical treatment at a sensible and affordable cost.” If we then look at “cost” as the parameter, is this the correct yardstick? I’m sorry, but in this, as most things in life, you get what you pay for. The CEO’s Mercedes is better than your Toyota. Sorry, that is just one of the inequalities of life.

If we were to lower prices (and let’s face it, profit margins) there are very well understood end results. Cut-price medical treatment results in simply:

Crowded wards

Long Waiting lists

Outdated technology (pick any two)!

My experience tells me that this cut-price scenario does not represent the “best possible medical treatment.” I would rather have my gall bladder removed by today’s (relatively expensive) ‘key-hole’ surgery than by yesterday’s old (cheap) open abdomen surgery. I would rather have my brain visualized with (expensive) Magnetic Resonance Imaging (MRI) than yesterday’s (cheap) simple X-Ray. Unfortunately, technology costs money.

I’m sorry to harp on this, but the CEO’s Mercedes is still better than your Toyota. If you want the best, you have to be ready to pay for it.

So is it a case of open slather in the private hospitals? Simple answer, it is not. There were 1,002 public hospitals, and 316 private hospitals registered with the Ministry of Public Health in 2010. There are obviously more by now. Costs will move according to prevailing free market forces. Like any business venture it is possible to price one’s self out of the market. The other 315 private hospitals will keep the 316th within the constraints of the market place. And if that is not enough, other surrounding countries such as India and Singapore are actively trying to attract patients from Thailand, using the “price” parameter.

Thailand’s private hospital fees, on a world scale, are very inexpensive. This is the reason that Medical Tourism to Thailand is continuing to grow. With procedure costs in Thailand between 30-50 percent of similar procedure fees in Australia or America, for example, Thailand is not considered to be expensive.

Returning to the question of how individuals and families may secure the “best possible medical treatment (and insurance cover) at a sensible and affordable cost,” there are some guidelines. Patients are medical consumers. Like all consumers you should shop around. Get more than one opinion both for the diagnosis and necessary treatment, and for the costs. Do not be afraid of hurting the doctor’s feelings. Second (and third) opinions are part of medical life, and a healthy part, I believe.