Retirees and medical insurance

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Thai government spokespeople, in recent years, have emphasized that that Thai hospitals are not free for foreigners. They have cited examples of sick and crowd-funded aliens desperate to get back to their home countries, or annual reports from public hospitals bemoaning the unpaid bills of foreign nationals.

So far not a lot has happened. Holders of one year 0/A visas or ten year 0/X, issued by Thai consulates and embassies abroad, do now require medical insurance worth at least 400,000 baht for in-patient treatment and 40,000 baht for out-patient care. But the vast majority of expat retirees in Thailand receive their annual extensions of stay at a Thai immigration office. They do not currently require insurance.

Will that change? It’s not clear. The government has already stated that long-stay aliens with a history of physical illness may be checked out before an extension of stay is granted. What this means, if anything, is unclear but it could signify the immigration bureau’s refusal if an applicant is discovered to have unpaid hospital bills.

One substantial reason for leaving well alone is that many expat retirees self-insure because they are too old or infirm to obtain medical insurance. But these wealthier retirees contribute billions of baht annually to (mostly) private hospital coffers when significant surgery is required. They would be forced out of the country if unobtainable medical cover was made compulsory, thus leading to a gigantic loss of income.

It’s also true that the mandatory insurance requirement for 0/A visa holders is modest. A sum of 400,000 baht may seem a lot but is unlikely to cover the total bill for heart surgery, most cancer operations and stays in an intensive care unit, at any rate in the private sector. In other words, the hospitals would still have problems recovering some, or even most, of the cash owed. To this must be added the consideration that most insurance policies carry exclusion clauses which can void individual claims.

There is no convincing evidence that expats in Thailand are the major drain on Thai hospital finances. Indeed, there is much evidence that younger tourists are the main problem and most of them are uninsured. Out of 10 crowd-funded evacuations publicized in the last year, all but one were under 50 years and several in their 30s.

Thailand hopes for 40 million visitors to its shores in the next year. The majority will be short-stay visitors from China and India who rarely will be insured. Even if all had travel insurance, perhaps issued at airports and border posts with the attendant chaos and delays, they would certainly be not be covered for many medical hazards.

Nobody disputes that insurance is a good thing. Just be careful you don’t throw the baby out with the bath water.