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 many clinics around town, but no well established primary care system.

Do not expect a lot of small clinics scattered around Bangkok. For most medical problems you will need to get to 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).

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 is 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.

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 doctor upcountry.

If you need a nurse of 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 what you can spend is 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 touch you 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.