The extensive network of private hospitals in Thailand is sophisticated in terms of the quality of care it offers for overseas patients and its marketing strategy. Many of the brands have become recognised globally for medical excellence. The growth has been astonishing.

Bangkok Hospital, which opened in 1972 with just four departments, is now under the umbrella of Bangkok Dusit Medical Services (BDMS), a group with 59 hospitals across six major brands, including Bangkok Hospital, Samitivej, BNH, Phyathai, and Paolo. Additionally, the group’s reach now extends into Cambodia with the Royal Phnom Penh Hospital, and the Royal Angkor International Hospital in Siem Reap, a city that welcomes huge numbers of tourists who come to visit the UNESCO World Heritage site of Angkor.

Of concern to the international patient, the care provider, and the insurer is how well the payment systems function. When you consider how many patients some of the hospitals are dealing with, and the multitude of differing circumstances, it is easy to understand the importance of an efficient system and one that has built-in safeguards.

Payment challenges

Katy Youngman, the Regional Manager Medical Provider Management – Asia Pacific at Allianz Partners, said that in general Thailand’s private hospital network meets international insurance requirements. “Guarantee of payment (GOP) is not usually an issue if contracted with the provider. Payment is also straightforward with these private international hospitals.”

She added that where there can be challenges is in hospitals without a dedicated international department, no foreign language capabilities, or limited experience and expertise in working with international insurance companies. “In this case, language can be a problem. Working with a local provider is usually required to overcome this,” she said.

Language can be a problem. Working with a local provider is usually required to overcome this

Although Danny Quaeyhaegens, Head of International Insurance Department/Manager International Service Division at Bangkok Hospital Pattaya, concurred that good communication is essential, he said that from the hospital’s perspective there are still many challenges, even with a dedicated international department. Upwards of 50% of his patients are foreigners, and, as you might expect for a hospital in the heart of one of Thailand’s top beach destinations, many are long-stay expats, retirees, or short-stay tourists.

Annually, the hospital sees around 60,000–70,000 patients, totalling 200,000–250,000 visits, an average of three visits per patient. Of these, it’s a 50/50 split between insured and uninsured cash payments. “Some would have no insurance or suffer a condition not covered by their insurance, such as a pre-existing condition. Some of them can’t pay for their medical expenses by themselves, or at least claim so.” Quaeyhaegens added that tourists can present additional problems. “The patient might be back in their home country a few days after treatment and then collection becomes difficult and is often unsuccessful.”

To help counter such issues, Quaeyhaegens said that the hospital requires a deposit or a guarantee from the insurer prior to performing elective procedures (or, in the case of emergency procedures performed without pre-authorisation, prior to being discharged). “Waiting until the next day, week, or month could, and often does, lead to non-payment which, if the patient has returned to their home country, is very hard to enforce, especially if they really are insolvent.”

Making sure GOPs work

To ensure that GOPs work for hospitals and insurers, teams follow a set procedure which begins by establishing the estimated cost and payment method. This is sent to the patient’s insurance company (or its assistance company) which can then check the eligibility of the claim. “If they find the treatment is covered, they will send a GOP to the hospital, directly or via the contracted assistance company,” explained Quaeyhaegens. “In case of direct billing, we will require a copy of the insurance card or documents, some sort of ID, a report detailing the required medical investigations or treatment, and, in the case of travel insurance, a copy of air tickets.”

A GOP is not, of course, a blank cheque. It is usually limited to a specified date and treatments, and up to a certain amount

A GOP is not, of course, a blank cheque. It is usually limited to a specified date and treatments, and up to a certain amount. “If it looks like we’re going to exceed the limits, we will request an extension, stating the medical reasons why the patient needs to stay longer than expected,” clarified Quaeyhaegens.

More insurers are keen to have cashless solutions, according to the medical providers ITIJ spoke to. “This is a system where, via bilateral agreements with the insurance company or via access to portals where our team can find details of patients’ benefits, we can directly bill medical expenses to the insurance or assistance company without us having to request a GOP, because we were able to self-assess the coverage of the case,” said Quaeyhaegens. Although this means faster service for the patient, there can be a certain amount of financial risk for the hospital if they misinterpret anything.

The discharge process

As soon as the patient is told they can go home, the discharge process begins. This involves the doctor’s discharge summary, the nurse closing the medical charts, the pharmacy preparing home medication, and the cashier calculating the final costs. The hospital will send all documents to the insurance company for a final review, especially if the length of stay and the final cost exceed the authorised length of stay and authorised costs.

They will then receive a final GOP. “If the assistance company is in Europe or the US, this can take time, due to different time zones. If the patient can’t wait, we will usually ask them to pay a deposit until final GOP comes through, after which we will immediately return their deposit,” said Quaeyhaegens. “Upon the patient’s discharge, we send an invoice for the covered expenses to the insurance or assistance company, along with the terms of payment and when it will be required.”

Interestingly, Quaeyhaegens said that some companies no longer use the term GOP, preferring to call it an ‘explanation of benefits’ or ‘verification of benefits’. “For hospitals, however, it is important that whatever they choose to call it, that it is actually a GOP as we need to know if the insurance will pay, yes or no, and how much,” he explained.

Overall, a GOP with insurers facilitates a smooth and timely reimbursement for hospitals

Dr Antika Jacqueline Klein, Director of Utilisation and Third-Party Payer Services, and the BDMS Medevac Center, said that as most BDMS hospitals, particularly those in Bangkok and major tourist destinations, cater extensively to medical tourists and expatriates, they offer packages that include treatment, accommodation, and other services at competitive prices. “Overall, a GOP with insurers facilitates a smooth and timely reimbursement for hospitals, while ensuring patients receive the necessary medical care without financial barriers, by establishing a clear agreement,” she said. She added that although payments can be more troublesome for the uninsured, hospitals within the BDMS group have taken steps to mitigate any problems by simplifying the payment process for uninsured patients.

Currency fluctuations

Currency value fluctuations also affect the hospitals. At Bangkok Hospital Pattaya, where invoices are issued in Thai baht, currency fluctuations can turn in favour of the insurer or against them. “Fifteen years ago, one euro was Bt50–53, then it went as low as the 30s. Now it’s a nice mid-range at Bt38.5,” said Quaeyhaegens. The hospital uses the OANDA currency converter to calculate the rate on the day of service. Quaeyhaegens also explained that for catastrophic claims that reach maximum coverage, there will be no difference for the insurer as a maximum claim is always settled in their own currency. “In such cases, it will be the patient that bears the risk as his excess could be higher or lower,” he asserted.

Dr Klein said that fluctuations in exchange rates not only affect the overall cost of treatment, but also accommodation, transportation and other expenses associated with medical tourism. “Our hospitals mainly invoice the insurers in Thai baht, though occasionally in USD or euro. Exchange rates can make a difference in the payments to the hospitals and, depending on the partnership, can lead to ongoing conversations,” she said.

Foreign exchange fluctuations also impact the premiums and coverage of health insurance policies held by expatriates residing in Thailand

“Of course, foreign exchange fluctuations also impact the premiums and coverage of health insurance policies held by expatriates residing in Thailand. This can potentially affect the accessibility and extent of their coverage for medical services.”

Seasonal factors

Bangkok Hospital Pattaya is less affected by seasonal factors as the majority of its foreign patients are retirees or expats who live in the area year-round. This is a marked change from 10–15 years ago when most were tourists and there was a distinct high season.

Nevertheless, there is still some variability throughout the year, which requires mitigation by the hospital.

Plannable activities such as fire drills, refresher training, cardiopulmonary resuscitation (CPR) training, and so on can be organised more during the low-season months. There can still be delays for some services, but, Quaeyhaegens said, “nothing compared to normal waiting times in some European countries. Here in Thailand, a delay may mean the waiting time for an operation might be one to two days in the high season, whereas in low season it might be done the same day. Likewise, a walk-in visit to see a specialist with no appointment may mean the patient has to wait 90 minutes, as opposed to 30 minutes.”

Thailand’s peak season is during the cooler months from November to February. It’s a time when many will travel not just for a holiday but for medical treatments. “A rise in traffic, congestion, and accidents may result from the growing number of tourists,” Dr Klein said. “This can place stress on healthcare facilities and potentially compromise access to prompt care and response times. However, we can plan ahead and try to accommodate the influx of patients during these periods.”

During the off-peak months, it provides our hospitals with the opportunity to focus on preventative care through community outreach initiatives

Conversely, of course, during the low travel season, hospitals experience significantly reduced patient numbers that lead to shorter wait times and more availability for appointments and procedures. “During the off-peak months, it provides our hospitals with the opportunity to focus on preventative care through community outreach initiatives designed to educate locals and expats on the value of wellness and disease prevention,” she said.

Dr Klein is upbeat about Thailand’s healthcare system. “It has adapted well to the challenges and demands of serving the needs of international patients. We are able to offer high-quality care at competitive prices while addressing various payment and logistical considerations for patients and insurers alike,” she concluded.