In addition to being a memorable holiday destination, Thailand is an increasingly popular destination for relocation, with many seeking employment opportunities in the country. It is also one of the world’s top destinations for medical tourism, due to the country’s relatively inexpensive but high-quality healthcare provision.
As things stand in the ever-changing pandemic environment, Thailand is currently open to fully vaccinated foreign visitors, including returning Thais and foreign residents, entering by air with no quarantine requirements. Travellers from more than 60 ‘low risk’ countries including the UK, US, China, Germany and Singapore can now visit Thailand. Unvaccinated travellers must take a PCR test before traveling, then quarantine for ten days on arrival.
Universal healthcare complemented by private provision
Healthcare in Thailand is provided via a universal system, overseen by the Ministry of Public Health and other government agencies. It is delivered by three separate schemes, which are used depending on an individual's employment status and other circumstances.
The three programmes consist of: the civil service welfare system for civil servants and their families, Social Security for private employees, and the universal coverage scheme which is available to all other Thai nationals.
With its tropical climate comes a number of health concerns including dengue fever and malaria – although malaria is rare. Prescriptions issued in other countries are widely accepted at hospitals and pharmacies across Thailand, although some are considered controlled substances. Restrictions prevent certain medications containing narcotic and pyschotropic substances from entering the country.
Although Thailand's public healthcare system offers a high-quality level of treatment and care, private facilities are popular among residents because public facilities may be busy and long waiting lists are common. Accessing these facilities requires private medical and health insurance or can be self-funded. Fortunately, private cover in Thailand is available at a relatively low cost.
A large number of private hospitals help complement the universal system, with most having an international liaison department with multilingual staff to assist patients and their families, and work with insurance companies.
Danny Quaeyhaegens, Head of International Insurance Department for Bangkok Hospital Pattaya, pointed out to ITIJ that travel and international private medical insurers will generally have to rely on the private healthcare providers forinsured individuals' medical needs. “Government facilities are rarely an option due to no direct billing facilities, language barriers (often Thai only), waiting times, no medical reports, limited availability of resources, open wards with patients of different age / gender / pathologies,” he explained.
there is a real thirst from hospitals in Thailand to demonstrate to the world that they are offering high-quality healthcare
Private hospitals in Thailand are regulated by the Medical Registration Division, under the Ministry of Public Health's Department of Health Service Support, and many have been assessed by the US-based Joint Commission International (JCI). It has awarded accreditation to 61 hospital and primary care organisations in Thailand, as of 2021. Of these, over half (34) are in Bangkok – the same number as Mexico, and only outnumbered by organisations in Saudi Arabia and the United Arab Emirates.
Joel A Roos, Vice President of International Accreditation, Quality Improvement and Safety, pointed out to ITIJ that there is a real thirst from hospitals in Thailand to demonstrate to the world that they are offering high-quality healthcare: “Healthcare organisations in Thailand have aggressively pursued JCI accreditation. Thailand represents one of the top-five countries in the world in terms of the greatest number of JCI-accredited healthcare facilities. It possesses the most JCI-accredited organisations in the Asia-Pacific region.”
Covid effect on healthcare provision
Due to the Covid-19 pandemic, the Thai authorities introduced new disease control measures at national and local levels, such as restrictions within and between each of Thailand’s 76 provinces. A nationwide vaccine rollout is underway for all residents of Thailand.
As of 25 October 2021, there have been 1,859,157 confirmed cases, with 18,811 deaths, so there is increasing pressure on medical services in the areas most badly affected.
following the introduction of a more pragmatic approach to managing positive Covid cases based on the level of symptoms, the capacity issues have eased
Romain DiMeglio, Regional CEO of APRIL International Care Asia explained: "Many of the hospitals for which international patients comprised a large part of their business faced challenges early in the pandemic, as closed borders led to low demand for their services. As the situation evolved particularly during the spread of the more-infectious delta variant many facilities, both public and private, became overwhelmed due to the requirement for mandatory hospitalisaton of even asymptomatic cases.
"Now, as the vaccination rollout gathers pace and following the introduction of a more pragmatic approach to managing positive Covid cases based on the level of symptoms, the capacity issues have eased. International business is still very limited however as border controls are gradually relaxed it is clear better times are ahead."
In 'the new normal', Thai patients regularly have consultations online or via phone, unless they need physical tests that require them to be present in person. Nevertheless, Thailand’s Covid situation has been relatively stable, raising hopes of the resumption of medical tourism and overseas visitors.
The many challenges posed by covid have been met head-on by the largest private hospital operator in Thailand, Bangkok Dusit Medical Services (BDMS). This group is one of the largest hospital networks in the Asia-Pacific region, managing 49 hospitals in Thailand and Cambodia.
BDMS told ITIJ that technology was put to the test and performed admirably in helping the hospital deal with the effects of the pandemic. “We must note that times of crisis are also enablers for innovation. All our efforts for digitalisation of healthcare services have been accelerated by Covid-19. Our telemedicine platform has been instrumental in this last aspect.
To illustrate this, Samitivej Virtual Hospital has increased its roster to 642 doctors covering 51 fields of specialty and has seen a 221-per-cent increase in call volume over the past 12 months. On top of its telemedicine platform, Samitivej Hospital has built several services to provide useful medical information in a safe delivery. The team at Samitivej also noted the importance of TytoCare devices (equipment that helps doctors make a diagnosis while providing 24/7 online consultations via the Samitivej Virtual Hospital), the Engage Care app, Samitivej Pace and Samitivej Prompt, all of which allowed virtual monitoring of patients and ensured communication between the hospital and patients.
Private healthcare provision in Thailand
Thailand's population of close to 70 million is currently served by 370 private hospitals plus more than 25,000 private clinics. Major provinces will have at least one private hospital, with more in tourist destinations.
Some of the top-ranked private hospitals in Thailand include Bumrungrad Hospital, Bangkok General Hospital and Samitivej Children’s Hospital and Phyathai Hospital in Bangkok, Bangkok Hospital Pattaya (the largest private hospital outside of the capital) as well as AEK Udon International Hospital in Udon Thani. There are also specialised private hospitals in the fields of ophthalmology and dentistry.
“The major Thailand hospitals have excellent facilities and are well-equipped to deal with international patients given Thailand’s status as a medical tourism hub,” said DiMeglio of APRIL International Care Asia. “However, the fact that many of the major facilities are under common ownership gives them significant pricing power,” he continued. “Like with any facility elsewhere in the world there can also be a tendency towards overtreatment. Medical protocols which may differ from those in the West can also lead to misunderstandings or differences of opinion between the treating doctors and insurance companies.”
Quaeyhaegens pointed out that where in Thailand a tourist is, has a significant impact on the quality of care he or she is going to receive, as the gulf between rural and tourist-heavy areas is important to note. Furthermore, how the hospital or clinic works with the international insurance sector is dependent on how frequently such providers see foreign patients and are set up to work with the insurance and assistance sectors. He explained: “In rural areas they may hardly ever see a foreign patient, may not know the insurance company and/or the claims handling process, may not be able and/or willing to provide medical reports or only in Thai language. Working with them as a foreign insurance / assistance is likely to be challenging, using a local intermediary might be recommended or even necessary. Also the patient may face some more hurdles in such a setting due to language barrier, food selection, unavailability of direct billing etc.”
In areas like Bangkok, Pattaya, Phuket and Chiang Mai, on the other hand, most hospitals are likely to have international teams and dedicated insurance claims handling teams in order to facilitate the three-way communications between insurance / assistance – patient – healthcare provider. “Most of these hospitals,” said Quaeyhaegens, “will also be willing and capable to work together directly but of course as you may need to contact a local intermediary in order to be able to work with the ‘less international’ and more rural facilities and OPD clinics, you might also choose to use this same intermediary to handle your cases here. Both are perfectly fine options with some pro’s (direct lines are always faster, no expenses for intermediary’s fees) and con’s (more in-depth knowledge of local situation and possibly volume-benefits).”
Relationships between private hospitals in Thailand and international insurers
Building strong relationships with the hospitals is of the utmost importance, DiMeglio believes. “Through dialogue and close medical monitoring tailored to local practices, potential pitfalls or misunderstandings can be identified quickly and resolved before they escalate. Negotiations and open dialogue can often bring mutually beneficial outcomes.”
This sentiment was echoed by BDMS, who added that ‘clear communication, timely response, cost containment and medical understanding of all parties involved’ are essential components to a happy insurer/hospital relationship. From the hospital perspective, providers are dealing with millions of international patients per year, coming from over 80 different countries with as many cultural backgrounds and understanding of what medical service delivery should be and working with self-pay patients, TPA or directly with payers. “Our role is to provide as much as possible a standardised medical service at the highest quality at the most affordable level,” BDMS concluded. “With so many different parties involved, high level of hopes, time pressure and cost considerations, meeting everyone’s expectations is hard. There are always cases that stand out, but for the most part, we succeed and a huge part of the credit must go to the operations teams from both the hospital side and the assistance and insurance side.
BDMS told ITIJ that overcoming difficulties during the medical assistance and treatment process is not rocket science, but the basics must be observed: “Having dedicated and autonomous teams whose sole responsibility is to access, monitor and communicate medical and cost information in real time. Having medical teams who are used to working with international partners who follow international treatment guidelines. The recipe for success is well known, it is how your teams will be able to implement it that will determine if you are successful.”
The clarity and flow of information between assistance company and hospital is integral to a smooth care pathway for the patient, and Quaeyhaegens urged assistance companies to ensure that their guarantee of payment (GOP) documents as crystal clear: “The crucial factor for most private hospitals regarding direct billing and accepting GOPs is clear GOPs which indicate exactly how much will be covered (and how much patient needs to pay), which items are covered and which are excluded. It’s very important that this GOP clearly informs us how much the patient needs to pay upon leaving the hospital and how much the insurance/assistance company will pay without any changes after the facts.”
In terms of relationships between insurers and the big private hospital groups, these generally run smoothly thanks to experienced operators on both sides. Almost all the private hospitals in Thailand can help patients liaise with insurance companies. But some challenges remain.
One top provider of international health insurance and expat insurance is the US-based International Citizens Group.
President Joe Cronin explained, "Because we work with a number of international insurers, we are familiar with some of the challenges regarding global medical insurance in Thailand. For several visas, travellers and expats are required to buy insurance from a shortlist of local Thai providers. Unfortunately, the visa-approved plans may not cover many of the needs of expats.
“For example, many plans do not cover accidents from motorcycle rides – a tough exclusion in a country where so many people travel on two wheels! This is why we strongly recommend that visitors to or expats in Thailand carry global insurance even if they have a local plan, so they can ensure they are fully covered.”
Exclusions are one of the thorny issues when it comes to hospitals and insurers working together – and for many expats in Thailand, who may be more senior in years, there are concerns about how many preexisting conditions have been declared, and authorisations from insurers to guarantee treatments will be covered can take longer than desired. From the insurers’ perspective, concerns are sometimes raised that treatment is over conservative and length of stay is longer than necessary. To this, Quaeyhaegens points out that age and infirmity is also relevant: “We see a huge proportion of elderly foreigners with not always the healthiest lifestyle and therefore often suffering from a vast number of underlying diseases. Nearly 70 per cent of our foreign patients are 60+, where that’s only about 20 per cent for our Thai patients, so the age-curve of our foreigners is significantly distorted to the right.” Other reasons for increased length of stay in hospitals, he added, could be attributed to a lack of primary care facilities, and a lack of a support network at home.
The London branch of the Tourism Authority of Thailand also has a mixed view based on their long experience. They point out that Thai private healthcare has possibly one of the best customer service and facilities in the world, not to mention one of the most popular. If the payment is made on time, they believe the operators will maintain a positive relationship with each other. Working together in a transparent way, being understanding of different cultures, processes and practices is key to ensuring the medical assistance being rendered to tourists and expats is seamless.
It's fair to say that while there will always be exceptions to the rule, holidaymakers, expats, and health tourists alike can be assured that they will be well cared for if they need medical attention in Thailand, thanks to the country’s inexpensive but impressive quality of healthcare services.