May 14, 2019
April 29, 2019 by Dr. Varner in Medical Tourism
I finally took that three-week vacation I’ve been dreaming of for years. And I essentially lived off of just water and bone broth the whole time.
It was glorious.
Okay, maybe I don’t know how to properly relax, but I swear, I had a good time. And besides, the life of a doctor is never totally relaxed.
So I did some work too, because (trust me) it’s good to keep yourself occupied when you’re doing a 21-day fast. Part of that work was completing an application for admitting privileges at a US hospital.
As part of the application, I had to prove to the hospital that I don’t have tuberculosis, which is one of the more necessary parts of the US healthcare bureaucracy.
Usually, this is done with a skin test –but way back in medical school I was exposed to a tuberculosis patient.
I had to take a nine-month course of antibiotics, and my skin test will be positive for life.
As a result, the only way I can prove that I don’t have TB is with a chest X-ray. So every year or two I end up getting an X-ray, not because I enjoy the process, but because I have to repeatedly prove I (still) don’t have TB.
If I were in Mexico, this would have been really easy as I’m very familiar with health care in Mexico and speak Spanish. But in Thailand, I know precisely three words of the local language.
I’m not one to shy away from new experiences, so I dove into the deep end. What I found there was quite revealing…
Thai health care runs smoothly
One of the best ways to find out about unfamiliar places is to use our old friend the internet, so I took to an expats’ facebook group to ask about what to do.
The consensus was that I go to St. Louis Hospital, which has an international admissions desk staffed with bilingual people who can help me.
I arrived, found the international desk, and explained what I needed…
They informed me that I had to consult with a doctor before I could get an X-ray at their facility.
The first step was to check in: I showed the international desk my passport, filled out a basic demographic form, and they gave me a printed slip of paper with my account number on it.
From there, someone took me to a kiosk and scanned my paper. They selected ‘English’ and told me this is how I choose my doctor.
The kiosk had every speciality under the sun, from cardiology to gynecology to pediatrics.
I chose ‘medicine’ and up popped the photos of about 15 doctors. There was a number under each one, which was the number of patients they had waiting in their line. Naturally, I picked the one without a long lineup…
Within ten minutes, I was in their office. He spoke English, but I wouldn’t say that he was truly fluent in the same language as me, something that’s essential in medicine.
I went to the waiting room, and about 10 minutes later someone from the international desk took me to the radiology department, where I got the X-ray done.
They then told me I have to wait for about an hour for the results. I took a brief walk, and saw the doctor again.
He pulled my X-ray up on the screen, told me that it was normal, and asked if I needed a medical certificate.
Next step? I went to the cashier. The total bill was THB 1,100, or roughly US $34. I paid and they gave me the radiologist’s report and the ordering physician’s certificate.
It was a convenient process, and the price can’t be beat. If I’d have gone through this in the United States, I’d probably have to pay $200 for this service.
Thai health care is accessible
I was impressed with St. Louis Hospital on a lot of fronts: the place was clean, modern and convenient. I loved the fact that you can go to a kiosk and choose which doctor and specialty to see –and probably be able to see them within 10-15 minutes.
The staff was nice, courteous and professional. It definitely has a patient-centered care model. It’s what you expect from a place where third-party payers haven’t corrupted the system.
But are cash-based hospitals exclusively the preserve of the rich? I don’t think so. It does have an international services desk, which suggests they market themselves to more wealthy patients.
But from what I could tell, I was the only foreigner there the whole time. I watched and saw lots of patients arrive as passengers on motorbikes, or in taxis, which is not the way the rich and famous travel.
I later found out St. Louis Hospital is around the middle of the market in terms of private health care in Bangkok. Sriraj and Bumrungrad are where the very wealthy go for ‘white glove treatment’ and to see the top specialists in the country.
There are other much cheaper (and less convenient) places where the poor go, but St. Louis hospital has a reputation for being a quality hospital that isn’t too expensive. It isn’t Ruth’s Chris Steak House, but it also isn’t McDonald’s –it’s more like Applebee’s.
I wasn’t really a medical tourist here –I didn’t have any questions nor did I need any treatment from this hospital. I just needed to fulfill a clerical requirement for the American bureaucracy.
Language barriers are an issue in Thailand
Would I go to St. Louis if I had a real problem?
Yes, but on one condition: I have my own translator with me. There were times when I wasn’t sure what was going on, and the international service desk, while nice, is there to guide international patients around the hospital, not to help facilitate serious medical conversations.
The last thing I want is to have a serious problem in a place where I don’t understand the language and do not understand what’s going on.
Would the language barrier be as big of an issue at other hospitals? Maybe not. I hear the level of English spoken at Bumrungrad is much higher, and most of the senior staff hold US board certification –which you can’t get without absolute fluency in English.
I’m not sure what the price at Bumrungrad would have been for this, but I wasn’t going to sit in a taxi for an hour in horrific Bangkok traffic for the best hospital when all I needed was an X-ray.
So what does this all mean?
In stark contrast to the US, Thailand has a medical sector that is consumer-focused. The kiosk, the choice in doctors, the international desk to guide me around the hospital: it was all geared towards the patient.
If you pick Thailand as a destination for medical tourism, you’ll need a medical tourism facilitator. Thai does not have common roots with English in the same way Spanish does, and the people don’t typically grow up learning both of them.
There’s no way to communicate without a translator. A large portion of people who claim to be ‘bilingual’ in Thailand are also not truly bilingual –at least not in the way you’d want them to be when medicine is concerned.
The key issue that will define your experience as a medical tourist in Thailand will be communication. This is true everywhere, but it is a bigger deal here than elsewhere.
What would I do if I got sick while in Thailand?
I’d feel comfortable with local care for sure, but I’d probably go to Bumrungrad where I know a lot of expats have received good care.
If I could make it, I’d go to Singapore. The cultural and language barriers just aren’t as vast, and if things got serious I’d probably feel more comfortable there.
This isn’t because Singapore is any better or worse than Thailand. It’s just culture and language are such important factors in medicine. It’s incredibly overlooked.
What would I not do? Fly back to the United States…
My health sharing plan will cover me anywhere in the world. If I have a serious medical problem, I want to be somewhere where I am valued as the customer, and you are only valued as a customer in a competitive market.
You certainly have to be a smart shopper in places like Thailand –but in the USA, you don’t even get the opportunity to shop. I’m on the inside of this system, and it’s rotten to the core. This is because of third-party payers who have corrupted the incentive structure and robbed patients of all their choices.
When the (inevitable) time comes in my life that I have to seek medical care for a serious problem, I will probably head to Mexico. But if I happen to be in Asia, I’ll probably stay put.