Ed Confession (formerly notes): Every Sunday morning we started our day listening to Marketplace on NPR hosted by Tess Vigeland. In one of the rare mistakes made by NPR, they decided after 11 years to change hosts. We must add a change not for the better. Tess left and wrote her first book, “Leap: Leaving A Job With No Plan B to Find the Career and Life You Really Want.” Since we had gone through a life altering shift 25 years ago, we became followers of Tess as she travels the world exposing herself to new cultures and people. Since we are at an advanced stage of maturity (age), we look forward to her postings and pretend that we are by her side. Below is just a sample of her experiences, and we invite you in subscribing to her blog and joining us as we travel with Tess.
Oh Great – A Visit to a Thai Hospital
By Tess Vigeland
If there’s one place you don’t want to have to go while traveling and living abroad, it’s a hospital — unless you’re there for medical tourism. Ok, you also don’t want to see the inside of a jail cell, but that eventuality is usually dependent upon your impulse control. Health doesn’t always work that way.
I’ve been sick on-and-off for the last couple of weeks with what started as a bad cold and slowly morphed into something far worse that kept me inside my Bangkok apartment for most of this past week. On the upside, I finished bingeing on Justified. On the downside, I hacked up at least a couple of lungs, and wasted many, many days in bed instead of exploring this place in which I now live. So I finally dragged myself to a hospital that came recommended by a friend who works for the UN here.
The four months I spent in Vietnam were four months I prayed “don’t let me get sick or injured” to any god that might be listening. Just looking at hospitals from the outside was enough to tell me I did not want to experience one. I decided early on in my time there that if something happened that required anything more than aspirin, I’d beg my travel insurance company for an evac to Hong Kong or Singapore, assuming I was coherent enough to make the request. Once I moved to Bangkok, I knew I was safer, and came to learn that, in fact, Thailand has a well-respected medical system and is a popular destination for the medical tourism I mentioned earlier. Quality healthcare — at least in private hospitals — for a fraction of the price you pay in the states.
Thailand’s health system operates on two levels. The government — even under the current military junta — provides universal, free care to Thai citizens at public hospitals across the country. At those facilities, patients are likely to encounter wait times and crowds, but they won’t pay out of pocket. Foreign nationals do pay, but not as much as they would in a private hospital. The private hospitals and clinics are the second tier of care in Thailand and are more expensive, but still far less so than, say, the United States. Universal healthcare has been in place here since 2002 and covers almost 50 million people (75% of the population), with the rest being served either by private insurance or through separate coverage for civil servants. A study of the first ten years of the program found that the number of families falling below the poverty level purely because of healthcare costs dropped to less than half a percent from nearly three percent. In the U.S., by contrast, medical expenses are the number one cause of bankruptcy filings.
I didn’t know much about the system before I walked into Mission Hospital (also known as Bangkok Adventist) this week. Mission is a private hospital, so I didn’t experience what the vast majority of Thais would experience. But it also did not replicate what I surely would have encountered if I’d walked up to the information desk, without an appointment, and without insurance, at a U.S. hospital. (As noted, I have travel insurance… but didn’t want to call on it until I had to.) So here’s what happened:
I walked in. They took my passport, handed me a face mask upon hearing the first cough, and showed me this sign.
For reference, as of this writing, that hospital service charge of ฿150THB (Thai baht) is about $4.50USD. The physician consultation fee of ฿600-1,000THB equals $17-28USD. Immediately after signing a one-page registration paper, a nurse took me to another waiting room, took my blood pressure and temperature, then asked me to sit in a nearby chair. Less than five minutes later, I was in with the doctor, who conducted a quick exam, mostly listening to my lungs, and said the words I wanted most to hear — “It’s not pneumonia” — and told me he’d prescribe some meds for acute bronchitis.
From there I walked about 50 feet to the payments department where they presented me with a bill for a whopping ฿1,788THB — or $50.77USD — and said to go around the corner to the pharmacy where, it turned out, I paid nothing more because the prescription costs were already included in the bill.
In the U.S., that bill would likely have been at least $1,788USD (and it would’ve arrived four months later under the misleading title “Explanation of Benefits”). Maybe with insurance it would just require a co-pay, but without insurance, those 15 minutes as a walk-in at a private hospital (or even a non-profit facility) would likely have amounted to a month’s rent back home in LA. This is why medical tourism exists. This is why people with the means to do so will fly long distances for elective procedures in a country like Thailand. I’m not knocking the care people receive in most hospitals in America… Cedars Sinai saved my life 13 years ago. But the system of how it all gets paid for is still asinine and unfair for so very many people. Health should not be pegged to the bottom lines of publicly traded insurance companies and hospital chains. Something is very wrong when a developing nation like Thailand eclipses the U.S. as one of the world’s affordable medical meccas.
Tess Vigeland is a veteran journalist, and a well-known voice to millions of American radio listeners. She is the CEO of Tess Vigeland Productions, a Los Angeles-based multi-media company. Tess spent 11 years as an anchor for public radio’s Marketplace, including six hosting the personal finance show Marketplace Money. Her first book, titled “Leap: Leaving A Job With No Plan B to Find the Career and Life You Really Want,” was published in August 2015, by Random House Harmony. When she’s not locked away writing, Tess can be heard as a backup anchor for NPR’s All Things Considered, as well as KCRW’s To The Point and KPCC’s Take Two in Los Angeles. She also serves as a professional emcee, speaker, panel moderator, and interviewer for conferences and other events. Tess also writes for The New York Times and The Guardian, among numerous other publications.
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