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Medical Malpractice in Thailand: Patient Rights in the Medical Tourism Industry
by Jason Armbrecht

25 August 2008

Read This Before Packing Your Bags

Thailand's main selling point to potential medical tourists, in particular the over 46 million uninsured Americans, is price. According to the Public Health Ministry, a heart valve replacement in Thailand costs a mere $10,000 compared to $160,000 in the US, and heart bypass surgery costs $11,000 as compared with $130,000 in the US. Hip and knee replacements run about $12,000 and $10,000 respectively, in Thailand, while in the United States they cost roughly four times as much - $43,000 and $40,000. With prices so low, 75% of foreign patients pay in cash, reducing the cost of processing insurance claims and further helping to keep costs down. The low cost of surgeries in Thailand combined with the high standard of service that the top private hospitals offer - foreign trained doctors, state of the art equipment and nurse and doctor to patient ratios much closer to 1:1 than most Western hospitals - has not only caught the attention of uninsured Americans, but also the insurance companies who cover the other 250 million and who are desperately attempting to cut costs. Blue Cross Blue Shield of South Carolina currently covers major procedures at an internationally run hospital in Bangkok for its 15 million customers, and Florida based United Group Programs, a small business insurance provider, also has deals in place with a hospital in Thailand. In addition, the West Virginia and Colorado state legislatures are considering bills which would provide incentives for state employees to travel to Thailand for medical care.

While the price of operations and service at private hospitals are indeed attractive, there are numerous drawbacks to traveling to Thailand for surgery that have given both potential patients and their insurance companies pause. According to experts, if the cost of surgery is more than $6000 dollars cheaper in Thailand, then it will be worth the trip, money wise. Anything less than $6000, you should seek care at home, although this number may rise along with the rising cost of travel. For many, especially those living on the east coast of the US, total trip time to Bangkok can stretch to over 24 hours. Plane rides of the length required to cross the Pacific Ocean or Asia can exacerbate medical conditions. Patients seeking care at hospitals looking to maximize their patient load through minimizing recovery time may find themselves back on a plane soon after surgery - a potentially dangerous situation, especially for those with heart conditions. Another potential danger for prospective patients is what attracts many tourists to Thailand, namely vice. The chances for debauchery - drinking, drugs, prostitution - are rife. Indulging in these can cause serious complications in the preparation for and recovery from surgery. There is also the question of language. While many Thai doctors are foreign trained and most can speak at least a little bit of English, the same cannot be said for most Thai nurses who are the ones who attend to patients day to day needs. Difficulties communicating between the patients and medical staff are all too common and these breakdowns can sometimes have tragic consequences.

What most experts consider the most serious drawback to medical tourism in Thailand is directly related to its biggest draw - price, and that is a lack of recourse for patients if something goes awry.

Victims in Paradise : Why Doctors Hate Lawyers Worldwide

What many medical tour companies and hospitals gloss over in their slickly produced websites, and is often overlooked by potential medical tourists, is the difficulty in obtaining legal redress for personal injury with the assistance of a Thailand malpractice lawyer if something goes awry. Although legal procedures for obtaining compensation do exist, they are often inconvenient and impractical (particularly when the injured patient is a foreigner) and the amount of money for damages awarded by courts is often less than what exists in Western countries.

Thai doctors pay very little for malpractice insurance, compared with Western doctors, which in turn helps keep the cost of medical care down. Foreign victims of medical malpractice also have limited options upon their return to their home countries, as most insurance plans will not cover repairs needed to fix overseas surgeries. Foreign governments whose health care plans do cover such repairs have recently begun to fight back against medical tourism in Thailand by discouraging their citizens from receiving medical care in the Kingdom. In 2006, Australia issued a travel warning regarding cosmetic surgery in Thailand, after a spate of cases where Australian women returned home needing repairs to poorly executed cosmetic surgeries, repairs that were covered by Australia's Medicare system.

The principle government oversight body of the medical community in Thailand is the Thai Medical Council. Statistics are kept concerning doctor misconduct and there is also a complaint procedure. In cases where a patient claims that they were a victim of medical malpractice, the Thai Medical Council will first investigate the claims against the doctor or doctors in question in order to determine, in their judgment, whether malpractice did indeed occur. The council may then advise the police as to the necessity of a criminal investigation. Critics of the Medical Council believe that the agency is not transparent and would benefit from having members in key positions that do not have vested interests in protecting the medical profession. In many other jurisdictions, to prevent perceived protectionism by the medical community, hearings are heard by non-medical lay persons in addition to medical doctors.

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