Holiday in Thailand, $60 for a Hospital Visit

With growing prosperity came an extension of the healthcare system to the smallest islands.


Last week, I spent some much-needed time off work, wandering around the Phang Nga Bay in Thailand. (I trust that all of you have missed my weekly HumanProgress chart.) My trip has provided me with an inspiration for today's post.

Last Tuesday, one of my American friends decided to go rock-climbing. Unaccompanied and unfamiliar with the rock face, he fell and badly injured himself. After he was found, all bloodied and bruised, by some hiking Norwegians, he was rushed to a local clinic on a near-by island. There an on-duty doctor x-rayed my friend's extremities, cleaned his wounds, bandaged him, gave him an abundance of painkillers and charged him $60. Distrustful of the expertise of a small-island physician, my friend's partner insisted on visiting a spanking new hospital on a larger island nearby, where the original diagnosis was confirmed.

While I am not in favor of the Thai taxpayers picking up the tab for the health expenses of irresponsible Americans, the story has left me amazed. In 1960, inflation and purchasing parity adjusted per capita income in Thailand was $1,629 or 9 percent that of the United States. Today, it is $16,227 or 29 percent of the U.S. income. Along with increasing prosperity came massive extension of the healthcare system, with clinics and hospitals catering to the needs of ordinary people (and crazy foreigners) even on the smallest islands of the sprawling Asian kingdom.

Environmentalists like to wax lyrical about the beauties of the wilderness, but there is something to be said for a thriving tourist industry and hiking Norwegians, and electricity and x-ray machines on tiny islands in the middle of the Andaman Sea.  

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  1. Sixty dollars??? MY COPAY IS LESS THAN THAT.

    Article premise: REFUTED

  2. Does Thailand have health insurance requirements? I bet not. That's why they're so cheap. Steve Forbes illustrated this perfectly to me several years ago. The two aspects of healthcare that are not commonly covered by insurance? Plastic surgery and Lasik eye surgery. The two aspects of healthcare that have gotten cheaper while still being safe? The very same: plastic surgery and Lasik. When people have to actually PAY for health care rather than relying on their insurance company, the cost gets cheaper. Next time you go to your doctor or dentist, actually ask for an itemized bill that shows what the insurance company is paying. My wife noticed that her dentist routinely bills $50 for "dental instruction" but all he does is provide her with a toothbrush and dental floss. Ridiculous! In Thailand people can't afford high hospital bills so the costs are cheaper because that's what they'll pay.

    You see the same thing with auto insurance. Repair costs related to accidents have soared. Why? Because the insurance company is paying, not the individual.

    1. Bad analogy with car insurance, because while car insurance is mandated by the state, they don't subsidize it, and the mandate does not include micromanaging coverage, such as requiring everybody to have bike carrier insurance, or penalize fifth wheel towing insurance as a luxury. And car insurance hasn't risen anywhere close to how health car has gotten more expensive.

      1. The third-party payer system results in higher costs, regardless of it is is subsidized or micromanaged.

        Look at it this way. How much do you think an oil change would cost if it was covered by car insurance? You think it would cost the same as it does now, or do you think Prompto and Jiffy would increase the price? It's not the owner that is paying, it's the insurance company. So the owner has no incentive to shop around. Not only that, but the insurance company doesn't care as long as they can pass the cost onto their customers. The result is higher costs, with fingers are pointed at greedy Prompto and Jiffy. Except that they wouldn't have doubled/tripled their prices if their services were never covered by insurance.

        1. Car repair costs and car insurance still haven't increased anywhere near as fast as health care and health insurance. A lot of that is probably due to better build quality postponing repairs for hundreds of thousands of miles, but a lot is also due to government interference in health care far more than in car repair.

          1. That's because most people pay for car repairs out of pocket. If car insurance covered maintenance, then you can bet the cost would skyrocket.

            1. I think the key point is that car insurance is actual insurance, but a large chunk of health care insurance goes to paying for long term expected care.

              Indeed, Obamacare makes this explicit and worse by capping the amount of premiums for older patients at 3 times the younger patients. What would make more sense, if you are going to mandate anything, would be to require younger people to fund a long term health care savings account with minimum contributions designed to cover their expected increase in medical costs from age 50 to 65.

        2. There is a lot more competition in oil changees than in medicine delivery .

          If oil changes went to 1 dollars at the chains the markets would be flooded with mom and pops.

          not so at your local brain surgery operating room.

          That doesn't dispute your assertion but it is a factor.

  3. Thai healthcare spending is about 4% of GDP: 1% private and 3% public.

    US healthcare spending is about 17% of GDP: 9% private and 8% public.

    Why the huge difference? Well, the US is richer and has more money to spend on medical goods and services. But that doesn't explain it all.

    I was in Thailand a few years ago, and a buddy of mine slipped in cave and suffered several lacerations. Later in the trip they became infected. We went to the pharmacy to inquire about antibiotics. A university-trained pharmacist looked at the infection, asked about allergies, and prescribed a topical and an oral antibiotic. Out of pocket, unsubsidized cost was about $12.

    Compare that with how this situation would be handled in the US. Trip to doc-in-the-box clinic, $200. Prescriptions, $20 - $100.

    The only difference between the two courses of treatment is that, in the latter, a nurse would take the patient's blood pressure. Well, that, and an enormous difference in cost.

  4. Environmentalists like to wax lyrical about the beauties of the wilderness, but there is something to be said for a thriving tourist industry and hiking Norwegians, and electricity and x-ray machines on tiny islands in the middle of the Andaman Sea.

    Not to an environmentalist. The jet travel that facilitates Norwegian tourists in the middle of the Andaman Sea causes global warming. The generation of electricity causes global warming. The introduction of technology disrupts indigenous cultures. The x-ray machines and medical technology extends life spans, which burdens the planet with a greater population load. Anything that benefits humanity is horrible.

  5. A universal health care system administered by the government and subsidized by taxpayers has low prices. Where's the news here? Why does this leave the author amazed?

  6. Should we be concerned that Thailand is committing cultural appropriation via the use of Western medicine?

    1. I feel microaggressed already!!!!

      1. I need a safe space!!

  7. Um, so what's the "moral" of this article? Stick it to the taxpayer?

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