RE:{Channeling Andrew:] Cost of private HIV treatment in Thailand

Question

Hello Dr Ben,

I gather the individual is not a Thai Citizen. I will endeavor to answer all the questions from both perspectives. Cost vary dramatically. Is a lengthy reply, as there are so many variables.

FYI, I have been HIV+ for about 7 years. I have lived and worked in Thailand for over 10 years. I am a Western guy. I have now retired and look after myself and enjoy life in The Kingdom.

THAI HOSPITALS AND MEDS:

The Thai Government have from what I have experienced a very very good medical system for all Thai's and Expat's. There are multiple choices from Private & Public Hospitals, Depending on the cost and the speed that you require. I lived in a major city for 7 years and was tested in a Private Hostpital (which you pay for as an expat) All Thais have almost free medical (if not hospitalised) When I needed my CD4 and Viral loads tested I have to pay. If I pay at a private hospital or public these 2 tests cost the following:

Thai Private Hostpital = 8700 THB = $281.37 USD (CD4 and Viral loads tests) *approx

Thai Public Hostpital = 1500 THB = $48.51 USD (CD4 and Viral loads tests) *approx

Both Private and Public blood tests are sent to specialized labs in and around the country. There are not many. For example Samui and Puhket will send blood to Bangkok. Results take about 2 to 3 weeks for both public and private.

The only difference between public and private are the cost and service.

PUBLIC: You have to pay cash, no insurance cover (at all) Generic meds, long waiting times, English is very limited. Cheaper.

PRIVATE: You can pay cash or credit card, Insurance accepted yet no treatment till confirmation that the insurance company will pay the Hostpital ( often have to pay then claim ... And often is not done correct and claims are rejected ) Generic Meds and Few Patent Meds ( at large Bangkok Hostpital's ) short and quick service, English usually available. Expensive

The medication I am on are all Generics. The Thai Governmental Pharmaceutical Organisation (GPO) make all the medications at their Government owned plant out side of Bangkok.

I now live in one of the poorest (yet most beautiful) area's in Thailand. I go to a tiny hospital that supports some 300 differing villages, There is a HIV clinic part of this hospital with only 1 HIV Doctor that only works with STD's and HIV issues. Their system here is well, simple, easy, yet some times can be a little frustrating due to a small amount of lack of communication and organisation. I can get all Meds, CD4, Viral Load tests here, yet the wait time can be challenging, some times can take a whole day.

I went on Meds from this Doctor in Thailand and originally went on an older regime, ( AZT, Zerit, Vired ) for one month, and when I visited my Western HIV clinic and had a check up, my Western Doctor suggested and wrote a letter to change my Meds as he was worried that I may suffer long term from facial wasting. He sated that Thailand and India are leading the way in Generic Copy medication and there all should be no problems.

And there hasn't been. Retired and on permanent HIV Treatment here my results are great CD4 1230 and Undetectable. So I guess being on 5 year treatment with generics with my doctor the results speak. I have never taken patent meds ... Only generics.

My 3 monthly vist to the HIV clinic here with meds of ( Vired "Tenofovir" 30 tabs | Viramune "Nevirapine" 60 Tabs | Lamivudine "3TC" 60 Tabs ) and a check up costs exactly 5,176THB = $161.60 USD (3 MONTH Supply)

My Doctor in Thailand had no issue in changing my regime to what my Western Doctor requested, I am Her only Western Patient. The list of Medication Tablets in Thailand is as wide and as large as what I have seen in the West. In the Clinic that I go to theirs is a Huge Chart of Tablets that are available.

I do find that the language barrier is a challenge, yet my partner helps me with that, however this site gives me an enormous amount of information and resources, I think sometimes I know a little more ( knowledge from this site ) than Her on some things (5 years ago it was NOT standard in Thailand Public to do Viral Load Tests) so I HAD to request and Pay, Yet as doctors learn more and more here it's is now standard in my Hostpital to have a Viral Load test with all the other frills you would expect in the west.

In my Western country HIV medication is free yet there is a Pharmacy dispensing fee of $45.00 USD for EACH 30 Tabs so I would be paying over $150 USD a month plus a doctors fee, yet Meds would not be generic. I keep in touch with my Western Doctor by email, and try and go back every 2 years to check up with them, I get a years supply of Multivitamins (500 Tabs) made here in Thailand for less that 230 THB = $7.31 USD

Thou if you are travelling, living, or extended holiday in Thailand, there are large Private and or Public Hostpitals in most centers, Chaing Mai, Chang Rai, Bangkok, Phuket, Nong Kai etc will have a on duty doctor that most likely will provide a prescription for use at the hospitals medication dispensing section, as long as you are able to provide the doctor with your current treatment (I suggest take your Med Bottles, Country of Origin Prescription, and your current labs), and state that you need 3 months of the same drug regime. (Costs described above , yet vary from public to private and clinic to clinic)

I am yet to meet a Doctor in Thailand, United Kingdom, or NYC that will provide Prescriptions longer than 6 months.

Following are Hostpital's, and Centre's in Bangkok and Thailand that can help.

http://www.redcross.or.th/old/english/service/medical_clinicaids.php

http://en.wikipedia.org/wiki/List_of_hospitals_in_Thailand

INSURANCE:

Insurance is a touchy and challenging subject. If you are a Thai Citizen you can get most if not all HIV treatment, Meds, Blood Work for free. So that would negate insurance.

If (which I am guessing) you are Not from Thailand and are from the West wishing to visit "The Land of Smiles" for an extended visit, and are investigating "travel Insurance"! The only advice I can give is READ, READ & RE READ the fine print.

Thailand is currently under "Martial Law" after a coup d'état on the 22 May 2014. Having lived through the previous coup ... Things revert back to normal pretty quickly. Yet with that said Insurance could and can be a issue.

Most, if not all, travel insurance policies exclude claims involving martial law and coups in the fine print of their product disclosure statements.

Read more: http://www.smh.com.au/travel/travel-planning/travel-news/thailand-military-coup-australians-face-travel-insurance-issues-20140522-38rrc.html#ixzz39CEcRLce

So as far as insurance is concerned you will need to investigate what the insurance company will and won't cover, ie: travel related expenses, delays, cancelations etc. And the BIGGEST question you need to find out is what will they cover for a Hostpital Visit. Will a pre existing condition be covered? Will they ( I doubt ) cover HIV TREATMENT in Thailand and pay for costs and generics? ( I doubt ) what Hostpital's will they accept invoices and or have agreements with ( public I doubt will be accepted ) Most large western travel insurance companies have existing agreements with most of the larger private Hostpital's. They have terms and conditions (discount access) for the western insurance claims. Yet most if not all have to be approved before treatment. If you stumble into a Hostpital that is not on your insurance company's approved list, your claim most likely will be declined.

Yet with that said, having insurance for car accidents, accidents in General, theft, etc is maybe a good idea. Thou I strongly suggest you obtain a firm letter sating what they will and won't cover. After you pay the insurance fee, and then the claim deductible ( if HIV TREATMENT is covered) I doubt you will save money, as costs here are not like the west, is far cheaper.

If you wish to obtain insurance once you arrive be very very carful. I doubt any insurance company will cover you, as you are not a permanent citizen, with a work permit and on the correct visa. If you arrive on a tourist visa, I doubt they will provide you cover as per your visa. ( yet they may say , yes yes yes ( and Smile ) yet when you claim here often you will get no no no and a Smile again) All policies are in Thai all fine print is in Thai. Even if you are able to obtain a English translation, I doubt it will perfectly reflect what the Thai policy states, which may in tern lead to "Decline" under the "Thai fine print"

If you feel you may need hospitalization due to a illness that may be associated with HIV ( like Pneumonia )and you have insurance, the claim will be assessed on what the Hostpital informs the insurance company. It may (which I would request) not mention HIV, yet what is really the issue and a claim may be processed. If your hospitalization is a result from a accident then you just need to be very well,informed of what you will and won't be covered. Motor bike accidents mostly are not covered (with or with out a helmet or who's fault)

If you need and want insurance and you have done the pros and cons and have read and re read and requested special conditions on your policy for your travel, then I would obtain from your country of origin not Thailand.

VISA:

You will need to investigate Visa and length of stay in Thailand. No longer can you come and go as a western person doing a border run, and obtain a 3 month tourist visa again and again. The new Army government has imposed harsh laws now for Foreigners wishing to stay extended time within The Kingdom. From now on the most time is really 3 months ( if your lucky ) depending on your entry point you may only be given a 30 day tourist visa. Extensions are difficult now. You may need to look at 3 months in Thailand and a month in Loas and then obtain a new travel visa in Loas for a further 3 months in Thailand. Best to speak to your local Thai Embassy and of Consulate to obtain the best visa In Reflection of your age and visit requirements. (Age over 50 can obtain a retirement visa for a year if your prove financials)

Immigration officials have announced that from August 12 foreigners will be banned from taking so-called visa runs to obtain short-stay, back-to-back visas that have allowed them to repeatedly extend their stay through border stamps. The visa runs have spawned businesses that facilitate cross-border trips by foreigners, some of whom are known to have been using the loophole for more than 10 years.

Read more: http://www.smh.com.au/world/australians-in-thailand-face-visa-crackdown-junta-warns-20140801-zzdvp.html#ixzz39CVC3MM8

If you obtain the correct visa, and do the correct thing. Like most countries, every thing will be fine.

If you can obtain 6 months ( or more ) of medication from your country before you travel! I would do so. If cannot, it is not a challenge in Thailand. Just patience, Money, Clear Communication, and Correct Hostpital and Doctor. Make sure you bring and provide your previous blood tests prescription copies so forth as will make it easier so much easier for you and the doctor. Other wise you will start again with blood work.

I hope the above is helpful, if any more questions, happy to answer.

Regards

Andrew (Thailand)

Answer

Hello Andrew,

I knew I could count on you to provide the latest information on the care situation in Thailand. I'm sure your detailed information will be of great value to our reader(s).

Hope you're doing well and best of health to you, BY