During my recent trip to Thailand I had occasion to visit hospitals in Chiang Mai, Bangkok and Trang. Here are my impressions and a comparison to previous visits. (See my previous blog Two Emergency Rooms from 2010.)

This year I visited the hospitals simply to get a Vitamin B-12 shot. I am deficient not for dietary reasons but because a problem my body has in processing B-12 and making it usable. The solution is a monthly B-12 shot. I had brought two vials to Thailand, intending to give myself the shot; unfortunately, this turned out not to be possible so instead I went to the hospital to have it done.

In Chiang Mai I went to Chiangmai Ram Hospital. Things went very smoothly. First I registered, which involved filling out a form, showing my passport and getting photographed. The next step was a doctor visit to confirm that I needed the shot. Then the nurse gave me the shot and I paid the cashier. The entire process took about 45 minutes. The cost was 212 baht, about $7.00 U.S. at the current exchange rate of 30 baht to a dollar. This included:

• Medication: 84 baht
• Medical Supplies: 28 baht
• Nursing OPD Service Charge: 50 baht
• Service OPD CHANGE: 50 baht

In Bangkok I went to what is now called Bangkok International Hospital, although on my card from previous visits it was called Bangkok General Hospital and it’s called Bangkok Hospital on its website.

When I went in, noting how much the hospital seems to have grown, I showed my registration card and they took a photograph. They then sent me off to the International Registration Desk on the second floor; a bit of a trek to find. Then the same procedure as at Chiang Mai: a doctor visit to verify the need, a nurse gives the shot and payment is made. The whole thing took about an hour and 15 minutes. The cost? 810 baht (about $27.00 at the current exchange rate of 30 baht to a dollar). This included:

• Medication: 260 baht
• OPD Nursing Charge: 150 baht
• Physician Evaluation: 400 baht

As a comparison, when I get the shot from my physician (at her office) in the U.S. I have a $10.00 (about 300 baht) co-pay.

I also visited two hospitals in Trang. I don’t have the names. None of the staff at these registration counters spoke much English at all. I was unable to get treated at either hospital because they did not have the medication available.

A few observations:

• It was certainly much cheaper at Chiang Mai – about 1/4 the cost compared to Bangkok.
• The discrepancy in medication cost is interesting: 84 baht in Chiang Mai, 260 baht in Bangkok – over 3 times as expensive. I find it hard to believe that the medication costs that much more in Bangkok. I chalk it up to Bangkok Hospital adding more mark-up on their pharmaceuticals so they can make more money.
• Another possibility is that Bangkok Hospital has two price scales now, one for international patients and one for Thais, though I have no way of verifying that. Several times in the past the fee for a doctor at this hospital was 200 baht and 300 baht for a specialist. This visit was the first time that a distinction was made between Thai patients and foreign patients and I was sent to an international registration desk: before, all patients went through the same procedure. I guess that international patients pay more: based on the previous standard fee of 200 baht for a physician visit and the higher medication cost compared to the Chiang Mai hospital.
• Over the years, Bangkok Hospital has become much more impersonal. The first time I came, there was a doorman to open the car door and a nicely dressed young woman to escort you to the registration desk. In the past, the people at the desk were friendlier – this time they seemed distracted and harried at both the downstairs desk and the international desk on the second floor. They used to have someone escort you from downstairs registration to your next stop: now you’re left to fend for yourself.
• Medical costs appear to be on the rise, at least at Bangkok Hospital.
• Bangkok Hospital has gotten less friendly, even compared to my Emergency Room visit in February 2010. The experience this time was more akin to a U.S. hospital, where it’s clear that making money is at least as important as treating the patient. I would be curious to know if the Thai side of the hospital still retains more of the previous friendliness.
• I had a better experience at Chiang Mai Ram hospital: I found the staff friendly and welcoming.
• One big difference between the U.S. & Thai hospitals as that no mention of payment is made before treatment: it is only after that you are sent to the cashier to make payment – there seems to be no need to make proof of payment before treatment.
• Bangkok Hospital must treat a large number of Arab patients. All of the signs are available in Thai, English and Arabic (and some in Japanese). A notice in the international waiting area tells where to go to change several Arabic currencies into baht.

Compared to the U.S., there’s still lots to like. I could never have gone to a hospital to get a B12 shot in the U.S. without an appointment and been in and out in 45 to 75 minutes. Simply wouldn’t happen. The overall costs still are much lower. The standard of care seems very good.

In future years, though, I’ll make sure to bring the medication and either administer the shot myself or go to a clinic to have it done. I may look for an alternative to Bangkok Hospital next time.