News Forum - Court rules for Health Ministry, calls dual pricing beneficial

[Soidog]

3 minutes ago, LoongFred said:

Thais will treat accidents as appropriate, but you or your insurance will get billed.

Yes of course. That was my point. In the U.K. we will treat accidents and you can hopefully walk out of the door without payment irrespective of nationality or status. If not then we will provide a free pair of crutches and most likely arrange a free taxi back to where you are staying, no charge. I guess we are just good hosts to our guests? 

[Stonker]

12 hours ago, Soidog said:

You are wasting your time with this guy. He’s read the “official policy” on line and then thinks that’s what really happens. Perhaps he also thinks that because it’s policy not to allow people to use cocaine then no one uses it?
 

One of my closest friends is an Orthopaedic surgeon with over 30 years experience. It’s a regular complaint of his regarding the poor processes and lack of incentives in place within the U.K. NHS to recover costs for foreigners. He doesn’t see it as his role to discuss such matters with patients. He has worked in 5 hospitals from Manchester in the North to Bristol in the South. He is quiet clear that unless it is a referral through a private hospital or usually a specialist clinic, then charges don’t even come in to it. The other main area where charges are easily recovered was with people from the Europe or EEA. In the case of a private clinic that becomes a charge to the private clinic or hospital and they in turn pass it on to the patient with mark-up. I’ve attached a link from “fullfact check.org which agrees with the comments by my friend.  
 

Here is a short extract which say it’s all in the sense that it is just not worth the time of the NHS and no incentive to do so.  

The money has to be recovered by the NHS bodies that provided the treatment and NHS Trusts don't have any incentive to identify overseas visitors. That's because, by flagging concerns about a patient's entitlement to free treatment, it'd be rejecting money that it would otherwise receive from the government. Once an overseas visitor is identified, the Trust instead has to recover its own debt, which will also run up administration costs.

But don’t waste your time with that guy. He reads his Google and assumes that gives him a unique window on the world. We know the reality in our own countries, and he’s just in denial. 
 

https://fullfact.org/health/health-tourists-how-much-do-they-cost-and-who-pays/

God Almighty.

It would be sad and funny if it wasn't so dangerously out of date and misinformed, and could cost anyone going to the UK so much.

Your link from “fullfact check.org which agrees with the comments by [your] friend",  which you think "says it all" was 100% correct when it was written but it was written (or at least published, and probably written earlier) on 13 April 2015.

The changes weren't introduced until May 2015, the following month, to be brought in gradually, and the system wasn't fully established February 2021, earlier this year, six years later.

 

11 hours ago, Soidog said:

Correct @Khunwilko. Although they can (It’s the law), they rarely do and for a whole host of reasons. In no particular order these include:

A large list of exemptions including GP’s (a majority of minor illnesses are treated at this level). Pregnancy and sexually transmitted diseases  

Reciprocal arrangements with other countries.

A multi-ethnic society which makes it very difficult to identify “foreigners” without the fear of litigation - so just don’t go there! 

A lack of incentives or process within the NHS to pursue and to recover costs. 

An overloaded system that simply prioritises health care over money. 

 

You've overlooked the most important reason -

BECAUSE  IT  WAS  ONLY  INTRODUCED  SIX  MONTHS  AGO!!!

TIMES  CHANGE, EVEN IF YOU FAIL TO NOTICE!!!

12 hours ago, Soidog said:

A lack of incentives or process within the NHS to pursue and to recover costs. 

The "process" is very simple, now that the guidance has been published and distributed, but since that only happened IN FEBRUARY it takes some time and hasn't been implemented overnight and will take time to be effected. That includes the mandatory requirement for NHS Trusts and contractors "to recover these charges in full in advance of providing them, unless doing so would prevent or delay the provision of immediately necessary or urgent
services." and NHS statutory policy is that "You'll need to pay the full estimated cost in advance if the treatment you need is non-urgent, otherwise the treatment will not be provided.

If you're a non-EEA national and you fail to pay for NHS treatment when a charge applies, any future immigration application you make may be denied."

While "necessary and urgent treatment" is always given, "Treatment is not made free of charge by virtue of being provided on an immediately necessary or urgent basis. Charges found to apply cannot be waived
and if payment is not obtained before treatment then every effort must be made to
recover it after treatment has been provided." (The NHS's bold)

The "incentive" is that if they fail to do so then the NHS Trust or the contractor foots the bill - so they're not just out for the treatment and costs, but they're out 150% of the costs.

The NHS isn't a bottomless pit and all NHS Trusts and contractors have to balance their budgets, and whatever they lose on uncharged patients is money lost from their budget for equipment, maintenance and cleaning.

12 hours ago, Soidog said:

An overloaded system that simply prioritises health care over money.

JHC, you're serious!

Since 1990 NHS Trusts have had to balance individual budgets and be run as a business, not a charity - they all even pay tax at full business rates.

Out of date and uninformed is one thing, but this is just dangerously delusional.

[Stonker]

I just noticed this little pearl in the NHS England  2021 Guidelines, slipped in quietly and unannounced on page 108:

13.1   The Secretary of State for Health has since April 2015 exercised the power under section 175(4) of the National Health Service Act 2006 to calculate charges for overseas visitors on a commercial basis, which may include a reasonable profit element. From 1 January 2021, commercial charging applies to all chargeable overseas visitors, irrespective of their country of residence. 

Dear God, even Thailand doesn't allow state hospitals to make "a reasonable profit " from "overseas visitors on a commercial basis"!

[Stonker]

17 minutes ago, Soidog said:

Yes of course. That was my point. In the U.K. we will treat accidents and you can hopefully walk out of the door without payment irrespective of nationality or status. If not then we will provide a free pair of crutches and most likely arrange a free taxi back to where you are staying, no charge. I guess we are just good hosts to our guests? 

"Hopefully" Phuket will get a million foreign tourists this year!!!

[Soidog]

4 minutes ago, Marc said:

First of all, I don't think there is a perfect country or system. There are flaws in each of them. My point is, I don't think that a "wild west me first and only me" approach, where everything is fine as long as it is beneficial to an individual or a group, is the best way to go. It's not even a good one.

It results in a massively divided society in which few do what they like and many suffer from it. This is the exact opposite of opportunity, freedom and justice for all.

Btw, the Thais don't believe that either. They've have given themselves a constitution with fundamental rights, check and balances and accountability (not just in the current constitution). Even the prime minister keeps talking, "You have to obey the law".

The issue is: a lot of Thais don't care. It's mainly about face and benefit, not about values or laws. And the prime minister couldn't care less about obeying the law. He only applies it when it's beneficial to him. That's double standards and hypocrisy. And that is not a healthy environment for the economy and development in the country. If you can't trust, not even in the law or the courts, many won't invest.

China is different, they don't pretend to be a democracy and most people don't even want to live in one. They walk the talk. You know it, you can trust in it. Like it or leave it.

Here you can only rely on one thing, in the end, you are on your own. If you stay under the radar or know how to handle your Colt, good for you, everything is perfect. Just don't pretend it's beneficial for the country, like the court did.

Great post there @Marc  I find myself agreeing with it all. 
 

Im increasingly disillusioned with Western style democracies. Churchill once said “democracy is the worst form of government – except for all the others that have been tried”. Im starting to think we need to try a few more! 
 

I don’t have a deep knowledge of the Chinese system, and on the face it I wouldn’t in anyway want to live under a regime such as the Chinese. However, one of the things I note is how the Chinese seem to regard their government as a wise old uncle. Putting trust in them and allowing them to get on and deal with the bigger issues. In the U.K. it’s such an adversarial set up, that all you get of challenges to almost everything. Unless it’s a moral issue which is hard to argue, everything is opposed, questioned, ridiculed, divided and watered down. Some would say that’s a good thing as it keeps government in check. I think that was its initial purpose of an opposition multi-party system, but in these modern times and the speed of information and social media, it’s actually destroying the ability for government to operate. I’ll give one example, and this is without judgement on who was morally right or wrong:

Some months ago a young footballer (soccer for our American members!) decided he wasn’t happy with government policy on free school means during school holidays. The government only supplied free meals during term time. He made his feelings known on social media that free meals should cover the whole year. The government were “forced” by the media to comment. Initially they rejected it. After a massive social media campaign and tv and print media campaign, the government backed down. Now some would say that’s democracy for you. I disagree. That’s social media influencers and a few media moguls flexing their muscles. This kind of thing is now how the U.K. operates as a country. Action groups turn to social media influencers. The left wing media jump on the news. Newspapers splash stories across the front page. Niche issues attract words such as “crisis”, “disaster”, “unacceptable”. MP’s run scared they will lose their seat at the next election, and the government follows popular and in the moment tactical fixes. No long term objectives. No long term strategy, no direction and instructions to society. In short, no leadership. That somehow doesn’t feel right to me any longer.
 

Are Churchill’s comment still right? I think it needs updating for sure!  

[MikeTexas]

12 hours ago, LoongFred said:

It's the Thais system not yours.  Why would they want to help you getting subsidized care. Your a guest here and shouldn't expect freebies.  

It's not a matter of you contributions via vat tax etc. It belongs to them. You should be grateful that the price is low. 

Ha, you keep talking about subsidized care but the money for the subsidization comes from the revenues the country collects and if those monies come from expats then is isn't the Thai subsidizing the expats.  More likely a lot of the expats contribute more so it is them that are subsidizing the Thai.  Tourist and visitors I can understand charging more since they don't contribute.

[MikeTexas]

10 hours ago, Stonker said:

While true, which in itself is increasingly unusual here, 'no' it isn't at least one for me because that isn't what I asked - which was "Name any that don't charge non-residents and non-nationals more. Any at all!".

Read for context and not to just try and make a point.  America doesn't' charge more for medical care for non-residents or non-nationals.  If you fly in for treatment you get charged the same as somebody that lives here.  The only difference is if you are insured or not.  Non-residents and non-nationals can be insured.  The negotiated rates your insurance has secured is what determines your cost when insured.  Without insurance the bill is the same for everyone based on which hospital, doctor, and procedure. 

[Inlandchris]

On 9/30/2021 at 2:01 PM, Stonker said:

There seems to be an enormous amount of misunderstanding mis-rep[resentation of the details of this case (I wouldn't call them "facts" as the only source are Coconuts Bangkok, repeated elsewhere, and a few local English or Dutch language rags, none of which are reliable), but due to a lot of hype and deliberate misinformation by a couple of posters here (literally just a couple) a great deal of what's been written here and commented on is simply factually completely incorrect.

The following isn't opinion but simple detail based on the various reports, with full links:

Erwin Buse was a train engineer in Holland before moving to Thailand in 2006, aged 37, to join his Thai wife. He has no work permit and pays no tax, has no pension and no income from abroad, but works a a goatherd for his wife in the Klong Wan area of Prajuab Khiri Khan.

He developed prostate cancer in 2015 but chose not to return to Holland but to be treated in Thailand at Hua Hin Hospital from 2015 to 2019. Total costs over four years were over 20,000 baht with an initial fee of 858 baht and a basic 300 baht charge every three months.

He first protested the charges to the Prajuap Khiri Khan Damrongthan (complaints centre) in 2016, three years before the change to introduce Tiered fees at state hospitals, and was offered a refund of 12,746 baht in 2019 which he refused as he said he should have only been charged 50 baht for each quarterly visit, not 300 baht, and no initial fee.

After rejecting the offer of a 12,746 baht refund as insufficient , he registered his complaint with the police in Hua Hin on 19 July 2019, over a month before the changes to state hospital charges were even published and approved.

The 50 baht he demanded instead of 300 baht was based on charges in 2004, in force when he first came to Thailand in 2006, for migrant workers under the HICS or Thais under the UCS, neither of which he was eligible for as he was neither a registered migrant worker from ASEAN nor a Thai. The 50 baht quarterly charge demanded was to cover all doctors charges, hospital fees, equipment, tests and medication / treatment.

All sourced, all linked, all reported.

All, also, enormously and deliberately mis-interpreted and mis-represented to paint a very different picture.

Nice story of one individual; I wont check out your story because I believe you. My story is I retired in Thailand in 2006 and had 5 ortho operations, because of old age. All operations in 2 different hospitals were excellent; best care and 4-5 stars for the operating doctors. Price is okay, no complaints. One doctor, however did not operate on me, wanted to put a stint in one or two arteries because I couldn't pass  stress test and was out of breadth all the time. I refused to believe him because I am an athlete and in shape so I made him give me a CAT scan, came out as something else; 20,000 baht versus 300,000 baht. You have to watch out and protect yourself at all times; someone is always trying to take advantage of a stupid Frang. I mean, the whole world, not just Thailand. 
But, this article had to due to a courts ruling that dual pricing is ok. In my opinion, its a shallow opinion based on prejudice and not pure logic.

[Stonker]

3 hours ago, MikeTexas said:

Read for context and not to just try and make a point.   

The "point" was that I asked a simple question to establish if any countries "don't charge non-residents and non-nationals more" and although you answered "America" you restricted that to nationality.

3 hours ago, MikeTexas said:

America doesn't' charge more for medical care for non-residents or non-nationals.  If you fly in for treatment you get charged the same as somebody that lives here.  The only difference is if you are insured or not.  Non-residents and non-nationals can be insured.  The negotiated rates your insurance has secured is what determines your cost when insured.  Without insurance the bill is the same for everyone based on which hospital, doctor, and procedure. 

I'm sure what you say is correct where payment for treatment is concerned, and that applies to most countries, where private / international hospitals charge everyone the same rate regardless of nationality or residence status.

Having told me to "Read for context and not to just try and make a point", though, you seem to be deliberately avoiding the context yourself as the context here is state funded medical care which is markedly lacking in the US.

As far as I can see those few hospitals in America that give free secondary treatment, which America designates "safety net hospitals", generally only do so for residents, not non-residents.

America is well behind most of the Western world in terms of any form of national health care, and way, way behind Thailand where 99.95% of the population, plus all registered migrant workers and all foreigners working legally get completely free health care of a reasonable standard.

[Stonker]

3 hours ago, MikeTexas said:

Ha, you keep talking about subsidized care but the money for the subsidization comes from the revenues the country collects and if those monies come from expats then is isn't the Thai subsidizing the expats.  More likely a lot of the expats contribute more so it is them that are subsidizing the Thai.  Tourist and visitors I can understand charging more since they don't contribute.

You don't seem to understand anything about the healthcare system here, or the system of residency and who gets free or subsidised treatment.

The "subsidized care" @LoongFred is talking about is also subsidised for expats working and resident here, not just Thais.

As you rightly say, "tourists and visitors ... don't contribute" so what you're saying just confirms @LoongFred's point

[Stonker]

3 hours ago, Inlandchris said:

Nice story of one individual; I wont check out your story because I believe you.

I'm not sure what to say to that - the "nice story of one individual" is what this case and the judgement was about - nothing else, despite the hype and spin in Coconuts and here.

3 hours ago, Inlandchris said:

But, this article had to due to a courts ruling that dual pricing is ok. In my opinion, its a shallow opinion based on prejudice and not pure logic.

Well, despite the clear implication in the article and in the source article from Coconuts, and all the bluster and prejudice here, it wasn't actually the court's ruling that "dual pricing was OK" as Erwin Buse makes clear when he says that he's appealing the verdict on the grounds that the charges hadn't been calculated properly.

Let's not let the facts get in the way of a good old rant about dual pricing by so many, though

[JamesR]

21 hours ago, Soidog said:

The lesson I have learned in life is this:  Too often we chase “happiness” and find stress and debt and a life of being unhappy. Chasing material things to give us a short lived buzz of being “happy”. What you need to do is learn contentment. If you are content with your life then happiness follows. If you chase happiness you may never find it. 

What I have learned in life is it horrible being skint (a long time ago that was), which makes people really miserable, I have seem many people without money miserable, not being able to do as they please, go where they please or buy anything,

I have never seen anyone with money and possessions feeling miserable.

Having material things like a car to get around in, washing machines, nice TV, house etc make most of us happy.

Contentment is having the things in life to make it happy, discontentment is having not enough to have an easy life financially.

I have noticed a lot of people who do have the required material things and a nice place to live and money at some point sit back and philosophise in a similar way to you have done, I have never seen a person without what they need doing the same thing and say they are happy not to have much.

A friend of mine makes me laugh as he says all he needs in life is a quiet spot and a few nice beers.

I laugh and say that spot is in the back garden  ( 2 rye) of your seven bed, seven bathroom, 7000 sq feet mansion in Chiang Mai, plus two detached houses in the UK and a large flat in Zurich.

The answer is, "Oh, yea, I forgot about those".

 

 

 

[Soidog]

32 minutes ago, JamesR said:

I have never seen anyone with money and possessions feeling miserable.

So Whitney Houston, Micheal Jackson? Those people has all the money you would want and more possessions they could ever need. They killed themselves !!

[Soidog]

34 minutes ago, JamesR said:

I have noticed a lot of people who do have the required material things and a nice place to live and money at some point sit back and philosophise in a similar way to you have done,

Wrong my friend. My father who worked all his life for minimum wage and has little or no possessions, yet hi is the happiest man I know. He lives in a small house, no money in the bank, never went far on holiday and struggled each month with his pay. But he was lucky enough to meet a woman he loved and they shared the problems of life. I have 100 times more than he has at a money and material level. But I’m still struggling to be as content as he is. 

[Benroon]

On 9/30/2021 at 8:16 AM, Stevejm said:

Very interesting. On that basis he should be on his knees in thanks rather than wasting the courts time 

Exactly what I was thinking 

[Benroon]

2 minutes ago, Soidog said:

Wrong my friend. My father who worked all his life for minimum wage and has little or no possessions, yet hi is the happiest man I know. He lives in a small house, no money in the bank, never went far on holiday and struggled each month with his pay. But he was lucky enough to meet a woman he loved and they shared the problems of life. I have 100 times more than he has at a money and material level. But I’m still struggling to be as content as he is. 

Money doesn't buy happiness - millionaires and billionaires commit suicide as well. What money does however is make poverty far less likely. I genuinely admire the people who are content with not much, its a huge personal quality.

But in the west over the last 50 years or so, or for sure the UK, we have been conditioned to get a bigger house, a faster car, work more hours, never relax, never rest and you are on that train for decades until one day you wake up, and think what the fuck am I doing, I live alone with the wife so why am I looking at 5 bedroom houses !!

It's the driving reason I live in Thailand, to get off that train and stay off and get away from a tax obsessed nation, but even now I eye up villas that are probably out of my price range, its a British thing IMO.

[Benroon]

20 minutes ago, Soidog said:

So Whitney Houston, Micheal Jackson? Those people has all the money you would want and more possessions they could ever need. They killed themselves !!

Did they ? I doubt if their deaths were suicide. One was a drug overdose and the other appeared to be an over zealous doctor. Though without being in the room I guess no-one can be sure

[Soidog]

3 minutes ago, Benroon said:

Money doesn't buy happiness - millionaires and billionaires commit suicide as well. What money does however is make poverty far less likely. I genuinely admire the people who are content with not much, its a huge personal quality.

But in the west over the last 50 years or so, or for sure the UK, we have been conditioned to get a bigger house, a faster car, work more hours, never relax, never rest and you are on that train for decades until one day you wake up, and think what the fuck am I doing, I live alone with the wife so why am I looking at 5 bedroom houses !!

It's the driving reason I live in Thailand, to get off that train and stay off and get away from a tax obsessed nation, but even now I eye up villas that are probably out of my price range, its a British thing IMO.

That’s my point mate. Money doesn’t buy you happiness. I agree. Contentment is the main goal, then happiness will follow. If contentment is living in a rented small apartment with your dog, a beer and the game on TV, great. If having a $100m yacht is contentment then fine. My point is that happiness is not the target, contentment is

[Benroon]

26 minutes ago, Soidog said:

That’s my point mate. Money doesn’t buy you happiness. I agree. Contentment is the main goal, then happiness will follow. If contentment is living in a rented small apartment with your dog, a beer and the game on TV, great. If having a $100m yacht is contentment then fine. My point is that happiness is not the target, contentment is

Own apartment, trusty dog, cold beer and football - that's not contentment, its nirvana !!

(but in the back of your mind will be that gas bill !! )

[Benroon]

On 9/30/2021 at 9:37 AM, LoongFred said:

I'm not going to the UK ever. I have no interest or desire to do so. I'd like to see many places in the world but not the UK.  

 

Whoa hang on there - your life will not be complete until you have been gouged an extortionate amount of money to get into the interminably dull Madame Tussauds !

[Soidog]

2 minutes ago, Benroon said:

Own apartment, trusty dog, cold beer and football - that's not contentment, its nirvana !!

(but in the back of your mind will be that gas bill !! )

Agreed my friend. Believe me when I say, I’m the last person to trivialise life’s challenges. However my point is that happiness is an unattainable goal. I also know it comes down to the definitions of words. However, I’ve noticed that people who are just content with what they have  and don’t seek more and more, are “Happy”. I wish so much I could go back 6 years and have what I had. I was content and happy. Now I’m like so many other people in search of the Illusive “happiness”. Hopefully one day soon I will find contentment? 
 

Be content and be happy my friend. 

[Benroon]

1 hour ago, JamesR said:

I have never seen anyone with money and possessions feeling miserable.

 

Allow me to introduce you to Mrs Benroon ......

[Soidog]

39 minutes ago, Benroon said:

Allow me to introduce you to Mrs Benroon ......

Well  you have made her “Content”. Good on you. You should be proud. Respect

[JamesR]

2 hours ago, Soidog said:

So Whitney Houston, Micheal Jackson? Those people has all the money you would want and more possessions they could ever need. They killed themselves !!

That is a bit extreme, have you given all your possessions and money away and live in a cave?

Why mention the above as you or I have no chance of having the amount they have, are you pretending you could but have decided not to?

It is a sort of snobbery about not achieving, eg a bloke once asked my job etc and I told him and he said you probably had to go to university to do that job, I said yes, he then told me in a very superior way he went to the 'university of life', I told him I had tried that for a few years and it is crap so I went to a real university.

 

[JamesR]

1 hour ago, Benroon said:

Allow me to introduce you to Mrs Benroon ......

Whaaaa, I know what you mean!