At some point, all expatriates face the question of how they want to obtain health insurance or whether they really need to insure themselves. This article is intended to help improve the basis for decision-making.
Actually, it should not be a difficult question. Everywhere and over and over again, every website points out the importance of health insurance abroad. Also and especially for emigrants, for pensioners – especially in Thailand. There is hardly a news channel about Thailand that does not focus on this. And right – the risk of illness, accident exists every day. Costs quickly become barely calculable. Illness and infirmity becomes more real with age. It is frightening. Not being insured is therefore not only a risk, but also a social stigma. Hardly anyone will publicly admit to not being insured.
Yet there are more uninsured than you might think. They keep a low profile. They don’t want to admit it. So you make your own plans and try to calculate your own risks in private.
And nevertheless … unfortunately … yes unfortunately …. there are also good reasons to come to the difficult decision not to conclude a health insurance under the given conditions in Thailand.
I know that now many want to beat me: “How can he say such a thing? Irresponsible !!!”
Indeed, such a decision must be very well thought out and well planned. It must never be done for financial reasons. If you can barely make ends meet in Thailand and simply cannot afford insurance, you are out of place in Thailand. He/she should return to Germany before it becomes a problem.
Being insured costs – but also not being insured costs!!!
Reasons for a health insurance for Thailand
There are very good reasons for a good international health insurance in Thailand for foreigners living permanently in Thailand. I am not talking about time-limited travel insurance in this context.
The most important aspect is the risk of illness which increases with age. Surgery, heart, cancer, chronic diseases, accident, and, and…… the list is long. A major surgery, even in state hospitals, can quickly cost over 500,000 THB. Cancer surgery, chemotherapy, if necessary, now recently the very promising immunotherapy for advanced carcinoma, which is very expensive. There are many other examples.
2. the aspect of perceived security should not be underestimated. Health insurance is reassuring, even in times when one does not need the insurance. One usually sleeps better, and this increases the quality of life. One feels cared for, safe.
3. illness always means stress. A good insurance ensures a less stressful course in case of illness and accident. The ambulance can come, insurance card shown, and all necessary doors are usually open, even in the best and most expensive hospital in town. This feeling of security “I am now being cared for in the best possible way, I can let myself go in the case of illness” plays a large and positive role in the case of illness.
5 With health insurance, people are more likely to go to the more expensive hospital. This may not be medically better than the good state hospital, the university hospital. However, the staff in the private hospital (e.g. Bangkok Hospitals) are trained in dealing with foreigners, know their needs, speak English, the food is adapted. Thus, the sick foreigner feels subjectively much better cared for. This is an important psychological aspect.
4 Further reasons are visa and legal reasons around the residence permit. Again and again, the host country threatens that the uninsured will soon have to leave the country. This causes fear.
5 It is also a matter of social acceptance. Without insurance, you are quickly looked at suspiciously. This leads to stress. For example in the German self-image, insurance is absolutely mandatory. In no other country is so much insurance taken out for everything and everyone. Germans love security, and insurance companies love Germans. There are a few countries in Europe that are not much different.
Reasons for not having a health insurance Thailand
Are there any arguments against such long-term health insurance? Yes, there are, unfortunately.
The health care system is based on profit; every party involved wants to earn money. And every treatment, regardless of whether one is insured or not, is ultimately paid for by the patient. And if he is treated in an expensive hospital, he pays more into the insurance. Good insurance is therefore expensive. An insurance company is a commercial enterprise; they want to earn money and that is exactly how the policies are calculated. I have no idea what the average insurance company charges for a profit margin. But it will be at least in the safe 2-digit range.
In addition, the insurance company has many administrative costs. These are of course also passed on to the insurance policies.
Another incalculable cost factor is the hospital. Especially the private hospitals in Thailand ask first and immediately for the insurance card.
Examinations are then easier to perform, and there are always arguments for examinations. Equipment must be used to capacity; purchases must be profitable. Indications for operations are made much more easily, as is often the case in Germany, often for economic reasons and not necessarily always for the good of the patient. Laboratory examinations or medications often cost 10 times as much in private hospitals compared to normal average prices in Thailand. Especially in Thailand, immense amounts of pills, injections and infusions are administered. Quickly the insured has a few diagnoses more on the neck, whether significant or not. The patient is a customer, and the insurance card is the open purse. The doctor can always argue. Nothing is completely impossible in medicine. And then an acute gastroenteritis (food poisoning) in the tourist strongholds costs over 100,000 Bath. Another would have laid down in bed at home, drunk a lot, bought some paracetamol and antiemetics for 100 Bath, and usually he is better after 2 days.
The next incalculable cost factor is the insured himself. Being insured is also seen as a privilege in Thailand. One is insured! One has paid! You hold the insurance card in your hands. And what you pay for, you want to get something out of it. And so the insured person goes to the doctor more often. With everything and everyone. He then quickly gets an overuse and some non-significant diagnoses imposed, which makes the insured further to a loyal customer for the hospital.
And there is the free choice of doctor. So the insured, the layman, decides himself which doctor, which hospital is good for him/her. The insured person will usually choose the expensive hospital. Decision criteria are often not based on the real medical quality. The basic conditions of the treatment are much more highly evaluated. What is expensive must also be good. The comfortable chair and hygienic conditions become the decisive argument whether it is good or bad treatment. The insurance company does not provide any guidelines for the choice of doctor. Free choice of doctor is “the golden calf,” and it is still seen as an achievement in Germany.
Private hospitals, doctors know this. Therefore, there is hardly any competition to keep prices low. The patient/customer wants the hospital to be expensive. And of course, the business enterprise “hospital” also behaves accordingly.
Thus, the insured one contributes even significantly to the immensely high and further rising costs and thus rising insurance policies. The now also in Thailand more and more spreading health insurance system is the reason for the fact that currently the costs in the health service in Thailand rise too much, substantially more than in any other economic sector, substantially more than the inflation, up to 10% and more each year. Insurance is one reason for these exorbitantly rising costs. If patients were confronted with the costs directly, they would behave differently.
Most insurances do not offer a reward system which would encourage the insured to live healthy or not to choose the most expensive treatment. So everyone, even those who really take care of their health, bear the full risk of everyone in the group, no matter what avoidable risk factors the other carries. Responsibility for one’s own health is not perceived or even rejected by many people.
From all this, it is clear that when a health insurance policy is purchased, many additional costs are incurred that far exceed the risk of the actual illness. The health insurance is thus significantly more expensive than the average of the expenditures which would be actually necessary for treatment costs. I don’t want to give a percentage figure; I can only estimate. I guess that an insured person pays at least twice as much as it would actually be necessary.
And again, every insured person must know: In the end, the health insurance company does not cover anything. The insured person always pays everything himself through the policies and far beyond.
And so the policies rise and rise.
Rising premiums and other problems
Anyone who pays 250 euros a month for health insurance at around 55 years of age must expect this to double in a few years. The age-related increases documented in the contract are not that important; they could also be calculated. Much more important are the regular “adjustments due to rising health care costs” (as the insurance companies call them). The plan that the insurance company presented when the policy was taken out is therefore no longer relevant after just a few years. At the age of 70, the insured person has to reckon with 1000 euros and much more per month. Thus, in the age many humans are forced to leave insurance, and/or insurance achievements in such a way to slim down that in the final result many developing costs are to be taken over again. Policies must be paid however further; reserves were not saved. The paid-in contributions do not come back. Thus, also an insurance is financially hardly calculable in the long term.
And pre-existing conditions are usually not covered, so health risks remain. The insurance company also always finds “loopholes” to deny or at least delay payments. The stress that you didn’t have when you were admitted to the hospital is all the greater when it comes to reimbursement.
Health insurance with a Thai insurance company
This is also true for Thai insurances. These are usually significantly cheaper, but also have significantly fewer benefits. The financial limits for reimbursement are often only in a framework that a normal citizen could well cover himself. The reason of an insurance, to cover incalculable medical risks, is not even reached with most Thai insurances. Services such as immunotherapy for cancer are not possible; the upper limit would be reached too quickly.
The compulsory insurance for foreigners, which is now being discussed in Thailand and has already been implemented in part, is not part of the solution either; on the contrary. It is designed in such a way that risks for the insured are increased rather than minimized.
Example: Outpatient treatment. Here, a foreigner in Thailand must be covered up to an amount of 40,000 THB per year. (Note on the amount: Everyone living in Thailand should be able to cover the 40,000 Bath themselves, otherwise he/she has no business in Thailand). However, insurance companies do not easily pay out the costs incurred up to the maximum reimbursable amount of 40,000 THB per year. Most insurances only pay a maximum amount of about 1400 Bath on average per outpatient doctor’s visit. But this up to 30 (!!) times a year. So you could go to the doctor 30 times a year, and it may always cost a maximum of 1400 THB. What does this have to do with reality? Who goes to the doctor every 12 days in Thailand? IdR one goes 2-3 times a year to the doctor, but then the costs are idR significantly higher. With examinations, the costs are quickly 6000 Bath and above. But the insurance will only cover 1400 Bath at the most. But an insurance should, by definition, cover amounts that exceed a certain level. 1400 THB can easily be paid by everyone as own contribution. The offer has nothing to do with insurance in the real sense.
Result: 99.9% of the time the insurance company makes a profit with this policy. The foreigner in Thailand can do without such an offer and put the money aside for real illness. But he must take out the insurance. The “insurance” is obligatory. One can see the lobbying of the insurance companies with the legislator. It is all about pure profit.
The alternative – no health insurance and own risk management
And so there are good reasons to do without insurance in Thailand. It is quite possible in Thailand to cover by far the largest and most common health risks to well over 90% yourself and save a lot of money.
But there are some things to consider.
First of all:
1. people without financial reserves must have health insurance, at least until sufficient reserves have been created.
2. rather anxious people should also have health insurance. Not being insured often requires strong nerves, it can make you nervous. Being insured gives a subjectively reassuring feeling, even if in reality insurance does not protect against illness or infirmity and death.
Not being insured means taking precautions and responsibility.
1. a healthy lifestyle. One must be able to take responsibility for one’s own health. This does not exclude illness, but it reduces the risks.
2. a realistic attitude towards illness – and also the understanding that one accepts that under certain circumstances not everything that is still possible can or should be done.
3. a thick skin. It is important to assess fears and risks realistically and not to be driven crazy by the many horror stories and the many requests to finally insure oneself.
4. go to the doctor regularly. Do not ignore your own risks. Do not try to avoid costs at all costs. Take cancer prevention seriously, a colonoscopy at the age of 60, or even earlier if there is a positive family history, can save a lot of costs and suffering. Just as the insured often go to the doctor too much, the uninsured tend to avoid doctor visits, ignore their own health risks and symptoms. Early detection can save costs and preserve quality of life.
5. Precise planning. It requires a trusted person, preferably Thai, who knows exactly the circumstances and the interest of the sick person. One should find out about the medical services available in the place of residence, quality, cost, etc. before a possible illness. There are huge differences in price and quality. If necessary, a medically experienced person in the personal environment is also useful. Regular exchange, a network with like-minded people to share experiences is very beneficial.
6. there must be a significant amount of money that can be released at any time and immediately if necessary. The amount should be able to cover at least two major treatments, e.g. surgery with temporary intensive care. The money is independent from other financial needs in Thailand, e.g. for visa or daily living. It is only and exclusively for possible medical expenses.
The amount of money may be flexible depending on income, expected service and risk tolerance. I consider (phi times thumb) 1 million Bath as the target. This pot should continue to be paid into on a regular basis. About 200 Euro a month brings over 100,000 Bath a year. Money which is taken out of the pot will be saved again.
And again, this amount is in addition to the 800,000 THB required for an annual visa. One has nothing to do with the other.
7. for this, a good and regular income is very important. In addition to basic living expenses, if it becomes necessary, there should be about 1000 euros each month for regular medical purposes. So if my basic living expenses, that is the money I absolutely need to maintain my standard of living, is 1000 Euros a month in Thailand, then I need a regular income of at least 2000 Euros a month. If the money is not needed, which is more likely, then you enjoy the better quality of life, and you treat yourself to the trip to the beach.
8. And finally, you need a good family and good, lovable heirs, for whom it is worth saving money and bequeathing it later. The probability is that at the end of your life you will have a lot of money left, exactly the money that would otherwise have gone to insurances and hospitals.
This means that not being insured is not necessarily cheap. But if you compare it to the ever-increasing insurance premiums over many years, it is significantly less. With planning, personal responsibility, and acceptance of some residual risk, a lot of money can be saved.
In conclusion, I would like to state that it remains desirable to have health insurance. It is not the fault of the individual that this does not always happen. It is the system that fails.
In this series I show different possibilities for health insurances in Thailand – no matter if it is for a trip or a life as an expat.
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