Bloggang.com : amatuer translator : Reflections of cultural differences (Medical Care III)

Reflections of cultural differences (Medical Care III)

The last medical bill came to our mailbox in late November of 20XX. It was almost 6 months after my wife gave birth to our youngest son at XXX Hospital, City XXX, State of XXX. There were numerous medical bills ranging from prenatal cares, doctor visits, doctor fees, laboratory expenses, hospital expenses, prescriptions, surgery room fee and a teddy bear.

The baby was really big (almost 10 pounds), C-section was done to pull “the giant” out. So, expectedly, the total expense would be unimagineably high for both of us. We gathered all the bills we paid from the beginning to the end, the grand total for all of everything including that cute blue teddy bear before insurance was almost 25,000 USD. As a J-1 VISA holder, it is mandatory for me and my wife to have a medical insurance for certain levels. Luckily my wife had 2 medical insurance policies, one was a complimentary from her scholarship sponsor and another one was our school (Blood Sucking University, BSU) health insurance policy which we were “unwillingly forced” to buy this one because the one from my wife's sponsor was not “equivalent” to the BSU health insurance policy.

We chose the school policy as our primary insurance and another one as our secondary policy. Hence all of the expenses would go through the school policy first, after that everything left over would go to the secondary insurance. Most of the claims to the school policy were partially paid and some of them were totally declined. So we sent the leftover part to the secondary insurance. Almost all of the claims were kindly covered by this one. If it was not covered by the secondary insurance, we would be pretty closed to bankruptcy. We definitely would be in a big financial problem if there was no “so-kind-but-not-equivalent-as-told-by-BSU” insurance to cover these expenses. Anyway we had to partially pay for that, it was around 3,000 bucks which seemed to be more affordable for ordinary graduate students like both of us. Anyway this insurance issue gave us some better ideas about how expensive it would be when we needed any medical care on the land where medicine and medical sciences are far more advanced than any other place in this entire planet.

Looking back to the advent of our first son who was born in XXXX Province, Thailand, almost 7 years ago, we paid only 3,000 Thai Baht (approximately 75 USD) for a special care from my wife’s gynecologist. Both of us were working as governmental officers, therefore the government gave us totally free and all-inclusive medical benefits to our family. So we did not have to pay to anything. However we preferred to have a special care from a gynecologist, so we asked a doctor to take a special prenatal, perinatal and postnatal care for the baby and his mother. So extra-money of 75USD was paid directly to the doctor with sincere gratitude for such a wonderful care given to our family. So it seems to me that such medical treatments and their related experiences in a hospital in the US and in my home country are drastically different resulting from two similar medical incidences. The health care systems between the US and Thailand were totally different in many ways to a point where it have changed my perspective to a word “hospital” between these two countries.

In the US, hospital is a place where I can simply buy medical services, if I have money. In contrast, a hospital in Thailand is a place where I can trust and have a faith in the doctors. My loved ones’ safety and good health can be obtained even though I have small amount of money. Even though it may not be a perfect and high-tech hospital, but I can account on it financially. In the US, to be honest, I am too scared to be sick or ill.

Why has a same word originally filled with heart and hope evolved in a different fashion? I wondered.

Before leaving to an academia career, I had been working as a hospital in a remote and rural area of Thailand for 4 years just like any other newly graduates including doctors, dentists, pharmacists and nurses. Almost all of us graduated from governmental-owned universities. Before our enrollments in those public schools, all of us had to sign a contract agreeing to work as a governmental officer for certain years after graduation or had to pay some fine if we did not.

This policy looks like a “slave” contract for some people but, to me, it was fair enough for general Thai taxpayers who have paid for every resource used in medical, dentistry, pharmacy and nursing schools. More importantly, this policy has contributed to equaled distribution of health professions in every area of the country regardless of how rural and urban it is. This ensures that there will be sufficient and adequate medical cares in every place in the country.

Again, if I was academically competent enough to get acceptance to a health-related school in the US with financial supports, I might be able to earn the degree. Then I would walk free to some other places as I wish to make money to pay back those loans, in a case that I borrowed someone’s money for my education. There was nothing obligatory between me, my countrymen and my country at all to serve or not to serve people. I just “bought” it by my own investment and I had a full right to take any advantages from my own investment. That’s the way the system, capitalism, works in the US.

Lawsuits in medical malpractice are a lucrative business in the US. The doctors have to pay many thousands of dollars a year for “medical malpractice” insurance to protect themselves from lawsuits from their medical practices. In some cases, it was true that some doctors have done something terribly wrong during their treatments. In these particular cases, they deserve to pay for unacceptable and unethical consequences they did. However, in some medical circumstances, their decisions in such an emergency situation lead to unintentionally adverse consequences. In some of these cases, that was the best thing anyone could possibly do there at the moment.

Someone does not think so. Those people coin the word “victim” to make profit from human’s mistakes. The best treatment the doctor can provide at the moment leads to an expensive lawsuit which totally ruins his life and makes the lawyer richer and richer. As a result, expenses in medical treatments are getting higher and higher as anyone can easily observe in routinely increasing health insurance bill.

Hospital which used to be a place for heart and hope had become a place for money and expectation. The souls of Hippocrates and the hearts of Florence Nightingale have long been disappeared. The doctors, dentists, pharmacists and nurses come to work everyday aiming for a good paycheck at the end of the month. For them, it might be just a good career with good pay. There is no sense and pride of serving and helping others in their minds. It’s just an ordinary kind of jobs in the neighborhood. I would not blame them either, they are just ordinary human beings. They do have their own life and their family to keep and raise just like everyone else. The point is they have to spare their money for “the sharks”. All protections need money which all adds up. The system has led them to this point and there might be nothing to do or whine about it. A hospital in the US is a place where I can buy better health as same as I can buy a box of cereal in a supermarket across the street.

In Thailand, Thai people seem to be more forgiving and understanding about these iatrogenic mistakes. They still consider and appreciate the health professions as ones who can help and willingly dedicate themselves to help and serve. They do not sue as much as the Americans do. However an alarming trend in medical-related lawsuits in Thailand has been noticeably increasing over these years. Capitalism might be addictively contagious I presume.

Few years ago, the Thai government has implemented a policy that every visit to any governmental health care facility would cost 30 Thai Baht (approximately 75 cents). This 3-quarters expense covers everything without any conditions. No matter what you are talking about vaccinations for your children, diabetes treatment for your parents, dental care for yourself or major injury from any accidents, all ot them will be 3 quarters per visit. Doctor fee, prescription drug, medical supplies, lab tests are all included in these. This policy ensures that Thai people can seek for medical treatment whenever they need. This policy might seem financially impossible and ludicrous for many critiques, both domestic and international. However, in Thai settings, it seems to be more feasible than settings in the west. Apart from two mentioned strategies, contracts among newly graduated health professions and forgiving will of the Thai, many actions have been taken for quite some time.

For Thailand which is a small and developing country, the use of generic drug substitutions seems to be a more pragmatic approach to a better health with lower and affordable cost. We also respect in intellectual properties. Hence we have also seriously enforced patent laws for newly developed drugs. According to this law, the patented drug will be solely marketed in Thailand for 15 years. After the patent expires, any local pharmaceutical company can register that drug if the company can show that their product is as good as the innovator’s is. I knew that prices of the patent drugs can be reduced significantly shortly after a generic formulation was marketed. For example, in Thailand, a Zocor® 40-mg tablet used to be 80 Thai Baht (approximately 2 USD) before a generic 40-mg simvastatin tablet was launched. It is now reduced to 20 Thai Baht. Interestingly, the same Zocor® sold in Thailand before the advent of a generic product and in the US in the same period had a different price. Zocor® is not surely manufactured in Thailand, it is, in fact, imported from the US. However Zocor® sold in Thailand was 50% cheaper than it was in the US where Zocor® was originally manufactured.

Thus it does not surprise me at all to see many elderly in the US are willing to take a bus across their home country to Canada or Mexico to buy their prescription drugs. From many sources, the US pharmaceutical companies are trying to argue that their research cost has led to a higher price of prescription drugs in the US itself. In my humble opinion, this argument is true but just in part. If I looked back to prices of stocks of pharmaceutical companies and compared those prices in the last ten years, I could see that there were significant increases in leading American pharmaceutical companies such as Pfizer, Eli-Lilly and Merck. Or when I looked into nowadays TV commercials, I could observe that there were a number of them on TV ranging from over-the-counter to prescription drugs. Lastly when I looked into the largest industry in the US, it would turn out to be the pharmaceutical industry. When I learned these facts, I came out with a simple yet reasonable question of why was that.

If the system still runs in the way it has, I am pretty sure that the bus will remain its routes across the border from the US to its destinations either in Canada or Mexico bringing those senior Americans to their hopes to prolong their lives to see a better day of tomorrow. American hospitals will remain “being a market” exchanging a better health for money primarily. A code of ethics and the sacred oaths of Hippocrates will be placed elegantly on the wall as a dried and misunderstood history giving their ways to a human’s basic instincts of greed and the system, capitalism.

Create Date : 16 มีนาคม 2549

Last Update : 17 มีนาคม 2549 0:09:59 น.

11 comments

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อ่านแล้วนึกถึงตอนมาเรียนใหม่ๆ มีอยู่ช่วงนึงดันชะล่าใจ ไม่ซื้อประกันเพราะคิดว่าอยู่เมืองไทยแข็งแรงจะตายไม่เคยต้องไปหาหมอซะที ปรากฎว่าอยู่ดีๆปวดท้องนอนร้องไห้ไปสามวัน จนแฟนทนไม่ไหวจับส่งโรงพยาบาล ผลปรากฎว่าเป็นไส้ติ่งอักเสบ ต้องผ่าตัดทันที ถามหมอว่าค่าผ่าตัดเท่าไหร่ พอหมอบอกว่าราวๆ$10,000เป็นอย่างต่ำ ยังแถมมีค่านู่นค่านี่อีก รีบบอกหมอว่างั้นปล่อยชั้นไปเหอะ ไม่ต้องผ่ามันหรอก ฮือๆ

โดย: M1ku

วันที่: 17 มีนาคม 2549 เวลา:10:40:49 น.

Absolutely agreed on the point. US Health system is suck. Insurance company and politician gain all benefits from this mess. My co-worker has Leukemia last year. Our company paid almost 1 million dollar for his treatments. When the legel allows he got kicked out. Now he is backrupt, the only way for him to get treatment is to be a lab mouse in clinical trial.

โดย: Piglet-Yorkie IP: 12.20.201.125 วันที่: 18 มีนาคม 2549 เวลา:2:17:48 น.

Khun AT, I have some comments on some of what you wrote here. My comments are quite extensive as well.

First, the advancement in medical sciences doesn’t equal free medical care in my opinion. I’m not sure if it is fair to assume that a country with great advancement in medical sciences ought to offer its people free medical care.

From what I understand from your writing (I may be mistaken), it seems that the situations, especially in the Thai medical system, sound almost idealistic. I never worked in a Thai hospital nor at a Thai medical school, so I don’t know the insider’s details (even if I have some colleagues in medical and dental schools).

However, I don’t think (medical) education you have described in the US is necessarily the way you made it sound. Khun BFP, one of the experts in education, may have his own remarks on this. True, it may seem, in a society with capitalism like the US, that money makes the world go around … the world go around … the world go around (borrowed from the Money song from the famous Broadway musical and movie Cabaret). Many undergrads have to pay (or “buy” according to Khun AT) their own way through college (or medical or dental or grad school) unless their parents can afford it. However, the money comes in many forms, including student loans, wages from working part-time, scholarships, assistantships, etc. So it’s not all that bad and I don’t think a lot of students would think of going to college as making that kind of investment and being able to reap all the benefits once they graduate. Why do I say this? Because if that were strictly the case, all Ph.D.s would work in industry and would probably establish their own hi-tech business. There would be so little scientific advancement that allowed free access to the public. There would be so much scientific advancement that everyone needed to pay to get access because it’s all patented. There would be so little breakthroughs in medicine because all the physicians went into private practice allowing them to make much more money than working as faculty in a medical school so that they could teach, do research, and care for patients. Sure, there are some bad apples, but not all of them are rotten.

Further, I think it’s a little unfair to think of these students as heartless souls such that they don’t feel obligated to their country, their countrymen, and whatsoever. You may be right, technically they may not feel that way since, to them, there isn’t a real reason to do that. And is that bad? Uhm, it depends (as you would say, I’m sure). On the other hand, from my interaction with these students, I find that many of them are passionate and devoted. Yes, passionate and devoted to do research, to work diligently and dedicatedly for the advancement of the scientific and medical communities.

I also don’t agree with the way you described physicians in the US in your writing. I’m sure there are some who are like what you just described. However, there are a number of physicians and people who work in the health-related fields who do not just go to work because they know they make a lot of money. They have passion for what they do and they are highly responsible. But believe it or not, the few of those that I know who may behave in such a way you describe are usually those who immigrated to this nation from the asian countires. Just my observation.

In my view, that fact that Thai people seem more forgiving and understanding and so on may be because “they don’t know better” or “they don’t understand it at all”. What do I mean by that? What I simply mean is this; there are an alarmingly large number of illiterate and/or uneducated Thai people, especially in the remote provinces of Thailand. Sometimes when they visit a local not-so-well equipped hygiene center because of some illness and they are treated well, they surely can’t help but to appreciate the treatment they receive gratefully from the medical staff. On the other hand, there are times when they do not obtain a fair and accurate treatment, what do they do? Nothing. They don’t have a heart to bring themselves up against whomever that gives them their unjust medical care. Are they more forgiving? Or are they more understanding? It is hard to say in my opinion. It could simply have to do with the fact that they don’t know better (or they don’t have enough knowledge). They don’t know better because they don’t read or can’t read. They don’t know better because they have no idea about what the doctors are saying. The doctors are always right, in their eye. The doctors are always smart, or so it seems to them.

Now the question is, is that true? Of course not, there is no truth to it at all. The doctors may seem smarter or know more (but not necessarily better) because they might have been more fortunate to have the kind of education that the poor villagers in the remote provinces cannot afford to have. But as Khun AT pointed out, the trend started to change, and I bet, perhaps more so now in a bigger city like Bangkok. Why? While it may be in part because of capitalism, but to me, it’s simply because people are more educated and feel the need to look out for themselves and to take care of themselves better. Thus, it is these people now who bring in another level of professional scrutiny to the medical system in Thailand. And this sometimes can make the Thai physicians, who are for a long time used to the idea that a lot of Thai people would “worship” them and their profession, feel increasingly uncomfortable, inadequate, and patronized.

P.S. With all that said, I agree with your remark on the US pharmaceutical industry though. Unfortunately the leading wealthy pharmaceutical companies operate with not only a scientific set of mind, but also a business and marketing one. In fact, as a lot of concerns have been brought to many discussion forums, the US government could have intervene this disturbing pattern and practice. But so far, it has failed to do so.

โดย: CIT IP: 131.215.11.201 วันที่: 18 มีนาคม 2549 เวลา:9:38:25 น.

I was in the middle of writing an important chapter and followed K. AT's kind invitation to these insightfu discussions on several issues that also have captured my interest.

One would get a better picture of both similarities and differences in terms of health care systems in the two countries, realizing that there are pros and cons as well as a lot of work to be done in both countries. I wish I would have time to join the discussions soon.

Thanks for the invitation, K. AT and thanks also go to the ideas shared above by other friends.

โดย: piangdin IP: 149.159.3.225 วันที่: 25 มีนาคม 2549 เวลา:4:47:12 น.

โดย: Thai Woman IP: 68.48.34.34 วันที่: 28 มีนาคม 2549 เวลา:23:29:40 น.

This is my first time to respond in a personal blog. This is a test.

I pasted my comment in here, but it did not show up.

โดย: Thai Woman IP: 68.48.34.34 วันที่: 28 มีนาคม 2549 เวลา:23:40:37 น.

มาแอบอ่าน

โดย: PatPDX IP: 70.162.170.169 วันที่: 16 เมษายน 2549 เวลา:23:19:53 น.

I agree in some point with Khun amatuer translator and agree with Khun CIT as well.

My only question to ask you regarding pharmaceutical company.

I would ask you, is there any business that do not have to concern about both scientific/technology together with marketing& business? I don't think so.

โดย: นู๋ต้น (dokdakmu@hotmail.com IP: 65.115.19.2 วันที่: 21 พฤษภาคม 2549 เวลา:11:33:57 น.

And the reason that could explain why pharmaceutical industry is much more important. Because as you mention earlier, human live can be categorized in 4 stage; born, get older, sick and death. And obviously that all those stage are significantly related to medical and pharmaceutical field!

โดย: นู๋ต้น (dokdakmu@hotmail.com IP: 65.115.19.2 วันที่: 21 พฤษภาคม 2549 เวลา:11:39:46 น.

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โดย: jin IP: 58.8.108.85 วันที่: 31 กรกฎาคม 2550 เวลา:23:23:06 น.

You did pretty good job so far for an amatuer. Dont be so humble.

โดย: ... IP: 125.24.28.102 วันที่: 2 มกราคม 2551 เวลา:12:49:50 น.