When Nancy Cuevas Guzman came to Thailand for abdominal and arm liposuction, she initially intended to have the surgery at Bangkok Hospital, which provided an estimate of 280,000 baht using the Body Tite technique.
She was also considering the World Medical Center (WMC), a newly established hospital on Chaeng Wattana Road, which offered a 300,000 baht package for liposuction of the arms, abdomen and fat transfer to the face, according to a quote provided by the hospital to her medical travel agency Caremondo.
When she travelled to Thailand to speak to Jakrin Bunchongkit, a plastic surgeon at WMC, she claims she was offered a more attractive deal which included fat transfer to the face, hands and buttocks, the latter known as the Brazilian Butt Lift, which could cost US$5,000 (175,000 baht) in the US. The estimate for the new package was 500,000 baht, which included a 30,000 baht discount.
The surgery was performed on May 1 and took seven hours. Ms Guzman was shocked to be woken up after anaesthesia and told they did not complete the surgery and would schedule a second operation in a week.
"Dr Jakirn had already marked up my hands for fat injections the day of the surgery. But he never finished the job, electing instead to draw it out over two surgery days to drive the costs up. I would never have agreed to this," said the 60-year-old American, who now resides in Spain.
Two days later, Ms Guzman was given a second estimate form, which showed a cost of 250,000 baht for the fat transfer to the face and hands.
She said she refused to sign the form, and demanded the hospital pay back the 123,060 baht they had charged her as a deposit. By then, she said she had already paid 623,060 baht. WMC has since refunded the deposit.
On May 8, Ms Guzman filed a complaint against WMC at the Pak Kret police station. Pak Kret police could not be reached for comment for this story.
Ms Guzman contacted her agent from Caremondo, who requested an invoice from WMC on her behalf.
"They have charged me for things I did not have and the itemised overcharges are out of this world," said Ms Guzman after receiving the invoice on June 1.
Nine types of surgical gloves totalling 10,746 baht were listed. One type of glove was sold retail for 2,040 baht for 40 pairs, according to one online medical supplier.
WMC charged 3,510 baht for gauzes, 7,420 baht for disposable gowns and 28,613 baht for the compression garments that she claimed Dr Jakrin has promised would be provided free of charge. She was charged 13,600 baht for an above-the-knee girdle set, which she said she never received.
"They told me several times in the meetings that WMC had nothing to do with what Dr Jakrin charged," said Ms Guzman. "But no other hospital charges that much for those procedures in Thailand, in the US or in Europe."
But WMC director Adisorn Patradul insisted it was made clear that the procedure would be divided into two operations due to the complications that might occur if the process is too long.
He defended the high medical bill, saying that "it's the same everywhere, at all hospitals". The surgical gloves, for instance, were of high quality and a large number were used during the seven-hour operation.
"The price depends on the satisfaction [of the doctor and patient]. We even had a foreign patient undergo a nose job costing one million baht here at the hospital," said Dr Adisorn, who is a former dean of Chulalongkorn University's Faculty of Medicine.
Dr Adisorn told Spectrum the hospital would be willing to offer a partial refund for the operation, provided Ms Guzman agrees not to publicise her allegations in the media. Ms Guzman declined the offer.
'A MAGIC NUMBER'
All hospitals are required under Thai law to display rates for medical treatment. While some hospitals such as Bumrungrad provide price estimates for several medical procedures on its website, WMC does not.
An American who recently called the hospital to ask for the price of breast augmentation was told to send an inquiry via email, and that the cost would depend on the size and the doctor, since "different doctors can charge different fees". When asked for a range, a hospital staff member gave her an estimate of 150,000-300,000 baht.
Dr Adisorn said surgeries at WMC are usually combined into "packages", and that the price varies according to the doctor performing the operation.
WMC is a three-year-old private hospital under the SET-listed Bangkok Chain Hospital Plc (BCH), which operates 11 hospitals.
BCH recorded a net profit of 527.33 million baht last year, up from 521.87 million in 2014. Total revenue was 5.85 billion baht, up from 5.38 billion in 2014, according to the SET. WMC alone earns around 60% of its revenue from foreign patients, with 30 Australians flying in per month for treatment, said Dr Adisorn.
Pongpat Patanavanich, secretary-general of the Thai Private Hospitals Association, said although hospitals operate on the basis of a free market, all are required to have a price list which patients can refer to for an estimated cost of treatment.
Section 32 of the 1998 Sanatorium Act made it mandatory for all private healthcare facilities to openly display their rates for medical treatment, service charges and the rights of patients. In practice, most clinics and hospitals have not complied, instead claiming they can refer patients to books where they can look up the prices.
Section 33 also prohibits hospitals from demanding a treatment fee or service charge other than displayed. Violation of the former carries a fine of up to 10,000 baht, while the latter carries a maximum fine of 20,000 baht.
Dr Pongpat reasoned that since there are tens of thousands of listings, it is impossible for hospitals to openly display the rates on the wall. In practice, most hospitals place a sign on the wall saying patients may ask for medical fees prior to seeking treatment. All hospitals keep a price list detailing all medical procedures, he said. "Hospitals can't just come up with a magic number for the treatment cost," he said, referring to the problem in general.
INCREASING DEMAND
Viroj NaRanong, research director for health economics and agriculture at the Thailand Development Research Institute, said price controls don't address the heart of the problem and are not a practical solution.
On the surface, it might look like certain items are being charged at an unreasonable rate, which might be true in some cases, he said. But the main reason for the skyrocketing increases in prices in private hospitals is the increasing demand for services.
The domestic demand for private health care has increased substantially -- along with the relatively high growth of the Thai economy in the past three to four decades. Private hospitals now have about half of all hospital beds, even though their main customers account for less than 20% of the population, said Mr Viroj.
Another new but important development is the recent influx of medical travellers to Thailand, which has spiralled in the past 10-15 years.
"Their purchasing power is even greater than the rich and middle class. Thais used to be the only customers of the private hospitals," said Mr Viroj. He said the demand from wealthy foreigners has become the main driver of the private healthcare price tags, and that Thailand's restrictions on employing foreign doctors and nurses had also contributed to the slower expansion of supply.
An outpatient visit to a medium to high-end private hospital for a simple illness often costs 2,000 baht or so, and an overnight stay can cost 20,000-50,000 baht or more.
Instead of price controls, Mr Viroj has previously proposed a system to collect a specific tax from medical tourists.
Not only did the private sector oppose the idea fiercely, it has continued to push the government to use more taxpayer money to help promote Thailand as a "medical hub" to bring in even more foreign patients, claiming the medical tourists would benefit the economy via their spending on other goods and services.
UNIVERSAL HEALTH CARE
Another measure that Mr Viroj proposes is to improve the quality of the universal coverage healthcare schemes.
"If this is achievable, private hospitals would be just an alternative and they would have to compete with the free or low-price services available from the public schemes," said Mr Viroj. "Then the few remaining unusual cases can be dealt with on a case-by-case basis by a designated organisation or committee."
Thailand achieved universal healthcare coverage in 2002, but many rich and middle-class Thais still opt out and continue to seek medical treatment from private hospitals.
The 30 baht healthcare scheme, which was initiated by former prime minister Thaksin Shinawatra, guaranteed coverage for visits to state hospitals. The scheme benefits about 47 million people -- two-thirds of the population -- but Prime Minister Prayut Chan-o-cha has branded it a "costly populist" policy.
Mr Viroj said it is unlikely access to the scheme will be improved, or the quality of government hospitals will be increased, since there continues to be division over the 30 baht scheme.
"Government leaders continue to complain about the cost of the 30 baht scheme while approving high military budgets," said Mr Viroj. "Meanwhile, the rich and the middle class are not willing to pay higher taxes and don't want the government to allocate a huge budget for those schemes that they don't see themselves using."
ONE-STOP SERVICE
In May last year, the Thai Medical Error Network (TMEN) submitted a petition with more than 33,000 signatures to the government calling for the establishment of a special panel to control medical fees charged by private hospitals, which they argue are excessive.
Following the petition, Gen Prayut instructed the Public Health and Commerce ministries to set standard median prices for medical care and medicines at private hospitals.
"The premier wanted the ministries to ensure the difference in prices quoted by private and state-run hospitals for the same treatment was not excessive," deputy government spokesman Sansern Kaewkamnerd quoted Gen Prayut as saying. "He said he was concerned that if private hospitals overcharge patients -- especially foreigners -- it could adversely affect the country's aim to become a healthcare hub."
A committee was formed comprising private hospitals, the Pharmacy Council of Thailand, Food and Drug Administration, Internal Trade Department, academics from the pharmacy faculties of various universities and representatives of the public. But TMEN president Preeyanan Lorsermvattana said progress has stalled since the new public health minister took up the position late last year, with only one meeting held in March. Ms Preeyanan is active in helping people who believe they have been overcharged by private hospitals, many of whom have gone broke over high medical fees. Although she doesn't keep track of the number of complaints, she says several are from expats and medical tourists.
The Health Service Support Department (HSS) has the authority under the Sanatorium Act to investigate such complaints, and does so by checking whether the items on the bills match the hospital's price list. But Ms Preeyanan said the process is time-consuming, since the HSS often refers the matters to relevant agencies such as the Internal Trade Department in the case of medicine or medical supplies. If the complaint involves doctor fees, the case is sent to the Thai Medical Council.
Ms Preeyanan doesn't follow up on the complaints raised to her, but said that state agencies are ineffective in resolving problems related to high medical fees. She claims that there are many cases involving hospitals charging a different price than what appears on their price list, and they are not punished.
"People who come to me to seek help usually get back to me if everything goes OK. But since no one has ever given me good news, I assume that nothing has been done," she said. "I am not against private hospitals, but they must not overcharge patients."
Anyone who has been through a similar experience at a Thai hospital is encouraged to contact Nanchanok Wongsamuth at nanchanokw@bangkokpost.co.th.
BEFORE AND AFTER: Cosmetic surgery patient Nancy Cuevas Guzman received liposuction on her abdomen. Ms Guzman has filed a complaint against WMC. PHOTO: SPUPPLIED/Nancy Cuevas Guzman
HOSPITAL LEADER: WMC director Adisorn Patridul, centre, has defended the medical bill. PHOTO: World Medical Center website
PRE-OP: From left, Nancy Guzman, Dr Bunchongkit Jakrin and a nurse. Ms Guzman claims she was charged for procedures she did not have and overcharged for certain items. PHOTO: SUPPLIED/Nancy Cuevas Guzman
SLICE AND DICE: Sixty per cent of World Medical Center's revenue comes from foreign patients, with around 30 Australians flying in per month for treatment. PHOTO: www.youtube.com
