I guess I just don’t understand that system. I lived in a 3rd world country (Guatemala) for 2 years and access to doctors, pharmacists and even a few physician’s assistants was expensive but still affordable for just about anyone. If you couldn’t pay, there was always some connection to get medical care.
The system here is complex. Very complex. Needlessly so. Read on if you want to work on a classic migraine.
First, all Thai's that cannot afford their own insurance, roughly 80% of the population, are assigned a hospital according to their location. Thus they get what services that particular hospital offers. Then the government implemented a form of socialized medical for that strata of the population. 30 baht, a bout $1, deductible, at that particular facility. The physicians that perform services under this program get, as you can imagine, chump change pay for their services. So every center of population has one or more welfare hospitals which are very often bare bones. The hospital local to me is typical. Acute care but no regular PoD. All emergencies brought there go into a holding pattern until the doc shows. Their diagnostics are limited to an x-ray facility and what the nurses have been trained to do. They can do 12 leads as example, as the most sophisticated cardio run up.
Then there are several million transient workers that are not Thai nationals. If the worker is highly valued, the employer buys insurance. Common laborers however go to the welfare hospitals where they go into a queue behind the Thai nationals, first come, first served. The queues can be several days long for non emergencies.
Then there are a few million hill tribe peoples. They are stateless but may apply for temporary status with immigration where they could qualify as a Thai for the 30 baht medical. My mother in law as example.
And then a LOT of illegal immigrants. The conflicts in Burma supply a never ending stream of these people. They are all considered hill tribe and thought of government wise as trying to bilk the system.
The above is somewhat simplified.
So as an example, my wife, Thai national assigned to a reasonably upscale hospital. She required a CAT scan. Only the upscale hospital has one. I took her there and they required a 5,000 baht up front deposit. Quite normal.
Another example. We have one hospital in the area that handles HIV positive or active AIDS patients. If no private insurance, the population for about 100 miles in all directions has to go there.
But on the bright side, Thailand is miles above Laos next door, and much of Cambodia. We have a constant stream of border jumpers trying to sneak into the Thai medical system. Then down in Malaysia it's first world more or less and below that, Singapore which beats all medical systems in the US cold. So it's all about locale to locale.
So, for this woman mentioned in the OP. She's on the 30 baht medical. Her condition is off the books. Childhood diseases are purely live with it. She makes decent money, $15 a day, but has a family to take care of. All totaled about 12 people. So she has no savings and no spare money for any medical care. She was brought to my attention, a facilitator, and I threw her hat in the ring with some NGOs. Fishing. If one or more of those are willing to take her on she goes on their waiting list. When she comes up to the top inquiries with physicians will start. The physician usually wants to know what s/he will be getting into. So I got a heads up. She will be coming up on the waiting list. Start the wheels turning. Thus my fishing here, getting some vague idea of which physicians to canvas for when her name comes up.
Since the physicians will almost certainly be working on a limited budget, we do doctor juggling. Some will take in any patient we send. With those there is always a waiting list and prioritization is required. Avoiding wearing out his good graces. This in itself can get pretty complex as I'm sure you can imagine. Maybe one doc will see her and instantly want to toss her to a specialist. Another doc is a qualified specialist but his gratis work is back logged for months. Some docs work gratis, but any diagnostic equipment supplied by a hospital has to be paid for up front. And so on.
Then in the case of this low priority woman, she will probably need therapy. Repeat the canvassing there and logistics will probably enter into it as she may get a therapist a hundred miles off.
PS Snivel and ***** time. And recently a monkey wrench tossed into the works. We utilize clinics a lot for rudimentary diagnostics. Then a certain president implemented the Mexico City Policy, the global gag rule, and we lost about 80% of the clinics. Many had to shutter completely, numerous others severely curtailed what services they offer.
