Life is just wonderful…until a medical scare. And for many expatriates and non-locals here in Chiang Mai, when that happens, panic ensues. Where to go? Who to listen to? Who to trust? How much will it cost? Am I making the right decision? Chiang Mai or Bangkok? Or even, home?
Dr. Gerard Lalande, a graduate of Paris XIII Medical School with advanced diplomas in tropical, emergency and aeronautical medicine, is the Chief Medical Officer of LUMA, the Thailand-based international health insurer provider, and has spent more than thirty years working in Southeast Asia, beginning in 1987 and later basing himself in Thailand. Part of his job is, in effect, knowing which hospitals, specialists and medical systems can be trusted with which problems.
“Chiang Mai is amazing,” he told Citylife rather reassuringly, “because the medical school was set up very early on. So this city has always been medically very strong.”
Bangkok remains Thailand’s medical heavyweight, particularly when cases are exceptionally complex. But Chiang Mai is not exactly a provincial medical backwater, either. The reason sits around Suan Dok.
Maharaj Nakorn Chiang Mai Hospital, known locally as Suan Dok, is the teaching hospital of Chiang Mai University’s Faculty of Medicine and the largest teaching hospital in Northern Thailand. Chiang Mai University describes the medical school as the first medical school established in Thailand outside Bangkok.
“Perhaps less famous than Chula and Mahidol’s hospitals,” Dr. Lalande says, “but it is just as excellent in day-to-day management of diseases.”
“Excellence of care,” he adds, “it is the same as the top medical schools in Bangkok.”
Part of the Chiang Mai University medical system is Sriphat Medical Center, the university’s private medical centre which offers specialist consultations, surgery, advanced diagnostic services with relatively fast appointments.
Foreigners can use Sriphat, and the private setting gives patients access to university specialists without necessarily paying the prices of a fully private international hospital.
The trade-off can be waiting time.
Take an appendectomy. The figures Dr. Lalande found on websites of medical centers, which are indicative and vary by case, put an open appendectomy at Suan Dok’s public wing at roughly 15,000 to 25,000 baht. The same operation at Sriphat is around 55,000 to 70,000 baht. A laparoscopic, or keyhole, appendectomy at Sriphat is around 100,000 to 120,000 baht, while the same type of procedure at a leading private hospital in Chaing Mai can run around 200,000 to 245,000 baht.
One city. One appendix. Four different prices!
Of course, the price difference is not simply a question of one hospital being good and another being bad. Private international hospitals offer speed, comfort, English-language support and a level of service many patients quite reasonably value, particularly when they are frightened and unwell. The university system offers something different: access to academic specialists and a major teaching hospital, often at considerably lower cost.
The trick is knowing which you need.
And that is not always something a patient can work out for themselves. A broken arm is one thing. A new cancer diagnosis, a recommendation for major surgery, a rare condition or a treatment plan is a whole other. Those are the moments when a second opinion becomes less of a luxury and more of a sensible and essential precaution.
When local is enough
For many everyday illnesses and injuries, there is absolutely no reason to get on a plane.
Chiang Mai has a large pool of specialists and a level of medical infrastructure that is unusual outside Bangkok. The city also has considerable experience with complicated medicine. The Chiang Mai heart centre, for example, performs more than 1,000 open-heart procedures a year, according to Dr. Lalande.
Case volume is important, we are told. A surgical team performing a complicated procedure hundreds of times is likely to have a different level of experience from one that performs it occasionally.
The more difficult question is what happens when the problem itself is difficult.
Modern medicine increasingly depends on teams rather than one brilliant doctor sitting alone in a room. Cancer is perhaps the clearest example. A serious cancer case must be handled by surgeons, oncologists, radiologists, pathologists and other specialists looking at the same patient and the same information.
“A serious cancer, you need ten to twelve doctors sitting around the table,” says Dr. Lalande.
Chiang Mai has that sort of academic and multidisciplinary capacity. The Suan Dok Breast Cancer Network, for example, brings breast surgeons, radiation oncologists and medical oncologists together to discuss cases and formulate treatment plans based on international guidelines of breast cancer management.
It is one thing to have a CT scanner, it is another to have the right people sitting around a table interpreting what it has found.
When you should ask again
This is also where the less comfortable side of private healthcare comes in.
Most doctors are perfectly capable and ethical. But healthcare everywhere has a medical side and a business side. As Dr. Lalande puts it, “There could be a lot of add-ons and unnecessary stuff going on.”
A patient may be recommended additional tests or procedures which are not truly medically necessary. Sometimes they are harmless. Sometimes they are expensive. Sometimes they can even carry risks of their own. And if you spend part of your insurance limit on things you didn’t need, there is less available when you really do.
This is where LUMA’s Medipro service comes in.
Medipro is a medical advisory service available to LUMA members, with an international medical team that helps patients navigate the healthcare system. It can be used before seeing a doctor, when a patient needs help finding the appropriate specialist; after a consultation, when a diagnosis or treatment plan is unclear; or when something serious has been diagnosed and another opinion is warranted.
The aim, as Dr. Lalande describes it, is straightforward.
“We want the patients to get the right care at the right time.”
And he is equally clear about why Medipro does not simply recommend hospitals.
“We don’t refer to hospitals. In any hospital, anywhere, experience varies from one doctor to the next. We want to make sure that our patient falls into the arms of the right doctor.”
So, when to go to Bangkok?
There are still some limits to what Chiang Mai can provide.
Transplant cases, according to Dr. Lalande, are still referred to Bangkok. And there are some highly specialised treatments that are simply not available here, such as diseases that are best treated with proton therapy, which is currently only available at King Chulalongkorn Memorial Hospital.
But needing Bangkok does not mean Chiang Mai has failed.
Much of the diagnosis, surgery, chemotherapy and conventional radiotherapy required for cancer care is available in Chiang Mai, and the city’s university medical system has a substantial history of multidisciplinary oncology care.
Needing Bangkok is not a judgement on Chiang Mai.
It usually means that one specific treatment, piece of equipment or specialist centre exists there and not here. The care available is different, not better.
And sometimes the sensible choice is neither.
For an expatriate with family in another country, returning home may make more sense, particularly for a long course of treatment. Cost, family support, treatment length and insurance coverage all come into the calculation.
This is precisely the sort of decision Medipro is designed to help with.
Chiang Mai versus the islands
The difference shows when Chiang Mai is compared with other popular expatriate destinations in Thailand.
Dr. Lalande sees it among LUMA’s own members.
“We have many of our members in the islands or beaches,” he says. “There are fewer options available to them.”
The issue is not that these places have no good doctors. They do. It is the depth behind them that differs. Fewer specialists, fewer standing multidisciplinary teams, and fewer facilities equipped for a case that turns complicated.
Chiang Mai has a medical school, a major university teaching hospital, a large specialist base and established multidisciplinary services. Other provincial centres may have excellent individual doctors and capable hospitals, but they lack the academic infrastructure behind them.
That distinction becomes important when something goes seriously wrong.
The other medical decision: Insurance
There is another decision which is considerably easier to make before you are sick and this is where LUMA steps in rather well.
Health insurance is designed to cover new conditions. If a condition already exists before applying, it may be treated as pre-existing and excluded from cover, or accepted with a premium loading. And if a policy lapses, anything that happens during the gap can create problems when applying again.
In other words, waiting until you have a medical problem to think about insurance is rather like waiting until the house is burning to investigate fire insurance.
LUMA has operated since 2012, providing health and travel insurance for people living and travelling in Thailand and Southeast Asia. Its current health plans range from lower-cost options to PRIME plans with annual cover of up to 50 million baht and guaranteed renewal to age 99, subject to the policy terms and continuous cover.
There are also options for outpatient, dental, vision and maternity cover, deductibles to reduce premiums, and group insurance for companies.
Dr. Lalande’s warning to younger people is simple. “Age is not protection.”
Motorcycle accidents do not check your birth certificate before happening. Neither does appendicitis. Neither does cancer.
“One accident can seriously impair your life without insurance,” he says. “It is important to have a layer of protection, that can allow you to promptly get optimal management of care.”
Travel insurance is a different matter. LUMA offers it for people moving around the region, but Dr. Lalande is clear that it is not a substitute for health cover. It is designed for unforeseen events on a trip, including treatment, evacuation and repatriation. It does not cover the health and wellbeing side of life, which matters more as you get older.
Digital nomads sit somewhere in between, and that is where the gap opens up. Someone spending years moving between countries on travel policies has cover for emergencies and nothing for the long term. Policy terms vary too, and a condition that arises or is treated during one period of cover can affect how the next insurer assesses it.
Where a nomad settles matters as well. Anyone based in Chiang Mai has the university medical system within reach, which means academic specialists and high quality care without a fully private hospital bill. Not every part of the country offers that.
So, do you need to go to Bangkok?
Sometimes…but certainly not every time.
For the expat living in Chiang Mai, the reassuring news is that the city has considerably more medical depth than its size might suggest. Maharaj Nakorn Chiang Mai and Chiang Mai University’s Faculty of Medicine provide an academic foundation that most provincial destinations simply do not have. Sriphat provides another route into that system for those who want private care.
And when something genuinely falls outside Chiang Mai’s capabilities, Bangkok is close.
The harder problem is knowing when you have reached that point.
Most of us cannot judge whether a diagnosis is correct, whether an operation is necessary, whether the proposed specialist performs enough of that particular procedure, or whether there is another treatment worth considering. We ask friends, search Google and hope the doctor sitting opposite us knows what he or she is doing.
Sometimes that is enough. Sometimes it isn’t.
That is the space Medipro occupies within LUMA’s health insurance: not replacing the doctor, not simply directing patients towards a particular hospital, but providing another layer of medical judgement when the stakes become higher.
After more than thirty years working around Southeast Asia, Dr. Lalande has seen how the healthcare systems have differences.
His point about Chiang Mai is a structural one. A city with a medical school behind it can handle a great deal more than most people assume, and most of what goes wrong will never need a flight anywhere.
That leaves the more useful question. Not Chiang Mai or Bangkok, but whether this particular case needs something that is only available in Bangkok. That is a medical judgement rather than a guess, and it is worth getting one before you get on a plane.
