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Published on March 31, 2008

Late one night, Samorn Sirinanta, 71, felt a chest pain and found it difficult to breathe. She was sent to a government hospital and admitted to the cardiac intensive care unit.

She had her heart condition checked with an electrocardiogram, blood test and chest X-ray.

The ECG provides the pattern of heart activity to help identify the cause of chest pain.

With the results, the doctor said she probably had acute coronary syndrome, meaning there was blockage in some of her coronary arteries. In other words, she had heart disease.

The doctor recommended further checks with an echocardiogram and coronary angiogram.

He told her that the echocardiogram would show the anatomical structure of her heart, while the angiogram would show the structure of her heart vessels.

The next day, the doctor performed both tests. Then, he told her that she really had coronary atherosclerotic heart disease, as some plaque had blocked her heart vessels, causing the chest pain and difficulty in breathing.

He recommended her to get a coronary artery bypass graft (CABG) and asked whether she was willing to have the operation.

Samorn was reluctant at first, asking whether she had any other choices besides surgery.

"Actually there is another way to treat heart disease, such as coronary intervention by using balloon angioplasty and stenting. But in your case, this treatment isn't suitable as you have multiple sites of stenosis in your heart vessels," he told her.

Coronary "stenting" is introducing an intravascular stent made of rigid wire mesh with a guide-wire into a blood vessel and expanding it into place by a balloon.

However, she wanted to discuss the treatment with her family before making any decision. The next day, she told the doctor that she wanted to go ahead with the heart operation. Then, a cardiac surgeon explained the operating procedure and possible complications, including death during the operation.

The operation queue was quite long and she was told to wait for six months. During this period, she would be provided medical treatment, as her situation was not an emergency. Samorn had also responded well to the initial drug treatment.

Then, she received medical treatment regularly.

Six months later, she was admitted on schedule.

The doctor had Samorn blood-checked and prepared for the heart operation for two days. Then she was asked by the hospital staff how she would pay for her treatment. Samorn said she wanted to use the Bt30 universal healthcare scheme for the cost of the operation.

On the operation date, she got four coronary artery bypass grafts.

She stayed in the surgical cardiac care unit for three days until she recovered enough to be transferred to a ward.

Samorn rested in the hospital ward for seven days until the doctor allowed her to rest at home with some medicine.

For follow-up, she needed to meet the doctor again in two weeks to have her operation wound examined. Then, the doctor wanted her to come in for check-ups every three months for the rest of her life.

With the Bt30 healthcare scheme, Samorn's heart operation was free in a state hospital, though she may have to pay for some special drugs that are off the Public Health Ministry's national drug list.

If she were a civil servant or her sons were state officials, the whole cost of the heart operation could be waived. She might need to pay some additional cost for a special room and food, if needed.

Another way to cover heart-disease treatment bills is the social security system. However, Samorn had already retired, so she could not use her social security card at the hospital.

However, it is widely known that the quality at state hospitals is much lower than in private hospitals in terms of service and drugs. Patients on the universal healthcare, social security or civil-service welfare plan won't be charged for medicines if they get them only from the Public Health Ministry's National List of Essential Drugs. Otherwise, they have to pay additional expenses for unlisted drugs, which mostly are expensive original medicines from overseas.

If Samorn had decided to have her heart operation in a private hospital where services and treatment standards are much better, things would have been much different. She would have had to pay for the actual cost, which could be almost Bt1 million.

The state hospital would have booked the treatment cost from actual costs, the medical-care price quoted by the Finance Ministry, and then the government would pay in the case of the Bt30 universal scheme or civil-service patients. The Social Security Fund will also subsidise the operation cost for its members.

The average actual cost of a CABG operation in state hospitals is Bt150,000-Bt300,000.

Jiwamol Kanoksilp

The Nation