Health Care as an Expat: Insurance or No Insurance?


This is the sort of room I stayed in last fall at Bumrungrad Hospital when I got food poisoning in Bangkok. There was another bed and another guest in the room (an old Thai woman whose family never left her side), but I had space and a sofa for the guests who didn’t come to see me.

I arrived at 1:00 AM after getting sick in my hotel room and hailing a taxi for the hospital. I was taken to the emergency room where I was pretty promptly seen by a doctor (the promptness may have been facilitated by my screaming in abdominal pain). I was given morphine and that stopped the screams quite nicely. Then I was examined and taken to a room like the one above. I did have insurance from my job in Bangladesh, and regularly visit Bumrungrad for medical stuff when I live in SE Asia, so check in was quite straight forward.

I was there for two nights and attended to pretty constantly. My check out bill was less that $100 US. Of course, without insurance it would have been much higher.

So, what is it like if you have no insurance?

Here is information about real costs at Bumrungrad from their website:

Total Knee Replacement
REALCOST estimates are based on the actual invoices patients paid upon leaving our hospital. They include surgical fees, doctor’s fees, medicine, lab tests, room fees… the total bill for the incident of care.
BASED ON DATA: January 2014 – December 2014
Median: THB 479,452 (USD 13,382)
Low: THB 451,417 (USD 12,599)
Only about 1 in 4 cases
cost less than this.
High: THB 535,786 (USD 14,954)
Only about 1 in 4 cases
cost more than this.
Here is a comparison of costs in different countries: (
Country Price (estimates)
Total Replacement Partial Replacement
U.S. $35,000 $17,000
Thailand $15,000 $7,000
Costa Rica $12,000 $6,000
Mexico $9,000 $5,000
India $7,000 $4,000
 No Insurance, or “going naked”:
Going without insurance. to my thinking, is only feasible if you have a reasonably good pension, and/or good investment income. On $1300 a month and a very modest savings, this is not an option for me. I’m fine now, but I’m not 85. We all should know that our health care costs will really go up as we get older.
I’m currently researching countries where there are good affordable health care programs available to expats. So far I’ve been looking at countries in Latin America, and some have great programs. In Columbia and Ecuador, you can get national health insurance and good health care for $100 a month or less. In Nicaragua you can join a hospital cooperative and get good care for a reasonable cost. This week I’ll be doing my homework, as I get my knees checked out in Melbourne, Australia. This is the reason for good insurance – I am sure I am in for some shocking numbers on my knee problems, and will probably appropriately postpone work till I am settled somewhere with insurance.

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