I saw this on Fraser Nelson’s Substack (it seems everyone has a Substack these days). The British journalist has been to Thailand with his wife, and noted this positive healthcare outcome in Thailand:
Thai private hospitals are a phenomenon. I had a foot complaint that had me hobbling around London for months, wearing trainers into the office. My local GP was of no use; I wasted money on private MRI scans and consultants trying to diagnose the problem. Nothing worked. But when I went into Wattanapat hospital in Aonang the problem was diagnosed, surgery carried out and completed all within 90 minutes. I felt like Lazarus for the rest of the holiday. In Bangkok, one of my friends had a trapped nerve in her leg – which was diagnosed and treated in two hours. She walked in without an appointment and was never unattended for more than a few minutes. Blood tests, x-rays, intravenous painkillers, specialist diagnosis, treatment pathway for when she returned home: all for 7,500 bhat (~£175). I was operated on by the same doctor who diagnosed me: they don’t seem to fragment it into specialities. I paid about £400. The UK has a good private health sector, but money cannot buy the integration or speed that Thai hospitals offer.
I found out later that people now travel to Thailand to bypass European hospital logjams. Most Thai private hospitals hold Joint Commission International (JCI) accreditation, a gold standard for global healthcare quality with ~350 standards for things like surgical hygiene, anaesthesia protocols, medical personnel qualifications and patient safety. I suspect most NHS trusts would fail to meet this standard, even though they cost far more money. UK private healthcare is more a premium-priced overlay on NHS infrastructure rather than a reimagined delivery model. Thailand shows what proper integration achieves: clinical outcomes Western healthcare once promised but increasingly fails to deliver.
I had the same frustrating experience in dealing with my own ankle/knee pain issues about six years ago, but unlike Nelson, I did not fly thousands of miles to get treated (which clearly has to be factored in for the health tourist equation to work. But then Fraser Nelson was in the country anyway on holiday.) I have private medical cover, but did not use it on this occasion, and got sorted with specially made insoles, and did physio and various exercises – including barbell lifts such as the deadlift – to strengthen my knees, and so forth. I am a lot better and feel fitter than when I was a decade younger.
Whatever the specifics, the example given from Thailand shows that the UK’s free-at-the-point-of-use system has major faults, because there’s less of a price incentive to focus on what people are looking for, and therefore fresh sources of supply aren’t drawn in. Prices are information carriers, and like a clogged artery, a healthcare system run on socialist lines can produce the national equivalent of a stroke. (This in some ways describes the economy of the UK.)
Healthcare needs a sharp dose of capitalism along with green veggies and a daily walk. Think of how under free market healthcare, technologies such as 3-D printing/processing scale up production, in a customised way, of items such as hip replacement parts, knee replacement parts, insoles, and other things. This tech already is being used, but under a more market-based UK system, this will accelerate. The toolkit that is promised by AI could really drive change in a positive way (and I am not as starry eyed about AI as some might be). Healthcare needs its Jobs, Dyson and Rockefeller.
Anyway , thoughts about health and wellbeing often crop up in the cold, post-Christmas days of January, so it is time for me to hit the weights. Wishing everyone here a happy 2026.
Its not really fair to compare the two, because the cost of living is so far different in the two countries. The salary it takes to have a ‘doctor lifestyle’ in Thailand would be far lower than the UK. Ditto all the other people who work in the system. And lower down the people doing all the grunt work (maintaining buildings, cleaning, logistics etc etc) are paid a fraction of their UK equivalent.
Yes of course a privately run system should be more efficient than the State run behemoth NHS, but the fixed costs of doing business in the UK (where the State regulates and taxes everything to an inch of its life, and minimum wages means everything costs more) means that just transporting the Thai private healthcare system to the UK would mean we would pay largely the same as we do now if we go private, as thats just what it costs to do anything in the UK. The only way we have anything approaching Thai healthcare costs is if all the UK regulations and taxes were abolished. Even then UK wage levels would mean the cost would be many times that currently paid in Thailand.
Reminds me of the tourist dentistry in Mexico for US types.
Good work for 1/3 the price.
(Most Americans don’t have comprehensive dentistry insurance, so it’s mostly paid for out of pocket – which makes it easy to compare values. The work is just as good, but the pay rates in Mexico are so much lower that the work is much cheaper. Also, in the US, you are backed by rather comprehensive malpractice insurance for dentists – and that adds a LOT to your bill. Not sure what coverage is required or standard for Mexican dentists.)
(ETA: Point being (about insurance), if your dentist screws up your mouth in the US, you’ll have access to rather high malpractice coverage, but in Mexico, you might get a refund.)
Yes Jonathan Pearce – paying up-front for medical treatment is likely to result in vastly lower costs.
It should be remembered that health insurance only became fashionable in the United States with World War II wage controls – companies could not offer higher wages, so they offered health insurance instead.
The poor were looked after either by fraternities (adult fraternities – of which most people were members, this is forgotten now) or free hospitals maintained by voluntary donation – which was also the case in the United Kingdom.
The NHS “inherited” (stole) about half a million hospital beds – there are now, with a vast larger population, only a bit over 100 thousand hospital beds.
As for my own experience of the NHS – I went for a prostrate cancer examination appointment, only to be told “don’t you know there is a strike on?” Silly me for turning up when I was told to do so.
That may not matter in my case – but a lot of people want to live, and the NHS lets them die.
Cost is one thing, but the diagnostic and treatment skills are more striking.
Just one comment on this — I find it interesting that everyone (including me) has a huge amount to say about the Venezuelan invasion, but there is little commentary here about the healthcare disaster in our country. Clearly healthcare is much more relevant to our day to day lives especially as we all get older, than foreign policy, even gunboat diplomacy. I think it shows how politics has twisted our priorities so far out of shape. Politicians LOVE those big foreign adventures to make them historic, and have history books and international prizes. But somehow the day to day grind of making the lives of their people better is buried under this. Politicians and I suppose the news, have this ability to misdirect us from what is important, what will actually impact our daily lives, with these big showy things. Perhaps because invading Venezuela is a lot easier than fixing the healthcare crisis on-going in the US and Britain.
I’m baffled as to when Trump became a neocon rather than a MAGA guy. I mean he still wears the hat and everything. Its like we have John Bolton for our President.
BTW, what is the solution to Healthcare in the USA, and similar in the UK? The answer is the simple one that the market has always offered. Free markets, competition, real insurance, deregulation, and the reduction in the costs of litigation. The reason for escalating healthcare costs are many, but administrative costs has skyrocketed (especially since Obamacare), prices are hidden, medical insurance doesn’t work, malpractice insurance is ridiculously expensive, patents drive up the cost of drugs and devices, and there is practically no competition in the market.
To give a simple example I have given before. For a diabetic it’ll cost you maybe $400-800 a month for insulin. However, exactly the same product can be bought in Mexico for maybe $20-50. So, if I were an enterprising sort, I’d get a refrigerated truck, drive down to Mexico, buy out the stock everywhere, and drive it back to the US and sell it. I’d make a lot of money, the Mexican pharmacies would too, and diabetics would save a fortune. So why not do it? Because it is against the law. Pharma companies have erected price discrimination at the border to prevent this.
A huge amount of the cost of healthcare is just transaction costs imposed by the government and big pharma. It is hard to break it down, but the cost of personnel is surprisingly small (especially since the US has broadened things with allowing nurses to do more, and introducing intermediate levels like PAs.) It is all the other bullshit that makes it so expensive.
If you look here this guy shows his $41,000 bill for an appendectomy, without personnel — which is about the simplest operation possible. Some of the costs are just “like WTF”.
https://kffhealthnews.org/news/appendicitis-is-painful-add-a-41212-surgery-bill-to-the-misery/
By comparison, in a truly competitive environment of elective cosmetic surgery, a boob job probably costs $5000, which is a much more complicated operation and uses plastic surgeons who are among the best paid doctors in the profession.
I was in Thailand visiting my wife’s family about 10 years ago when our daughter came down with a weird rash on her left forearm. My sister-in-law took us around to a local private hospital in Bangkok to get it checked out. We waited about 15 minutes and were ushered into an examining room where a qualified, US-trained, dermatologist took a look. asked a few questions then wrote a prescription for some cream and some tablets. We took it down to the hospital pharmacy where it was promptly filled and we were sent on our way. The entire duration of the visit was a little over an hour and the cost was about 1,400 baht or about $42 US. The medications had daughter’s condition cleared up in a couple of days. .
Jonathan Bailey – excellent Sir, that is how things should be.
Fraser Orr – your writing on health care is quite correct.
However, even limited reform will be stopped by “Leader Thune” who will say “I do not have 60 votes in the Senate”.
When asked where this “filibuster rule” is in the Constitution of the United States, establishmentarians have no answer.
This made-up “filibuster rule” is a perfect excuse for establishmentarians to do nothing about health reform – or anything else.
I live in Thailand and can confirm from personal experience that the state system is superior to the NHS and the private hospitals are world standard.
I can recommend Cyprus for cancer treatment; thd German Oncology Institute in Limassol was excellent.