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Ankle Fusion Treatment Cost in Thailand

Do you know why most of the accidents registered in the world's book of accident consist of a higher percentage of teenagers? Yeah, you might be thinking that this has something to do with them being teenagers it’s a straight no. The reason is adrenaline; the high boost of nitro level which is often found in teenagers which is often the reason for these accidents and accidents can occur from any type of falling, from the tree or road accident or bad landing after jump etc. The first thing which gets most affected is your leg which contains this ankle joint. This is the most fragile joint in the body. But sometimes this is not the only reason for ankle fusion surgery; sometimes the surgery is due to arthritis which is a serious problem for the old age people. As we know that in today's time everything is just a touch away & our body is not used for this type of relaxation this makes the bones & joints fragile not taking proper nutrients or calcium is also the reason for having a fragile bone in the body so this the primary reason for arthritis Sometimes it is genetic or an accident which happened in childhood & didn’t receive proper treatment.

This ankle fusion fills the gap between the joints and emits out the reason for having the joint not to work properly. The surgery process for ankle fusion is not some space science, in fact, it is very easy. First they inject some anaesthesia into the patient body so that they don't feel any pain during the surgery then they make a cut around the ankle that makes easy for them to perform the surgery and by making sure that they are gaining access to the part of action on which surgery is going to be performed they insert a metal piece in that gap which ensures the working between the joints properly. Then after the suggested time for rest, the patient will be able to walk properly.

Pros of ankle fusion surgery

• It will help you to walk properly- After the surgery, the surgeon will give you a prescription which will include the details of rest and the further processes involved. So, just follow that properly and then feel the spirit of walking.

• It will give back your life- We only know the value of something when it's gone but having that back again will increase its value more.

• Some surgeries won't even require the complicated metal piece.

Cons of ankle fusion surgery

• Other joints get affected by this surgery

• If proper rest not taken then this surgery might result in failure.

• Having a minor accident after this surgery might result in permanent failure of that body part. So being cautious every time is the primary factor of this surgery.

Cost comparison

Basically, this depends on the type of surgery you are opting for is it an ankle fusion surgery or fully ankle replacement surgery. Does the surgery requires a metal piece or is it the surgery without metal piece so after deciding the type of surgery for your condition the surgeon will describe its costing and procedure.

In the USA it costs around USD 66K-80K this is the highest of all countries then followed by the UK with some decrease in numbers around 50K in euros then followed by Singapore and Malaysia they cost around 7k-9K USD which can be referred as a medium line. Then the lowest goes to India and then to Thailand, which will be around 5K USD. Sometime the patients health also matters if he/she is having a previous record of any illness which might affect the surgery in any way then that patient will have to stay some days before and after the surgery for proper treatment because if not done so it might result in the failure of surgery and then the further consequences will be worse.

Country wise cost comparison for Ankle Fusion Surgery:

CountryCostLocal_currency
CzechiaUSD 5240Czechia 118896
GreeceUSD 7000Greece 6440
HungaryUSD 5000Hungary 1742800
IndiaUSD 4010India 333432
IsraelUSD 20000Israel 76000
LithuaniaUSD 3090Lithuania 2843
South KoreaUSD 12000South Korea 16112280
SpainUSD 22000Spain 20240
TunisiaUSD 3900Tunisia 12129
TurkeyUSD 7020Turkey 211583
United KingdomUSD 6230United Kingdom 4922

Treatment and Cost

15

Total Days
In Country
  • 3 Day in Hospital
  • 2 No. Travelers
  • 12 Days Outside Hospital

Treatment cost

USD3500 - USD7000

9 Hospitals


Types of Ankle Fusion Surgery in Piyavate Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6054 - 16761216396 - 606600
Ankle Arthrodesis6061 - 10883219177 - 390215
Open Ankle Fusion Surgery9166 - 14564324157 - 525505
Arthroscopic Ankle Fusion10902 - 16346386533 - 581696
Minimally Invasive Ankle Fusion12725 - 16939464172 - 615558
External Fixation Ankle Fusion14702 - 17110514485 - 610089
  • Address: Piyavate Hospital, Khlong Samsen Road, Bang Kapi, Huai Khwang, Bangkok, Thailand
  • Facilities related to Piyavate Hospital: Choice of Meals, Interpreter, TV inside room, Accommodation, Airport Transfer

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SPECIALITIES

5+

FACILITIES & AMENITIES

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Types of Ankle Fusion Surgery in Krabi Nakharin International Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6180 - 17294212810 - 604629
Ankle Arthrodesis6070 - 10852217394 - 388704
Open Ankle Fusion Surgery9119 - 14738323018 - 520654
Arthroscopic Ankle Fusion10887 - 16130398278 - 588220
Minimally Invasive Ankle Fusion12846 - 17218455534 - 597989
External Fixation Ankle Fusion14558 - 16954517602 - 604488
  • Address: Krabi Nakharin International Hospital, Pak Nam, Mueang Krabi District, Krabi, Thailand
  • Facilities related to Krabi Nakharin International Hospital: Health Insurance Coordination, Mobility Accessible Rooms, Private Rooms, Religious Facilities, Nursery / Nanny Services

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1

DOCTORS IN 5 SPECIALITIES

15+

FACILITIES & AMENITIES


Types of Ankle Fusion Surgery in Phyathai 2 International Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6025 - 16891221369 - 604832
Ankle Arthrodesis6050 - 10828212084 - 381466
Open Ankle Fusion Surgery9113 - 14740322725 - 513448
Arthroscopic Ankle Fusion11136 - 16217383144 - 580852
Minimally Invasive Ankle Fusion12981 - 17292457525 - 617305
External Fixation Ankle Fusion14567 - 17293519329 - 610338
  • Address: Phyathai 2 Hospital, Phahonyothin Road, Phaya Thai, Thailand
  • Facilities related to Phyathai 2 International Hospital: Choice of Meals, Interpreter, SIM, TV inside room, Accommodation

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DOCTORS IN 11 SPECIALITIES

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Types of Ankle Fusion Surgery in Kasemrad Ramkhamhaeng Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6183 - 16936220232 - 618825
Ankle Arthrodesis6090 - 11163216410 - 396360
Open Ankle Fusion Surgery8933 - 14288318167 - 513267
Arthroscopic Ankle Fusion10860 - 16303387860 - 574061
Minimally Invasive Ankle Fusion12590 - 17131449723 - 601459
External Fixation Ankle Fusion14759 - 16977523882 - 608811
  • Address: kasemrad hospital ramkamhang Ramkhamhaeng Road, Saphan Sung, Bangkok, Thailand
  • Facilities related to Kasemrad Ramkhamhaeng Hospital: Online Doctor Consultation, Post operative followup, Mobility Accessible Rooms, Rehabilitation, Religious Facilities

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14

DOCTORS IN 8 SPECIALITIES

19+

FACILITIES & AMENITIES


Types of Ankle Fusion Surgery in Vejthani Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6129 - 17213219623 - 597707
Ankle Arthrodesis5996 - 10706215563 - 392356
Open Ankle Fusion Surgery9154 - 14512318562 - 510280
Arthroscopic Ankle Fusion11160 - 16175384814 - 595605
Minimally Invasive Ankle Fusion13015 - 17358445977 - 622716
External Fixation Ankle Fusion14887 - 16954528316 - 598205
  • Address: Vejthani Hospital, 1 Soi Lat Phrao 111 Klong-Chan Bangkapi Bangkok, Thailand
  • Facilities related to Vejthani Hospital: Choice of Meals, Interpreter, SIM, TV inside room, Accommodation

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50

DOCTORS IN 13 SPECIALITIES

6+

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Types of Ankle Fusion Surgery in Bangpakok 9 International Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6178 - 16807219253 - 605137
Ankle Arthrodesis6069 - 11152220168 - 390384
Open Ankle Fusion Surgery9010 - 14560320188 - 519034
Arthroscopic Ankle Fusion10698 - 16659383674 - 592631
Minimally Invasive Ankle Fusion12951 - 17281459677 - 615326
External Fixation Ankle Fusion14530 - 16975511760 - 615886
  • Address: Bangpakok 9 International Hospital, International Hospital, Rama II Road, Bang Mot, Chom Thong, Bangkok, Thailand
  • Facilities related to Bangpakok 9 International Hospital: Choice of Meals, Interpreter, SIM, TV inside room, Accommodation

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51

DOCTORS IN 13 SPECIALITIES

6+

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Types of Ankle Fusion Surgery in MALI Interdisciplinary Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)5488 - 15459195511 - 548943
Ankle Arthrodesis5489 - 9878195756 - 350721
Open Ankle Fusion Surgery8255 - 13208292760 - 467417
Arthroscopic Ankle Fusion9830 - 14787352124 - 525893
Minimally Invasive Ankle Fusion11532 - 15409411994 - 547387
External Fixation Ankle Fusion13163 - 15413469489 - 551912
  • Address: MALI Interdisciplinary Hospital, Ekkachai 85 Alley, Bang Bon, Bangkok, Thailand
  • Facilities related to MALI Interdisciplinary Hospital: Choice of Meals, Interpreter, SIM, Accommodation, Airport Transfer

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5

DOCTORS IN 12 SPECIALITIES

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Types of Ankle Fusion Surgery in Bangkok Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6073 - 16956214067 - 620069
Ankle Arthrodesis6102 - 10778213905 - 386500
Open Ankle Fusion Surgery8982 - 14313327486 - 530278
Arthroscopic Ankle Fusion11023 - 16723391845 - 580350
Minimally Invasive Ankle Fusion12608 - 17343450864 - 599733
External Fixation Ankle Fusion14392 - 16837526300 - 599682
  • Address: Bangkok Dusit Medical Services, Nong Prue, Bang Phli, Samut Prakan, Thailand
  • Facilities related to Bangkok Hospital: SIM, TV inside room, Accommodation, Choice of Meals

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42

DOCTORS IN 13 SPECIALITIES

4+

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Types of Ankle Fusion Surgery in Sikarin Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (THB)
Ankle Fusion Surgery (Overall)6177 - 17404212615 - 620154
Ankle Arthrodesis6102 - 11045212261 - 397601
Open Ankle Fusion Surgery9116 - 14795328000 - 524830
Arthroscopic Ankle Fusion11120 - 16536397929 - 590366
Minimally Invasive Ankle Fusion12642 - 17125457544 - 618715
External Fixation Ankle Fusion14771 - 17272509022 - 601639
  • Address: Sikarin Hospital, Lasalle Road, Bang Na, Bangkok, Thailand
  • Facilities related to Sikarin Hospital: Interpreter, SIM, TV inside room, Airport Transfer, Choice of Meals

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SPECIALITIES

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FACILITIES & AMENITIES

Other Related Hospitals


Parkway East Hospital located in Joo Chiat Pl, Singapore is accredited by JCI. Also listed below are some of the most prominent infrastructural details:

  • Total capacity for 143 beds
  • Hospital rooms are available- Single room, 2-bedded room (8), 4-bedded room (2), Deluxe room, and Orchid/Hibiscus Suite
  • All rooms are equipped with all ensuite facilities like Free wifi, mini fridge, sofa couch, telephone, in-room safe, TV, etc.
  • Maternity wards- Accredited as a baby-friendly hospital under the World Health Organisations Baby-Friendly Hospital Initiative (BFHI)
  • 1 Neonatal Intensive Care Unit (NICU) with 14 cots
  • Intensive Care Unit
  • 1 Operation Theatre with 5 Operating rooms
  • 1 Nursery with 30 cots
  • 1 Parentcraft room
  • 24-hour walk-in-clinic (for emergency)
  • 24-hour Pharmacy

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SPECIALITIES

15+

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Types of Ankle Fusion Surgery in Medanta - The Medicity and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (INR)
Ankle Fusion Surgery (Overall)5117 - 9179416211 - 738400
Ankle Arthrodesis2285 - 4553184792 - 376912
Open Ankle Fusion Surgery3392 - 6771282236 - 546488
Arthroscopic Ankle Fusion4489 - 7723362084 - 634038
Minimally Invasive Ankle Fusion5707 - 9114466324 - 740330
External Fixation Ankle Fusion6775 - 9054550097 - 736341
  • Address: Medanta The Medicity, Medicity, Islampur Colony, Sector 38, Gurugram, Haryana, India
  • Facilities related to Medanta - The Medicity: Mobility Accessible Rooms, TV in room, Religious Facilities, Health Insurance Coordination, Cafe

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61

DOCTORS IN 14 SPECIALITIES

18+

FACILITIES & AMENITIES


Mount Elizabeth Hospital located in Singapore, Singapore is accredited by JCI. Also listed below are some of the most prominent infrastructural details:

  • 345 bedded Hospital
  • Maternity wards
  • The Mount Elizabeth Patient Assistance Centre (MPAC)
  • 1 major operating unit with 12 operating rooms and 1 operating theatre dedicated to in vitro fertilisation (IVF)
  • Intensive Care Unit
  • High Dependency Unit (HDU)
  • Neonatal Intensive Care Unit (NICU)
  • Accident & Emergency Department
  • Rooms are categorized as Single rooms, 2-bedded rooms, 4-bedded rooms, Executive deluxe suite, Daffodil/Magnolia suite, VIP Room, and Royal Suite
  • All patient rooms are equipped with electric safe, LCD, sofa cum bed, wardrobe, radio channels, and much more
  • Parking lot

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SPECIALITIES

20+

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Types of Ankle Fusion Surgery in Apollo Hospitals and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (INR)
Ankle Fusion Surgery (Overall)4998 - 8906406893 - 737050
Ankle Arthrodesis2241 - 4524187920 - 374431
Open Ankle Fusion Surgery3338 - 6855281663 - 556829
Arthroscopic Ankle Fusion4532 - 8049364545 - 656191
Minimally Invasive Ankle Fusion5735 - 8924467069 - 735277
External Fixation Ankle Fusion6665 - 9128543269 - 734050
  • Address: Apollo Hospitals Jubilee Hills, Film Nagar, Hyderabad, Telangana, India
  • Facilities related to Apollo Hospitals: Post operative followup, Mobility Accessible Rooms, Online Doctor Consultation, Air Ambulance, Religious Facilities

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36

DOCTORS IN 14 SPECIALITIES

20+

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Types of Ankle Fusion Surgery in Venkateshwar Hospital and its associated cost

Treatment OptionApproximate Cost Range (USD)Approximate Cost Range (INR)
Ankle Fusion Surgery (Overall)4584 - 8111372914 - 667037
Ankle Arthrodesis2032 - 4045165648 - 331317
Open Ankle Fusion Surgery3057 - 6116250673 - 497728
Arthroscopic Ankle Fusion4056 - 7119332567 - 584099
Minimally Invasive Ankle Fusion5051 - 8088415247 - 665863
External Fixation Ankle Fusion6073 - 8150498068 - 663961
  • Address: Venkateshwar Hospital, Sector 18, Sector 18A, Dwarka, Delhi, India
  • Facilities related to Venkateshwar Hospital: Post operative followup, Mobility Accessible Rooms, Online Doctor Consultation, Air Ambulance, Religious Facilities

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36

DOCTORS IN 13 SPECIALITIES

20+

FACILITIES & AMENITIES


Gleneagles Hospital located in Napier Road, Singapore is accredited by JCI. Also listed below are some of the most prominent infrastructural details:

  • 270+ bedded medical facility, which includes suites, single rooms, two-bedded, four-bedded rooms and maternity wards (9 delivery rooms)
  • 12 operating rooms
  • Surgery ward with 40 beds
  • State-of- the-art intensive care unit (ICU) with 16 beds
  • State-of- the-art neonatal intensive care unit (NICU) with 14 cots
  • Separate transplant unit
  • Endoscopy Centre (VIP room)
  • 24-hour accident and emergency (A&E) and outpatient Unit
  • Accommodation availability for the patients
  • The Hospital has a dedicated Patient Assistance Centre, which is to cater to multi-faceted needs of international patients. It provides services like air evacuation and repatriation, visa application and extension, language interpretation assistance, etc.

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SPECIALITIES

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About the Ankle Fusion Surgery

What is Ankle Fusion Surgery

Ankle fusion operation, also known as ankle arthrodesis, is a surgical procedure conducted to close the joint space by joining the bones that make up the ankle joint.

Your ankle joint is an articulation of three bones. These three bones are known as the tibia, fibula, and the talus. During ankle fusion operation, the cartilage covering the bony surface of the ankle joint is scraped off. The diseased part of the bones is also trimmed.

Next, the newly exposed bony surface of the tibia and the talus are placed in close contact. Additionally, they are compressed using screws. New bone formation takes place in and around the joint resulting infusion of the bones into a single bone.

Candidates for Ankle Fusion Surgery

Ankle fusion operation is recommended for patients experiencing unbearable pain during ankle movement. The pain may result because of the following reasons:

  • Joint wear and tear
  • Rheumatoid arthritis
  • Post-traumatic arthritis
  • Infection in or around the joint
  • Neuromuscular disease
  • Failure of previous non-surgical treatment

Not all patients with the aforementioned conditions are always suitable for ankle fusion. Patients with the following characteristics are not suggested to undergo this surgery:

  • Insufficient quantity and quality of bone
  • Severe deformity in the leg
  • Vascular diseases that prevent proper healing

How is Ankle Fusion Surgery performed?

During the surgery, you are given either local anaesthesia or sedation to numb the entire ankle area. The doctor makes a small cut on the lateral side of the ankle through the skin so that the joint can be seen clearly. If more visibility is needed, the doctor makes an extra cut in the front of the ankle.

The doctor then uses a saw to remove the articular cartilage on the surface of the joint bones. The diseased bone is removed, exposing the healthy part of the bone. The healthy bone surfaces are compressed using large screws. The bones join naturally through deposition of bone material as is the case with natural fracture healing.

Sometimes, a doctor may place an artificial bone graft or a bone grafted from your fibula to ensure fast healing of the bony surfaces. Before placing the screws, the doctor carefully positions the ankle to ensure maximum movement possible. The ankle is placed at 90 degrees to the lower leg and the heel is slightly outwards. Then the skin is brought back in place and sutured together.

Recovery from Ankle Fusion Surgery

Ankle fusion recovery time depends on how seriously you take the following precautions after the surgery:

  • You need to keep the leg raised and give yourself cold compression to avoid swelling.
  • You may sometimes feel tingling sensation early in the morning once you put your leg down. This is because sudden rush of blood towards the ankle when you change the position from an elevated position.
  • You should take pain medicines as directed by your doctor.
  • You should come back to the hospital 10 to 15 days after the surgery to get the stitches removed.
  • You will have to carry the splint for 6 to 12 weeks.
  • Your doctor will put you on a no-weight bearing program for 6 to 12 weeks. This period can be extended if your doctor finds that healing is not fair enough.
  • You will be advised to go ahead with gentle physiotherapy after removal of splints to prevent stiffness in joints.

Alternate treatment options:

Arthroscopic ankle fusion surgery: This procedure is similar to the open ankle fusion surgery. However, the incision is very small and the entire procedure is carried out by inserting an instrument that has a camera attached to one end. It helps the doctor clearly view the interior cartilage and bones. Faster recovery and healing are the two advantages of this approach.

Ankle joint replacement: During this procedure, the entire ankle joint is replaced. The advantage of this technique over ankle fusion is that it retains complete movement of the ankle.

Ankle Fusion Recovery Time

  • The minimum time that it takes to recover from fusion recovery is between 12 to 15 weeks.
  • During the first 6 to 8 weeks, you are not supposed to put any weight on the ankle. If you do anything like that, it may disturb the natural healing of the joint.
  • During 8 to 10 weeks of a recovery period, your doctor will advise you to get an X-ray done. If the healing is good, you will be allowed to conduct the light physical activity with the help of cast boots.
  • During 10 to 12 weeks, you can increase the physical activity, but you will be asked to take help of supportive ankle devices.

Patient Stories

Ask your healthcare adviser for the best multiple options and choose the one that meets your expectations

Frequently Asked Questions

Why go for Ankle Fusion Surgery in Thailand?
As per the availability of surgeons and hospitals with quite low fees which definitely include world-class treatment Thailand is the best place for having an ankle fusion surgery. The services and hospitality are the same as that you will get in other countries so getting down in coasting doesn't mean that we are compromising with the quality.
What is the cost of Ankle Fusion Surgery cost in Thailand?
The cost might vary from hospital to hospital as not all the hospitals' works on the same principle, but the difference in the cost is unnoticeable. In any hospital, the surgery would cost around 7K-8K USD including all the services are included in this costing.
Which are the top Hospitals and top Orthopedic Surgeons for Ankle Fusion Surgery in Thailand?

Thailand is known for some of the best hospitals and clinics for Ankle Fusion Surgery. There are plenty of hospitals and clinic for ankle fusion surgery in Thailand; some of them are named as follows: Bangkok Dusit Medical Service, Yanhee international hospital.

Which are the best cities for Ankle Fusion Surgery in Thailand?
Bangkok & Krabi are the two major cities where all these hospitals situated that deals with ankle fusion surgery and ankle replacement surgery. There are plenty of other too but according to comfort and reach, these two cities are much popular than any other cities in Thailand for surgery.

FAQ's Related to Thailand

Which are the popular multispecialty hospital groups in Thailand?

The hospitals in Thailand are renowned for their clinical care and personal touch they bring to every patients' well being. The option of having several specialties at one place makes it easy for any medical traveller to compare and explore their treatment options within several hospitals. The specialists in these hospitals are recognised globally as the best of treatment is provided by them. We bring to you some names of the multispecialty hospital groups such as:

  1. Bangkok Dusit Medical Services (BDMS),
  2. Bumrungrad International Hospital, Bangkok,
  3. Vejthani Hospital, Bangkok,
  4. BNH Hospital, Bangkok,
  5. Yanhee Hospital, Bangkok,
  6. Sikarin International Hospital, Bangkok,
  7. Princ Hospital Suvarnabhumi, Bangkok,
  8. Samitivej Sukhumvit Hospital, Bangkok,
  9. Bangkok International Hospital, Bangkok,
  10. The Bangkok Christian Hospital, Bangkok,
  11. Phyathai Hospitals, Bangkok,
  12. Saint Louis Hospital, Bangkok and,
  13. Central General Hospital, Bangkok.
What is the quality of doctors in Thailand?

Thailand has always been considered to be a one of the top medical destinations in the world. Their doctors and surgeons are considered to be on par with the world's best medical specialists. The doctors are well versed in their field of expertise and their skiils are vouched for by various experts. Innovation aiding medical care implementation has ensured that the quality of doctors in Thailand is unmatched. Experience in treating international patients has meant that Thai doctors are sought after from the world over.

What are the popular procedures available in Thailand?

Thailand is a medical tourism hub for various reasons. Low prices, excellent healthcare systems and numerous tourist attractions together ensure that remains one. There are many popular procedures available in Thailand. Following is the list of some of the most popular procedures in Thailand:

  1. Eyelid surgery procedures,
  2. Rhinoplasty,
  3. Breast augmentation,
  4. Laser treatment,
  5. Dental treatments,
  6. Spine and orthopaedic treatments,
  7. Cardiac treatments,
  8. Infertility treatments,
  9. Bariatric surgery,
  10. Ophthalmology and eye surgery.
What are the other facilities provided by hospitals in Thailand?

The latest technological advancements ensure that Thailand hospitals are able to achieve success in different kinds of procedures. There is a center for international patients in the hospitals in Thailand which caters to all the travel, transfer and accomodation needs of patients and their co travellers. Integrated medical support services and emergency services are present at Thailand hospitals. There are a variety of medical facilities available in Thailand hospitals such as radiology services, operating theaters, Intensive care units, cardiac care units, diagnostic laboratory and pharmacies.