The government’s groundbreaking move to allow Thais to receive universal healthcare treatment at any public hospital has been greeted by cheers – but also fears.
While the policy promises greater convenience for patients, critics warn of potential risks including the collapse of the primary healthcare system and increased public healthcare expenses, as well as overcrowding and excessive workloads at popular hospitals and medical facilities.
“Since this policy may have undesirable impacts, those overseeing its implementation closely must monitor the results and prepare proper guidelines,” said Dr Yot Teerawattananon, a founder of the Health Intervention and Technology Assessment Programme (HITAP).
Research by his team shows that while the policy was formulated to improve Thailand’s healthcare services, make access more convenient and reduce travel expenses, the stakeholders are concerned about its negative effects.
Welcomed with caution
Prof Dr Somsak Tiamkao, who teaches neurology at Khon Kaen University’s Faculty of Medicine, believes the new scheme may prompt patients to skip primary healthcare services in favour of larger hospitals.
Easier access may also place extra burdens on hospitals, he said.
“If it is so easy to seek medical treatment, then some people may opt for treatments that are not immediately necessary. There is also a risk that people will pay less attention to their health because they think they can more easily get medical help for free.”
If this is the case, public health costs could soar to the point where the National Health Security Office (NHSO) cannot sustain the scheme.
Moreover, patients may also face higher costs due to increased travel expenses when seeking medical help far from home.
Somsak also expressed concerns about the redundancy of medical services due to overlaps between bigger hospitals and smaller local facilities.
Dr Chutinard Chin-udomporn, an Operational Doctor Union’s representative working outside the government sector, echoed these concerns.
She noted that health records may not be automatically linked across all participating facilities, leading to redundant services.
“Friends who are government doctors have told me that patients do not bring along their health records from their previous doctor when seeking treatment at a larger hospital because they believe all participating facilities are linked,” she said.
She added that some doctors at large state hospitals expect their workload will increase significantly because many patients believe that the bigger the hospital, the better the care.
“Growing workloads also mean longer queues in hospitals,” she pointed out.
‘Careful implementation vital’
Despite their concerns, both Somsak and Chutinard support the government’s initiative to improve the universal healthcare scheme by allowing beneficiaries to see a doctor at any participating facility.
However, both stress the importance of careful planning and clear communication for effective implementation.
“You need to keep all relevant parties in the loop. If patients and service providers do not have a full understanding of what they can and cannot do, then misunderstandings and conflicts may emerge,” Chutinard said.
Somsak, meanwhile, said that though the policy was positive and well-intentioned, relevant authorities should still focus on encouraging patients to seek treatment at primary healthcare units for the sake of efficiency.
More than 50 million people in Thailand are eligible for free treatment under the universal healthcare scheme.
Until recently, members had to seek basic medical help at hospitals or clinics near their homes.
If the patient’s condition was complex, then they could be referred to secondary or tertiary hospitals.
“We need people to understand that they can still seek primary treatment from a place in their neighbourhood. Dental care, physical therapy and common medicines, for instance, can be provided in their hometown.”
“In these cases, they don’t really have to travel far in the hope of getting treatment from a big hospital,” Somsak said.
Coming to Bangkok soon
The groundbreaking initiative was launched earlier this year as a signature policy of the ruling Pheu Thai Party, which came to power last August.
Dubbed 30Plus, this initiative allows members to use their national ID card at any participating facility on the day of treatment.
If they have lost or misplaced their ID card, they can use their passport or driving licence instead.
The pilot phase kicked off on January 8 in Roi Et, Phetchaburi, Phrae and Narathiwat provinces.
The initiative proved to be a great success and this month, the NHSO expanded 30Plus to 42 more provinces, including Bangkok.
However, implementation of the scheme in Bangkok has been delayed for further preparation as the area of coverage is large.
Currently, the 30Plus scheme is active in 45 provinces, including Nakhon Ratchasima, Chiang Mai, Ayutthaya and Songkhla.
Potential to save lives
Proponents of the scheme say the ability of patients to “self-refer” to larger hospitals will help save lives.
Thiranan Chuayming of civic charity The Mirror Foundation told ThaiPBS TV that had 30Plus been implemented earlier, 42-year-old Pongsak Yaowachai may still be alive.
Pongsak died on June 15 from a brain tumour after his surgeries kept getting delayed due to the complicated referral process of the existing scheme.
“We noticed that he had developed eyesight problems in January and transferred him from Buri Ram to Bangkok for treatment,” Thiranan said. “But it took so long to schedule his first surgery, which was eventually set for May 24.”
The Mirror Foundation has filed a complaint against the NHSO, saying the patient died because one of its clinics delayed Pongsak’s referral to a well-equipped hospital.
“The clinic said in March that it could refer no more than four patients per day,” she said.
Improved access to healthcare
Dentist Porut Yuthai, whose clinic in Sing Buri joined 30Plus more than a month ago, reports positive results.
The number of patients visiting his clinic has risen by 20%, with many of the new patients being elderly people who had never received dental services before.
“They opted for my place because it’s closer to their home. They used to avoid dental treatment because they dreaded the long queues and wait times at state hospitals. Sometimes the queues were so long that patients had to be at the hospital as early as 3am to register,” he said.
By Thai PBS World’s General Desk
