At 59, Wan needs to visit a doctor every four months to keep her hypertension and high cholesterol under control. So, she ends up being a factor in hospital overcrowding and has to suffer long queues for treatment.

“I turned up at 7am today and waited until 1.30 to see a doctor. Then, I had to wait till nearly 3pm to get my medicines,” she said.

Wan ranks among 47 million Thais who are covered by the universal healthcare scheme, under which citizens receive most medical services for free. The main providers of these services are state hospitals, which operate under the Public Health Ministry.

Records show that the number of outpatient visits almost doubled from 155 million in 2013 to 300 million in 2017. Queues have thus become longer at state hospitals. This is putting an increasingly severe strain on both patients and medical staff, more and more of whom are complaining of exhaustion.

At some overcrowded hospitals, patients are unable to see a doctor without a prior appointment even if they queue up as early as 6-7am.

Initiatives to ease hospital overcrowding 

The Public Health Ministry and the National Health Security Office (NHSO), which manages the universal healthcare coverage scheme, have tried to ease hospital overcrowding with several initiatives.

For example, patients with non-communicable diseases are now permitted to pick up medicines from their local pharmacy instead of a hospital. And some hospitals refer patients with non-serious conditions to clinics for treatment.

Khon Kaen University medical lecturer Dr Somsak Tiamkho believes the role of primary-care pharmacies in providing public healthcare should be expanded even further to help ease overcrowding and benefit patients.

“I think the NHSO should encourage people to consult well-trained pharmacists and get the medicines they need at a quality pharmacy near their home,” Somsak said.

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Pharmacists can help

According to Somsak, about 80% of outpatients at hospitals are suffering from non-communicable diseases. Of this group, at least one-third have stable conditions and need only regular doses of medicine. In other words, they can be taken care of by pharmacists.

“If we promote such an initiative seriously, hospital overcrowding will significantly ease,” the medical lecturer said.

Although blood tests cannot be offered by pharmacies, patients can still use them to measure their blood pressure and blood sugar level. They can also consult pharmacists about their symptoms to get the medicines they need.

“If we could match quality pharmacies with mentoring hospitals, that would be even better,” Somsak commented.

He believes that the social security scheme and the health scheme for civil servants and family members should consider implementing this initiative as well.

Pharmacies’ current roles

In October 2019, the universal healthcare scheme introduced the “Pharmacies Near Your Home” service. It enables patients with chronic illnesses like diabetes, hypertension, asthma or psychiatric disorders to receive medicines from pharmacies close to their residences.

A total of 1,081 pharmacies and 29,299 patients participated in the project in 2019. Patients in the 61-75 age group, where chronic illnesses are common, have so far received 54,730 batches of medicine from pharmacies under the service, which is offered by 141 hospitals.

Dr Roongnapa Khampang, a researcher at the Health Systems Research Institute, cited a survey showing each patient saved an average of 58 minutes by visiting pharmacies instead of hospitals.

The survey was conducted at 15 hospitals, where overcrowding was found to have fallen by 8.5%.

“Patients’ travel expenses dropped by 71% and patients’ counseling time rose by three minutes,” she said, based on the survey’s findings.

Moreover, the survey showed patients participating in the project were “very satisfied” with the services. They were happy that they could save time, avoid making long trips, and benefit from attentive pharmacists.

Roongnapa said patients who managed to avoid overcrowded hospitals were also at lower risk of contracting communicable diseases.

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Some patients still reluctant

The same survey found that a huge number of patients declined to use the service because they wanted to see a doctor, did not have a pharmacy in their neighborhood, or were worried about the quality of pharmacies.

Wan, who frequently braves huge crowds at a state hospital, said she continued to see her doctor at the hospital because she needed assurance that she had not developed complications as a result of her health condition.

“If there were a choice of alternate visits to a hospital and pharmacy, I would be interested,” the 59-year-old said. “But if the service means I can only visit the pharmacy, I am not okay with it.”

Roongnapa said more patients would use the service if doctors themselves recommended it.

Pharmacy services for common illnesses

Napa, who sells congee for a living in Bangkok, recently checked into a pharmacy near her home to pick up free medicine for her sore throat. It was the second time she had used the service since the NHSO started providing free medicines for 16 types of minor illnesses via participating pharmacies last November.

“I am impressed. It’s convenient, free, and good,” she said.

She praised the service as a practical and effective solution given the fact that she herself is reluctant to visit a hospital for minor illnesses.

A total of 1,081 pharmacies are participating in the initiative, said NHSO secretary-general Jadej Thammatacharee. In the seven months up to July 4, the service was used by 174,554 people and saw 305,913 trips to pharmacies. Of these trips, 123,725 were to pick up medicines for fever, cough, and/or sore throat. Other visits were mostly related to joint/muscular pain, rashes, stomach ache, eye issues, headache, diarrhea, nausea, toothache, and minor injuries.

The service is not perfect, however.

“Sometimes, there are other customers in the store and I am not able to serve people right away,” said a pharmacist at Pho Thong Osoth pharmacy in Betong district, Yala.

Another common problem is that she is often unable to follow up on patients’ conditions after three days – a rule in service delivery.

“If their condition doesn’t improve within three days, I have to recommend they visit a doctor,” she said.

Records show that 97.5% of patients who use the service recover within three days, said Preecha Bhandtivej, a pharmacist association executive.

“The response has been positive. The use of pharmacies for this purpose is good because they are close to communities and their operating hours make them more convenient for people,” Preecha said.

By Thai PBS World