Care system sadly in an unhealthy state

Less than 10 days after the Prayut Chan-o-cha government implemented the Universal Coverage for Emergency Patients (Ucep) scheme which requires private hospitals to accept emergency patients within 72 hours, Natee Sarawaree suffered a cerebral haemorrhage after a fall. Without consciousness, he was rushed to the nearest private hospital, which admitted him presumably as a patient under the so-called “red category”, meaning his condition was critical and required immediate treatment. A transfer to the state hospital he was registered with was ruled out as it was deemed too risky. And under the new scheme the hospital is prohibited from rejecting a patient in the red category.

Natee, a housing rights activist, received brain surgery at the private hospital and recovered. He was supposed to be discharged without having to pay for the medical bills as the hospital is supposed to reimburse the cost from the state under the so-called “fee schedule” system, which features a listing of fee maximums that is used for reimbursement on a fee-for-service basis.

According to the Ucep principle, the state, through any of the three health schemes — namely the Universal Healthcare Coverage scheme, the Civil Servant Welfare and the Social Security Scheme — that a patient originally registers with will pay for the treatment cost for the first 72 hours after the admission.

But Mr Natee faced an unexpected problem.

After the surgery, the activist was told by the hospital that it placed him under the less serious yellow category, which means he had to pay for the treatment, accounting for 400,000 baht. That prompted his family to seek donations.

In Mr Natee’s case, the Public Health Ministry eventually stepped in and, after investigation, it ruled that the activist was a red category patient and can benefit from Ucep. Although the case unfolded favourably for the patient, it indicates there is a loophole in implementing the new scheme, especially when there lacks a clear definition of emergency.

In fact, there have been similar cases to that of Mr Natee since the scheme, which was then known as the emergency care scheme, was launched in 2012 under the Yingluck Shinawatra government. Under the original scheme, private hospital operators gave cooperation on a voluntary basis.

It remains unclear if Mr Natee’s case was resolved because he happens to be a well-known activist.

The National Health Security Office (NHSO), which then managed the scheme, said it received 119 complaints from patients from October 2016 to February 2017 as some participating private hospital operators recategorised the patients and eventually charged medical fees.

According to the NHSO, 261 out of 370 private hospitals in Thailand voluntarily joined the scheme since it took effect in 2012 until November 2016. Before Ucep, participating private hospital operators made reimbursements on a diagnosis-related gauge.

There are reports that some private hospital operators were reluctant to accept emergency patients as they may not be able to make full reimbursement for treatment costs. They claimed that running private hospitals requires more budget as they offer higher salaries to medical personnel and obtain more expensive high-tech equipment, plus marketing costs.

But when the Prayut cabinet approved the Ucep proposal on March 28, as proposed by the Public Health Ministry, it also revised the Sanatorium Act that would penalise hospital operators if they reject emergency patients who require immediate medical treatment. The penalty is a maximum two-year imprisonment, a 40,000 baht fine, or both. It also placed the scheme under a newly established National Institute for Emergency Medicine (NIEM), which reports to the public health minister.

The government should be praised for making a bold decision in upgrading the healthcare system and implementing the Ucep. It is a big step in improving the welfare of less privileged people.

But as Mr Natee’s case demonstrates, there are problems when it comes to practice. What the government, in particular the NIEM, should do further is to make sure that the scheme runs smoothly with efficiency, closing the gap between patients and private hospital operators, especially on the definition of emergency patients.

The institute must assist the needy patients and guarantee that they will be treated fairly and fully benefit from the Ucep and, at the same time, make sure that the fee schedule is fair with transparent calculating processes.

It remains unclear if Mr Natee’s case was eventually resolved in favour of the patient because he happens to be a well-known activist. But that should not be the case. All patients should get similar benefits from the new scheme. In so doing, the National Institute for Emergency Medicine should engage in an active PR campaign to make sure less privileged people are well aware of their rights and get the access to the scheme.

It requires an attitude change on the part of the private hospital operators in accepting the scheme and becoming more active in providing welfare, not just making profits.