'Fights loom over emergency care'
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Heads of national health schemes fear clashes with patients unless conditions are spelt out to public
The rush to give citizens free access to emergency medical services from any hospital – while a progressive advance in public health policy – could cause clashes between patients and doctors due to a lack of clarity.
“The confrontation between healthcare providers and patients was the biggest concern for the committee of the three national healthcare schemes,” Dr Winai Sawasdivorn, secretary-general of the National Health Security Office (NHSO), told The Nation recently.
The authorities have yet to identify which diseases or conditions are eligible for emergency medical services.
“It’s not so easy to make people understand the emergency conditions that will be treated. We will absolutely have a lot of problems in the future,” he said.
Many prestigious private hospitals have also not confirmed their participation in the plan due to the lack of detail about funding reimbursement.
Starting on April 1, the three national healthcare schemes – NHSO, Social Security Fund and Civil Servant Medical Benefit Plan – will provide unlimited emergency care to all patients regardless of which scheme they belong to.
Patients just need to show their national identification card to receive emergency medical services at the nearest hospital. They will be treated until they recover. The NHSO will pay the hospital directly for their medical bills.
“We are now looking for a way to explain and communicate with people. We will find easy words on what the emergency conditions are and what kind of condition will put their lives at risk,” Dr Winai said.
NHSO will hold a press conference tomorrow to inform the public about the definition of “emergency”.
It will also build understanding among its officials including medical staff who are the heads of emergency wards at the 300 health service units across the country.
“At least, they will be the first person to see the patient and explain to them about the conditions,” he said.
Prime Minister Yingluck Shinawatra had instructed him to produce plastic banners and put them up in front of hospitals to show and explain emergency medical conditions to people, he said.
The unclear definition of emergency medical conditions also worried Dr Suradej Waleeittikul, deputy secretary-general of the Social Security Fund.
“It will lead to misunderstanding between patients and medical workers. This will be a big problem in the near future,” he predicted.
For example, a patient who suddenly blanks out might think he is having an emergency, but he or she may have just skipped breakfast and lacked sleep the night before.
Suradej said if medical workers did not explain sufficiently about emergency conditions to patients there would be conflicts between them.
“Saving people’s lives is the most important duty for physicians during emergency hours. What would you [medical workers] do if someone collapsed in front of your hospital? Is this an emergency case?” he asked.
Winai said the new healthcare benefit would help patients suffering from severe conditions during emergency hours to receive immediate medical attention at the nearest hospital.
“If you remember the Santika pub fire a few years back, we found that patients from this accident were not sent to the nearest hospitals. Some of them were asked to show their patient’s card. Some of them were
immediately charged for medical services instead of receiving treatment. We hope this problem will no longer exist under the new healthcare benefit,” he said.
Preeyanant Lorsermvattana, chairwoman of the Patient Network, said she hoped the government’s new policy on healthcare would reduce obstacles for patients to access emergency treatment.
Dr Pongsak Viddayakorn, director and executive adviser to Bangkok Dusit Medical Services, a private hospital chain, also raised the possibility of confrontations between hospital medical workers and patients due to any unclear definition of emergency care and unclear remuneration for hospitals.
“Being sued for medical malpractice was one of our biggest fears about joining the new healthcare scheme,” he said.
The hospital and network would join the first phase of the emergency care scheme and see if they should remain as members.
“We will withdraw from the scheme if the government pays us with small funds that are not enough to cover our expenses, as this will affect the treatment for patients,” he said.
“This is not about corporate social responsibility. It’s about the standard of care to save a patient’s life,” he added.
Authorities have said they would pay attending hospitals at least Bt10,500 per condition. The reimbursement rate would rise according to the severity of each condition. For example, it could go well above Bt100,000 for a heart operation.
But this rate is not enough for upscale private hospitals to cover their medical costs.
