DEBATE is raging on over differences in quality and unequal treatment under the country's three healthcare schemes.
Dr Surasak Kantachuvesiri, a kidney expert at Mahidol University’s Ramathibodi Hospital, has claimed that there was a rather high fatality rate among kidney disease patients under the Universal Coverage Scheme (UCS) because the scheme limits patients to undergo peritoneal dialysis first. The Social Security Scheme (SSS), meanwhile, was worse, he said, as kidney patients must first cover treatment costs of about Bt30,000 per month for up to three months until their coverage is approved. Surasak said they also have to cover the Bt6,000 per month expense of dialysis liquid.
Khon Kaen University kidney disease division chief Dr Thawee Siriwong has argued that the fatality rate of kidney patients covered by UCS who undergo dialysis is within international standards. He said most patients were ailing elderly people, so their risk level was already high. Treatment provided under the universal scheme helped prolong patients’ lives compared to before 2008, when poor patients in the last phase of the disease did not have access to treatment, hence the high death rate.
Thawee admitted that UCS patients were at a higher risk than those under the other two schemes, as most SSS subscribers were of working age and healthier, while those under the Civil Servant Medical Benefit Scheme (CSMBS) were better off financially.
Thawee said the UCS fund for chronic kidney disease, as far as he knew, was mostly spent on buying dialysis liquid for patients and the rest on system development and human resources.
As a doctor taking care of kidney patients for a long time, he said, the universal scheme gave people better access to treatment and some 50 to 60 per cent of patients in the last phase of the disease had access to treatment. He said use of peritoneal dialysis had been introduced due to budget and manpower restraints, though this approach ensured that last-phase chronic kidney disease patients were taken care of.
Surasak said both peritoneal dialysis and haemo-dialysis yielded good results and prolonged the patients’ life span, while noting that a patient’s treatment depends much on a doctor’s diagnosis.
Subscribers to CSMBS have greater benefits, as patients are treated according to a doctor’s diagnosis and the reimbursement matches the actual amount of the bill, Surasak said. On the other hand, UCS patients need to undergo peritoneal dialysis even if their condition does not require it, hence the result can sometimes be inferior to patients under CSMBS, he said.
UCS patients also face a higher risk of infection because they are mostly elderly who are unable to conduct dialysis cleanly at home, Surasak said. Surasak said UCS subscribers found to be unable to use peritoneal dialysis – such as those who have been infected in their stomach several times and their peritoneum can no longer support the dialysis method – would be eligible for haemo-dialysis.
“However, the problem has to arise first before the treatment method can be changed,” he added.
Meanwhile, the SSS had the greatest drawbacks , compared to the other two schemes, Surasak said.
SSS patients have to wait three months to get approval for reimbursement from a medical committee. While they wait, the patients have to cover monthly medical expenses of up to Bt30,000, he said.
Also, an average-sized person requires four bags of dialysis liquid, while a larger person needs five to six bags, he said. CSMBS covers the expense of all the bags, but the UCS only covers four bags a day and SSS covers three bags. Hence, if a patient has to buy an extra bag daily, the expense could amount to Bt6,000 a month, he said.