By Chularat Saengpassa
The public, after all, has heard too often over the past five years how so many families struggle with massive medical bills after their beloved were rushed to hospitals. This is in spite of the fact the Public Health Ministry first unveiled the policy to give people the right to free emergency medical services in 2012.
Last month, a woman paid more than Bt100,000 for emergency treatment given to her 84-year-old mother during the first three days of her treatment after the mother fell down and broke her bones. “At first, I called a state hospital for an ambulance but no one answered,” the woman’s daughter, Wimontip Charoenchuen-suwan, said. “So, I called a nearby private hospital that dispatched an ambulance to our home within 10 minutes.
“My mum got into the ICU and underwent an operation. As a daughter, I tried to save my mother and did everything the hospital told me to, including paying more than Bt100,000 during the first three days.” It was not till her mother started to get better she was advised that her mother should have been treated for free in the first 72 hours.
“Later on, the National Health Security Office [NHSO] confirmed that my mum has that right and told the hospital to return the money to me. But till now, I have not got paid back,” Wimontip said. She urged relevant authorities to help protect her mother’s rights and get her reimbursed.
“Please help us and all the patients facing the same fate,” she said.
In 2015, the Foundation for Consumers received 19 complaints about patients having to pay for emergency medical services.
Dr Visit Tangnapakorn, head of the Health Service Support Department, said the free medical service policy had not worked in all cases because it still relied on cooperation with private medical facilities. “But things are going to change soon with the introduction of clear regulations,” he said.
Public Health Minister Piyasakol Sakolsatayadorn assigned Dr Sopon Mekthon, permanent secretary for Public Health, to fully implement the policy from next month. “We will issue three ministerial regulations to enforce the policy,” Sopon said.
His ministry plans to implement the regulations under the Medical Facilities Act (Version 4), which came into effect on December 21.
The regulations will go into detail about the definition of emergency cases, prescribe punishments against medical facilities that refuse to provide free emergency medical services in line with prescribed procedures, and specify the standard price for emergency medical services.
“We will let private hospitals get reimbursements based on the actual but reasonable cost. We won’t require them to take the flat rate,” National Institute of Emergency Medicine deputy secretary general Dr Phumin Silaphan said.
He hoped the new reimbursement method would shore up the willingness of privately-run medical facilities in the delivery of free emergency medical services to patients.
The current reimbursement method lists a flat rate based on treatment categories. When the actual cost reimbursement takes effect, health authorities are expected to shoulder a financial burden of at least Bt600 million more each year.
There are three major healthcare schemes, with the universal coverage programme having the most – about 48 million people.
Medical facilities are expected to provide medical help in emergency cases for free, without asking questions about the patients’ ability to pay first. They should be able to get reimbursement from managers of those healthcare schemes via the NHSO. But because some private medical service providers believe the reimbursements are not high enough for their standards, many have chosen to demand money directly from the families of emergency-medicine patients. Phumin said when the ministry passes the three new regulations offending hospitals would face legal punishment for any lack of compliance.
“Offenders will face a fine of up to Bt40,000 and/or two-year imprisonment.” And aside from legal penalties, private hospitals should also think about their reputation, he said.
Preeyanan Lorsermvattan, of the Thai Medical Error Network, said she hoped relevant authorities would also pay attention to the need to improve relevant hotline services.
“I call the hotline centre that is supposed to co-ordinate between patients and hospitals when a problem occurs or to help facilitate hospital transfers. But more often than not, no official picks up the call. It is mostly an automatic voice response,” she said.