The sight of an elderly woman suffering from chronic renal failure, heart disease, ulcers and asthma clutching an oxygen flow tube in one hand and attempting to organise piles of documents required for treatment under the gold card universal healthcare scheme with the other, is a poignant reminder of its efficacy.
Gold card holders in Bangkok who require transfers to larger hospitals are facing hardship due to a budgetary change implemented by the National Health Security Office (NHSO) since March 1. Since then the NHSO and Public Health Ministry have received an earful of complaints.
Their frustrations are justified. The budgetary change has resulted in chaos for patients. They encounter a myriad of problems in being rejected by secondary hospitals despite possessing transfer documents. Some are told their primary care unit is changing to a hospital far away, without notice. The new policy even requires them to return to the primary care unit for every appointment, even for long-term treatment.
Additionally, they are required to manage all patient records themselves for each transfer -- a major hassle especially when they have to make multiple trips back to the primary unit.
The confusion and hardships experienced by patients not only undermine the government's pledge for universal access to medical services based on the patient's national ID card, but also make a mockery of it.
At present, these "universal" services actually are available only in four provinces -- Roi Et, Phrae, Phetchaburi and Narathiwat -- leaving millions of citizens underserved.
In November 2020, then-deputy prime minister and public health minister Anutin Charnvirakul announced a pilot project to digitise patient records for referrals to reduce the paperwork burden.
Four provinces (Nakhon Ratchasima, Chaiyaphum, Buri Ram and Surin), took part in the NHSO's service upgrade at that time. Mr Anutin even vowed to improve upon the initiative and expand it to cover the entire kingdom within two years.
The reality evidently has fallen far short of the promises. According to Public Health Minister Dr Cholnan Srikaew, only 12 provinces are currently equipped with health databases that can be shared electronically.
To its credit, the NHSO acknowledged the problems faced by its members in Bangkok and set up a war room to address complaints promptly.
The problem, however, is disparities between the seemingly magnificent policy and its practical implementation seem to persist.
Dr Cholnan admitted the referral system in Bangkok has been erratic, yet he described the problems as "transitional", even while citing the yet-to-be-realised dream of universal access with a single ID and fully connected public health databases as the ultimate solution.
The NHSO insists on the need for the change, saying it responds to requests from some primary care units in Bangkok. It also insisted the change should not affect patient referrals.
The NHSO has called for cooperation from both primary care units and hospitals, urging them to provide necessary services to patients even in the absence of referral documents. It says it has enough money to cover the costs so the participating clinics and hospitals do not need to worry about reimbursement.
In the long run, the NHSO announced its intention to develop a system that would enable automatic patient transfers based on their medical conditions, reducing the need for discretionary decisions by primary care units and eliminating the hassle of obtaining transfer documents altogether.
A committee will be set up to mediate cases in which patients encounter difficulties in obtaining referral documents.
Despite the NHSO's announcements, complaints continue about referral documents and the hardships they impose on sick individuals and their families, who are forced to waste valuable time and energy navigating the inefficient system, adding to their already burdensome situation.
There is no doubt the NHSO's 30-baht universal healthcare coverage is one of the most remarkable policies in the country's history. While its all-encompassing nature has drawn criticism in the past for its strain on the national budget, its benefit as a health safety net for the majority of people is undeniable.
The attempts by successive health ministers to improve the healthcare system, whether to make it truly universal and accessible anywhere or digitise all health databases, deserve commendation.
However, the National Health Security Office must remain vigilant against policy deficits -- the disconnect between high-level aspirations and the realities on the ground. The gap, manifested in the recent referral controversy, appears to be a significant issue causing an otherwise well-intended policy to falter.