Smaller private hospitals which are having trouble referring patients to larger city hospitals have called for changes to health funding, saying patient health will suffer.
Thirteen out of 87 hospitals which are contracted to the Social Security Office (SSO) are struggling to refer patients with severe and chronic illnesses to bigger hospitals because of the slow clearance of treatment payments.
Dr Kumpol Plussin, president of the Social Security Fund's (SSF) private hospital contract partners group, said about 20 large hospitals, known as "supra contractors", have suspended their patient-sharing contracts with smaller private hospitals.
Under the social security scheme, smaller hospitals are obligated to enter relationships with larger hospitals to ensure patients are offered a wider range of treatments, Dr Kumpol said.
About 100 smaller hospitals cover about 6 million people who benefit from the SSF.
Dr Kumpol said the SSO was failing to following the deal stated under its medicare reimbursement model, prompting hospitals to suspend their partnership contracts.
Dr Kumpol said the model is based on categories created by the Diagnosis Related Group (DRG).
The SSO has allocated an annual budget cap of 1,446 baht per patient whose symptoms are classified as being below the DRG's Level 2, which indicates a "common illness". About 10.5 million people have access to this fund.
Treatment for a patient whose symptoms are classified as being Level 2 or above - those with "critical" illnesses such as cancer - is funded by the SSO from a separate 4.5-billion-baht fund.
When patients fall into this category, they are usually transferred from smaller private hospitals to the supra contractors, who must then be reimbursed for providing treatment.
Under the deal, Dr Kumpol said, the SSO is supposed to reimburse the bigger hospitals directly. Instead, the SSO has been paying the referring hospitals, who then pass on the money, leading to the delays. The deal also states the SSO must reimburse the big hospitals 15,000 baht for each Level 2 patient taken on.
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Writer: Paritta Wangkiat