Healthcare activists have expressed concerns over Health Minister Anutin Charnvirakul's plan to provide 48 million universal healthcare programme subscribers access to medical treatment at any participating hospitals.
They are concerned whether the plan, which was announced last week by Mr Anutin, would be possible to pull off, challenging the National Health Security Office (NHSO) about the handling of the plan's would-be repercussions, such as constraints on existing hospitals, as patients might end up choosing bigger hospitals over smaller, less well-equipped facilities.
The NHSO on Friday organised an online meeting to hear the opinions of stakeholders on Mr Anutin's plan.
Saree Aongsomwang, secretary-general of the Foundation for Consumers, voiced her concern that small hospitals might face financial problems if the plan was enacted, saying the budget of smaller hospitals in the programme depends on the number of registered patients they have.
Any change to the kingdom's universal health policy must not affect smaller hospitals, Ms Saree said.
In a bid to develop access to medical treatment in remote areas, the ministry is upgrading community health offices into community hospitals, with the hope of reducing the number of patients seeking treatment in provincial hospitals. It would also provide locals with the opportunity to seek treatment near their homes.
Mr Anutin's plan, if approved, could limit the development of smaller hospitals, Ms Saree said. However, the change may start with providing free medical services, such as for cervical cancer, and also vaccinations instead of allowing free access at any hospitals for all the services.
"It would be better to get started with the things that have less impact," she said, adding that if the ministry were to start giving away free treatments, the rights of locals would be promoted.
"Many studies show that people have less awareness of free services and we hope the new policy will [instead] provide more convenience to those people so they will not be reluctant to use the service at any hospital," Ms Saree said.
NHSO's deputy secretary-general Athaporn Limpanyalers said civil rights advocates also suggested Mr Anutin's plan should be expanded to cover complicated medical treatments for illnesses such as cancer, which require advanced medical teams and equipment.
Moreover, the NHSO should set up a more effective patient rights transfer system, which should take effect on the registered date, not 15 days afterwards as required in the current practice, the civil rights advocates was quoted as saying.
This photograph taken on April 2 shows patients queuing at Pranangklao Hospital in Nonthaburi. Pattarapong Chatpattarasill
They also said the plan's pilot project should first be done in the capital, Dr Athaporn said.
On the financial impacts that may occur, he said further studies would be needed.
Currently, universal healthcare subscribers are given a gold card, designating patients to specific hospitals. They are only allowed to access free services provided by their designated hospitals.
A total of 140 billion baht per year has been allocated to these hospitals. How much they receive depends on how many registered patients they have, which is limited by capacity.
The scheme offers access to other services provided by other hospitals only during emergencies.
Mr Anutin wants to eliminate the scheme's limitations by allowing patients to access hospitals with advanced medical treatments.
Dr Athaporn said his office initially agreed with the minister's idea because it would bring convenience for patients.
"We agreed with it because it is good for all. But things that we are going to do must not [negatively] impact hospitals, especially big hospitals, which are prone to be overloaded," he said.
"We expect to translate [the plan] into action by at least next year if everything is ready," Dr Athaporn said.
Worawit Tontiwattanasap, director of Um-Phang Hospital in Tak, said his hospital is unlikely to be affected should Mr Anutin's plan be enacted because the facility is located in a rural area. However, he said bigger hospitals would still need help.
Dr Worawit said bigger hospitals need to be managed better so their staff are not overloaded with work when patients flock into facilities that offer better medical treatments.
Dr Worawit's hospital, which is located near the Myanmar border, has received a 50 million-baht budget per year with 100,000 visits per year.
About 35% of its out-patients and about 46% of its in-patients do not subscribe to the universal healthcare scheme.
His hospital, he said, survives on donations.