Experts are urging the National Health Security Office (NHSO) to scrap the Cancer Anywhere (CA) programme after several major public hospitals reported operating losses due to the overwhelming number of patients requesting cancer treatment.
Introduced in 2021, the CA programme allows individuals who are subscribed to the universal healthcare scheme, also known as the 30-baht gold card programme, to choose where they would like to receive their treatment.
Initially, patients could only request treatment at the hospital or clinic that they were initially registered at, but this often led to delays in treatments, as many patients were registered in smaller and/or regional facilities that do not have the capacity to administer cancer treatments.
Under the CA scheme, cancer patients can receive treatment at any hospital registered with the NHSO and the costs of their treatment will be covered by the National Health Security Fund (NHSF), said a source.
Patients are only required to show their ID cards at registered hospitals to access the service, and the hospitals will claim the cost of their medical treatment from the fund.
Before the scheme was launched, if a patient had to be referred to another hospital, the hospital which made the referral covered the cost of the treatment.
Since the CA scheme was launched, several hospitals have seen a spike in the number of patients seeking cancer treatment, putting a strain on their finances.
These hospitals include major public facilities like Siriraj Hospital, Ramathibodi Hospital and King Chulalongkorn Memorial Hospital, which means the NHSF also has to spend more money to cover treatment expenses.
This prompted the NHSO to revise payment conditions to cover only chemotherapy, radiotherapy, surgery, hormone therapy, as well as laboratory testing and cancer-specific medications. Other kinds of medicines, such as antihypertensives, and antiemetics, as well as accommodation, food, X-ray and blood tests will not be covered by the fund.
The change will take effect on Jan 1.
The aforementioned hospitals responded by saying the costs incurred by cancer patients referred from other hospitals will have to be covered by the hospital which made the initial referral.
Other hospitals have also said the NHSO is too slow in reimbursing the cost of treatments incurred by cancer patients who were referred by smaller hospitals.
Dr Somsak Tiankao, director of Khon Kaen University's Srinagarind Hospital, said the NHSO has made only partial payments on the medical bills submitted by the hospital. In some cases, the NHSO has not made any payment at all, he said.
"The hospital has had to shoulder these financial burdens over the past three years," he said, adding the daily overload of cancer patients under the CA scheme has made it difficult for medical staff to provide proper service to every patient.
At the start of the programme in 2021, the number of cancer patients at the hospital stood at 3,617. The number rose sharply to 16,514 in 2022; 25,896 in 2023; and 30,241 this year, or an increase of 830%, he said.
As such, the NHSO and the Public Health Ministry should scrap the scheme, and revert back to the old system because provincial hospitals or regional cancer centres have the capacity to treat cancer patients, Dr Somsak added. "Only when they are working beyond their capacity, can they refer patients to prestigious hospitals which have their own medical schools," Dr Somsak said.
Public Health Minister Somsak Thepsutin said on Sunday the government will ensure the new 30-baht gold card scheme, which allows patients to access medical services nationwide using only their ID card and without any referral document, will cover all 77 provinces by the end of this year. So far, the scheme has been implemented in 46 provinces, he said.
