Health chiefs aim to stamp out bent clinics

Health chiefs aim to stamp out bent clinics

New system for claiming cash for treatments has seen fraudulent claims skyrocket

Phatchari Koetphaibanlak is immune to being told her access to medical treatment at a designated facility under the "gold card" universal healthcare scheme is in place pending a transfer.

She has been told her rights are being transferred to a different facility so many times she is used to it by now.

Nonetheless, she is now trying to calm others in the community where she lives in Pathumwan district of Bangkok that the suspension is not the end of the world. In fact, it will help flush out the "bad egg" clinics in Bangkok which swindle money from the National Health Security Office (NHSO), the agency that runs the gold card scheme.

The NHSO has axed contracts with 189 medical clinics, hospitals and dental clinics fraudulently claiming money from the universal healthcare scheme.

That means gold card members registered to receive medical services with the 189 clinics have nowhere to go for treatment while the NHSO is sorting out the mess and re-allocating them to other medical facilities.

"I try to tell people in my community that their right to use the 30-baht healthcare scheme is still active," said Ms Phatchari whose access to treatment had been shifted to another facility once before. The clinic she was registered with was also embroiled in budget disbursement fraud.

However, the malpractice may have been motivated changes in the NHSO's system of calculating payments to affiliate medical facilities.

As leader of the community, Ms Phatchari advised the gold card subscribers affected by the NHSO contract revocations who fall sick to visit any hospital or healthcare centre near their home for the time being. Ms Phatchari is among the two million gold card members having to make do.

The NHSO accused the 189 medical facilities of falsifying claims forms which are presented to the agency under the gold card scheme.

A year ago, more than 500 auditors collected over one million copies of documents impounded from clinics and hospitals across Bangkok which partnered with the NHSO. They ran checks and confirmed many were fraudulently claiming funds from the agency.

According to the NHSO, more than 100 medical facilities had falsified documents and lied that people had check-ups for metabolic conditions such as diabetes and high blood pressure. They then asked the NHSO for reimbursement of the non-existent costs.

Somchai Krajangsaeng, a civil society advocate working on healthcare security, admitted the NHSO's decision to close the 189 healthcare and medical facilities has had a severe impact on gold card subscribers. However, it also sends out a strong message that the NHSO is serious about prosecuting establishments which fail to engage honestly in business with the agency.

Previously, the office resorted to a "soft approach" by asking medical clinics involved in fraud to return the payments in return for keeping their contract with the NHSO.

Mr Somchai added that the latest problem occurred when the NHSO streamlined its method of distributing funds to the registered clinics and medical facilities. In the past, the agency paid the clinics and facilities a lump sum that covered the costs of medical treatments as well as disease prevention services for patients.

Many clinics and facilities made a lot of money because fewer gold card members than targeted sought disease prevention services.

Under the NHSO's new system of calculation, the costs of medical treatments continued to be given in a lump sum. However, the fund disbursed for disease prevention had to reflect the real number of people who obtained the services.

That caused the clinics and facilities to receive less budget and some establishments decided to inflate the number of disease prevention service recipients and produced fake documents to get a larger slice of the budget from the NHSO, according to Mr Somchai.

"Fewer than 10% of healthcare universal cardholders in the capital take advantage of the disease prevention programme because they don't know about it," he said.

Viroj NaRanong, Thailand Development Research Institute (TDRI)'s research director for health economics and agriculture, said the fiasco is a clear indication of the vast difference in how healthcare service providers in Bangkok and the provinces operate.

At state-run clinics in the provinces, health volunteers are on hand to disseminate information to people on how to obtain free medical services under the gold card healthcare scheme. This practice is rare at gold card-registered clinics and medical facilities in Bangkok.

Mr Viroj said the NHSO adopts the same practice of calculating budget allocations to clinics and facilities, which does not reflect reality.

He insisted a new system of figuring out payments needs to be put in place so that the facilities registered with the NHSO, including small clinics, can survive financially.

Meanwhile, Wayo Assawarungruang, vice-chairman of the House committee on public health from the Move Forward Party, cried foul over the two million gold card subscribers being troubled by the access suspension.

He said some were denied medical treatment by gold card-registered clinics near their homes. Mr Wayo added the committee has suggested to the NHSO board that all gold card-registered clinics should be opened to serving patients whose designated clinics' contracts with the NHSO have been revoked.

He insisted people must continue to get treatment because the problem has nothing to do with medical standards. The contracts should be severed only after a court's judgement as members do not deserve to be shunted when their health condition is at stake.

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