Fights Loom Over Emergency Care: Thailand

[webfact]

'Fights loom over emergency care'

Pongphon Sarnsamak

Chularat Saengpassa

The Nation

Heads of national health schemes fear clashes with patients unless conditions are spelt out to public

BANGKOK: -- The rush to give citizens free access to emergency medical services from any hospital - while a progressive advance in public health policy - could cause clashes between patients and doctors due to a lack of clarity.

"The confrontation between healthcare providers and patients was the biggest concern for the committee of the three national healthcare schemes," Dr Winai Sawasdivorn, secretary-general of the National Health Security Office (NHSO), told The Nation recently.

The authorities have yet to identify which diseases or conditions are eligible for emergency medical services.

"It's not so easy to make people understand the emergency conditions that will be treated. We will absolutely have a lot of problems in the future," he said.

(click for large image)

Many prestigious private hospitals have also not confirmed their participation in the plan due to the lack of detail about funding reimbursement.

Starting on April 1, the three national healthcare schemes - NHSO, Social Security Fund and Civil Servant Medical Benefit Plan - will provide unlimited emergency care to all patients regardless of which scheme they belong to.

Patients just need to show their national identification card to receive emergency medical services at the nearest hospital. They will be treated until they recover. The NHSO will pay the hospital directly for their medical bills.

"We are now looking for a way to explain and communicate with people. We will find easy words on what the emergency conditions are and what kind of condition will put their lives at risk," Dr Winai said.

NHSO will hold a press conference tomorrow to inform the public about the definition of "emergency".

It will also build understanding among its officials including medical staff who are the heads of emergency wards at the 300 health service units across the country.

"At least, they will be the first person to see the patient and explain to them about the conditions," he said.

Prime Minister Yingluck Shinawatra had instructed him to produce plastic banners and put them up in front of hospitals to show and explain emergency medical conditions to people, he said.

The unclear definition of emergency medical conditions also worried Dr Suradej Waleeittikul, deputy secretary-general of the Social Security Fund.

"It will lead to misunderstanding between patients and medical workers. This will be a big problem in the near future," he predicted.

For example, a patient who suddenly blanks out might think he is having an emergency, but he or she may have just skipped breakfast and lacked sleep the night before.

Suradej said if medical workers did not explain sufficiently about emergency conditions to patients there would be conflicts between them.

"Saving people's lives is the most important duty for physicians during emergency hours. What would you [medical workers] do if someone collapsed in front of your hospital? Is this an emergency case?" he asked.

Winai said the new healthcare benefit would help patients suffering from severe conditions during emergency hours to receive immediate medical attention at the nearest hospital.

"If you remember the Santika pub fire a few years back, we found that patients from this accident were not sent to the nearest hospitals. Some of them were asked to show their patient's card. Some of them were

immediately charged for medical services instead of receiving treatment. We hope this problem will no longer exist under the new healthcare benefit," he said.

Preeyanant Lorsermvattana, chairwoman of the Patient Network, said she hoped the government's new policy on healthcare would reduce obstacles for patients to access emergency treatment.

Dr Pongsak Viddayakorn, director and executive adviser to Bangkok Dusit Medical Services, a private hospital chain, also raised the possibility of confrontations between hospital medical workers and patients due to any unclear definition of emergency care and unclear remuneration for hospitals.

"Being sued for medical malpractice was one of our biggest fears about joining the new healthcare scheme," he said.

The hospital and network would join the first phase of the emergency care scheme and see if they should remain as members.

"We will withdraw from the scheme if the government pays us with small funds that are not enough to cover our expenses, as this will affect the treatment for patients," he said.

"This is not about corporate social responsibility. It's about the standard of care to save a patient's life," he added.

Authorities have said they would pay attending hospitals at least Bt10,500 per condition. The reimbursement rate would rise according to the severity of each condition. For example, it could go well above Bt100,000 for a heart operation.

But this rate is not enough for upscale private hospitals to cover their medical costs.

-- The Nation 2012-03-26

[theblether]

Looks like a step in the right direction. There can't be any shock that people are fighting over the financial details, but anything that allows Thailand to move closer to universal healthcare has to be applauded.

[Buchholz]

For example, a patient who suddenly blanks out might think he is having an emergency, but he or she may have just skipped breakfast and lacked sleep the night before.

Still, a very serious situation as that is what killed 85 people in Tak Bai, according to some.

.

[Thai at Heart]

One would imagine the private insurers might love this because it will stop the dual pricing that goes on for insuread an uninsured people.

[h90]

Looks like a step in the right direction. There can't be any shock that people are fighting over the financial details, but anything that allows Thailand to move closer to universal healthcare has to be applauded.

Universal healthcare implemented wrong causes huge costs and lower quality of healthcare....

(Instead of paying 500-1000 Baht and getting good service, you get for free a very bad service or you pay 10.000 Baht).

My trust that this government can find any smart solution is very limited.

[hellodolly]

For example, a patient who suddenly blanks out might think he is having an emergency, but he or she may have just skipped breakfast and lacked sleep the night before.

Still, a very serious situation as that is what killed 85 people in Tak Bai, according to some.

.

My thought was how do you find out unless you first examine the patient.

Sounds to me like the medical insurance in the states a whole bunch of easy outs to get away from paying the hospitals.

[bedouin1990]

This is more complicated than most non-medical people understand. Suffer me to share some thoughts as a retired American Orthopedic Surgeon. No matter how much bureaucrats and bean-counters like it, the medical phrase "emergency," is not easily definable A bad cold is not an emergency in a normally healthy person, but it is for someone with an underlying serious medical condition. A broken finger is different as an emergency from a fractured femur. Anyone who is sick or injured naturally feels their problem is an emergency. So would most of the readers.

Here, as in America and the rest of the more advanced world, physicians must practice triage-assign the seriousness of what comes before them on the basis of the where their ministrations and technology can provide the greatest good for the most people. No governmental system is capable of substituting their "rules" and "standards" over the educated judgement of trained doctors. Systems no longer trust doctors, and that is the fundamental problem. They throw the bottom financial line out as the standard of care. Budgets, stockholder interests above patient care.

I sympathize and empathize with Thailand on this issue. It is a country of limited resources, and practical necessity forces them to draw lines. It is good medicine to allow emergencies to go to the closest hospitals. But can the government truly reimburse the private facilities for their care? I doubt it. Even in the world's wealthiest nation-the US- Medicare and Medicaid paid me only 20-25% of my usual fees, and even less to the hospitals and Clinics.

So..... what is the answer? I certainly do not have it! When I retired after 31 years of practice, my accountant said I gave away 1.5 million dollars worth of free care ( 450 million . That's almost as much as Thaksin makes a month on his investments. No matter. When I graduated from Medical School, I swore an oath. To use my knowledge and skills for the betterment of mankind. I was true to my oath.

Am I looking for sympathy or praises of nobility for doing it MY WAY? S**T no. The first responsibility of a doctor is to give the best care. That-not money is what it is all about. In all countries.

[anterian]

Triage is fine in an emergency situation, for example the battlefield or a major civil accident. But in other circumstances I think more than an eyeball assessment is needed. Ultimately I think the simplest way to define an emergency condition is one which is life threatening and where age and previous history may be relevant.

What is really needed are trained paramedics who can act as an initial filter between the patient and the hospital.

[ginjag]

6.3 billion for TAT-miracle Thailand, here we are with people dying because of little money.  Get smart P.M. show some guts and spend money wisely.  70 billion on a high speed line to her family home--pewk

[hansnl]

Bedouin 1990.

The healthcare in the US is completely delivered to insurance companies and shareholders.

It is so expensive and selective that most people not covered by a policy for a company are not able to pay the premiums.

I do not think that the US system is an example how healthcare in a society should be.

Yes, the quality seems to be fantastic, but if not available to everyone, what's the use?

And yes, I compliment you for what you did.

I know enough MD's, hospitals,that will send you away if they even think that you can not pay or have no insurance, sadly!

In my view, a general healthcare system, paid for by premiums related to wealth or income, is the best.

General healthcare should not be governed by shareholders who will always stand profit before care is if it will generate more income.

[moe666]

Will the government fund the program completely. There have been several stories on Thai visa about the government hospitals being in a finicial crunch because of the 30baht scheme not paying the bills as the program has not been funded completely

[SICHONSTEVE]

For example, a patient who suddenly blanks out might think he is having an emergency, but he or she may have just skipped breakfast and lacked sleep the night before.

Still, a very serious situation as that is what killed 85 people in Tak Bai, according to some.

.

"For example, a patient who suddenly blanks out might think he is having an emergency, but he or she may have just skipped breakfast and lacked sleep the night before".

I wonder just how many people have the cause of death as being "emergency" - I wonder what the symptoms are!!!!

[Jimjim]

Thailand is one of the last places in the world you would want to be if you were having an emergency. In many Western countries, although not perfect, people's lives are saved every day due to super-fast response times instead of dying of a heart attack or other sudden occurrences.

In Thailand, people don't even move aside on the road for ambulances, and the long minutes it takes for an ambulance to reach you in BKK means people die when if they had been in another country they could have lived, or had a much better chance.

The selfishness and ignorance of Thai drivers with regards to ambulances is criminal, it really is.

And emergency services are just not good enough.

One of the extremely unfortunate aspects of living in Thailand...

[Bagwan]

For example, a patient who suddenly blanks out might think he is having an emergency, but he or she may have just skipped breakfast and lacked sleep the night before.

Still, a very serious situation as that is what killed 85 people in Tak Bai, according to some.

.

Will the hospitals be deluged with bar ladies? Reminds me of the joke about a lady who on wakening in the morning told the client she was horny. 4 times he went to the well after she reiterated her message so that he might well have needed medical attention himself. She finally got through to him that she was hungry.