Text and photo by Mathira Sutiwatananiti
It is safe to say that most people are willing to pay anything to save their own and loved ones’ lives even if it means incurring a lifetime of debt. But when private hospitals are allowed to charge patients up to 400 times more than their public counterparts for similar drugs and up to six times for medical procedures, one woman cannot help but ask, “Don’t you think it’s time we do something about this?”
The price we pay
Despite the merits of the universal health care scheme launched in 2002, the programme has put a huge strain on public hospital resources and brought about an overcrowding crisis. Without personal connections, the chances of getting a bed in public hospitals are almost next to impossible.
Consequently, a growing number of Thais are forced to seek medical care at private hospitals. The surge in demand, coupled with a rise in the number of medical tourists flying in to seek help in Thailand’s private hospitals has led to a steep increase in the cost of hospital treatments over the last few years.
According to a study released in May this year by the National Legislative Assembly’s committee on public health, the cost of medical treatments in private hospitals has quadrupled between 2009 and 2014.
Still, the most urgent issue raised in an online viral petition by founder and president of Thai Medical Error Network (TMEN) Preeyanan Lorsermvattana is not that private healthcare is expensive. Rather, it is the lack of effective mechanisms to protect healthcare receivers against systemic overcharging and fraud.
Turning pain into power
As one of the country’s most fervent advocates for patients’ rights, Preeyanan is no stranger to lengthy and uphill battles. Into the eleventh year of her struggle to seek legal redress over the alleged childbirth medical negligence of her son*, this mother-turned activist was on the verge of giving up on life. Her family had lost their home and life savings and was facing a 100-million baht defamation lawsuit following her television interviews. In a moment of despair, the thought of her two young children stopped her from jumping off a bridge. From that day on, Preeyanan vowed to turn her pain into power. In late 2002, she gathered 150 fellow victims to start TMEN with the aim to be the support system for affected patients and their families and help them navigate their way through the labyrinth of Thailand’s healthcare and judicial systems.
“At the beginning it was very hard. We faced a lot of resistance not only from medical professionals but also the general public who saw us as having nefarious agenda. What they didn’t understand then was that the only reason we had to sue doctors or hospitals was because there were no other mechanisms in place that could give us a fighting chance. That is why we have been running a campaign all these years calling for legislation and enactment of the healthcare victim protection bill and establishment of the Patient for Patient Safety programme** so that we can build a better system to improve patient safety, compensate victims and reduce medical errors and lawsuits,” said Preeyanan who has, for the past eight years, been invited by medical schools across the country to give lectures on the human cost of medical negligence.
Under the Emergency Claim Online (EMCO) policy, emergency patients are encouraged to seek treatment at any nearby hospital, be it private or public. The hospital should then bill the National Health Security Office (NHSO) for the medical expenses incurred without requiring the patient in question to pay. Since the policy took effect in April 2012, the government has been unable to stop private hospitals from collecting payment from patients or filing lawsuits against patients who refuse to pay.
“It’s because private hospitals do not accept the reimbursement rate set by the NHSO and are able to exploit a loophole that EMCO is merely a policy that is not supported by legislation,” explained Preeyanan. “In the past three years, there have been repeated calls for the government to reconsider the policy and fix the problems faced by us and other organisations, but nothing has been done. Even now, we’re still receiving EMCO-related complaints on a regular basis.”
In April 2015, Preeyanan turned to her network of 5,000 friends on FaceBook to gauge initial support for an idea to establish a central committee for handling private hospital overcharging.
The key points in her proposal are that the committee will comprise representatives from every sector including the civil society and function as a one-stop service. It must also have the authority to investigate overcharging claims and penalise wrongdoers. “If this happens, it’ll help remove a majority of the hurdles and roadblocks we face in the current system.”
Encouraged by the positive response, she launched the petition on Change.org on 19 April. It quickly went viral after media outlets picked up on the story. By the time the 33,000 signatures were handed to the public health minister on 12 May 2015, Preeyanan’s petition had become one of the most talked-about topics on national news and prompted a response from the Prime Minister (PM) who ordered relevant agencies to look into the matter on 7 May.
Braving the change
A few weeks later, two committees were set up to find a solution to the unreasonably high private hospital prices. So far, short-term measures that are targeted at improving price transparency, billing practices and EMCO implementation have been announced. All these are expected to take effect after October 2015.
“It was a welcoming gesture when the PM acknowledged the severity of the problem and took the lead. But since then the progress has been slower than we’d have liked and at every stage we still have to fight to be heard and be part of the solution. Our plan is to do whatever we can to represent the people’s will, keep the conversation going and push forward until the broken system is fixed. What we need now is for those in power to be brave and make good so that we can see real changes together.”
*Preeyana’s 23-year case over an alleged childbirth medical negligence ended up being dismissed by the Supreme Court in December 2014 on statute of limitations due to an error by her lawyer. The defamation lawsuit was dismissed by the Supreme Court in 2007.
**The Patient for Patient Safety programme was launched in August 2014 with TMEN working in partnership with the Ministry of Public Health and the World Health Organization (WHO)
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