Emergency treatment: Private hospitals refuse govt regulation

Yingluck govt policy encouraged emergency patients to use nearby hospitals (public or private) which resulted in huge bills & lawsuits with private hospitals repeatedly disobeying govt regulations.

HEALTHCARE

The big business of saving lives

A landmark legal case will soon rule on the responsibilities private hospitals have in emergencies [emergency care], as high prices and murky regulations on fees and repayments land patients deep in debt
10/05/2015
Abridgement of Spectrum article by Nanchanok Wongsamuth here

Patcharin Arabiya secured a room at Thonburi Hospital's coronary care unit while doctors performed CPR on her mother, Samruay Sopajaree, after the 78 year old suffered a heart attack in 2013.

Almost immediately, her children began planning for her discharge from the hospital. But the next morning, they were shocked to learn that the single night in hospital had cost 76,000 baht. Despite what Ms Patcharin said were numerous requests, doctors allegedly refused to discharge Ms Samruay, citing health concerns. The bill eventually soared to 480,000 baht.

On April 5, Ms Patcharin finally managed to get her mother a bed at Somdej Prapinklao Public Hospital, but she said Thonburi would not allow the patient to leave without payment.

Finally, on April 18, Thonburi allowed the patient to be discharged without paying the 480,000 bill, after the NHSO intervened.

A year later, Ms Patcharin would wind up in a landmark legal battle to test people’s right to free emergency treatment.

NEW EMERGENCY TREATMENT POLICY

The new Emergency Claim Online (Emco) policy was an attempt to lower healthcare disparities, [the policy was] created in 2012 under the Yingluck government.

The government encouraged emergency patients to seek treatment at any nearby hospital — public or private. Local governments in each province were told to promote the scheme. 

Ms Patcharin, like many, said she believed the scheme meant the National Health Security Office (NHSO) would cover her mother's emergency care bill.

The NHSO plan was that private hospitals would be reimbursed based not on full costs but on so-called diagnosis-related groups (DRGs), a system used in the US to determine how much is paid to hospitals. The NHSO says this method would prevent hospitals from overcharging patients. A similar scheme was already in place for universal coverage (UC) patients, which covers 48 million people.

Hospitals are required by law to treat emergency patients, and the NHSO will partially cover the costs during the period when the patient is in a critical condition.

However, the government’s scheme faced problems, with many private hospitals failing to comply.

In the past, private hospitals have asked the NHSO to increase the DRG payment from the current 10,500 baht per unit of treatment, to 15,000 baht, but the hospitals refused to submit their service costs as the NHSO requested so that they could know the actual costs of private hospitals, so the payment amount was never increased.

PAYMENT PROBLEMS

Some hospitals request a patient pay a nominal upfront fee and then seek reimbursement from the NHSO. Others directly bill the NHSO without asking the patients to pay, which is the correct practice.

For the first six months of the fiscal year 2015, a total of 248 private hospitals filed for reimbursement from the NHSO under the Emco scheme, representing 70% of Thailand’s 353 private hospitals.

Out of the 5,504 patients using the service, only 2,824 received reimbursement, which totalled 78.87 million baht, as some hospitals delayed the submission of information to the NHSO.

Although Emco does not require emergency patients to pay in advance, the NHSO is in no position to punish hospitals that do not comply with the scheme's regulations.

LANDMARK LEGAL CASE

A year after the incident, Thonburi Hospital sued Ms Patcharin for 446,255 baht. Later, their lawyer would ask the court to summon the NHSO as a co-defendant and the NHSO has promised to help with the case.  If the patient ends up losing the legal case, the NHSO has promised to bear responsibility for the costs. The NHSO said there are hundreds of similar cases which have not yet resulted in lawsuits.

"I want to fight until the end, because what they did to us is not right. Upon arriving, the hospital did not mention the Emco scheme at all and asked us to pay 5,000 baht for the room," Ms Patcharin said. "We requested a discharge a day after my mother was admitted, but the hospital kept us there until the fees reached almost 500,000 baht."

Thonburi Hospital claims Ms Samruay stayed on voluntarily and that her children had chosen to have her stay in the hospital after her condition had stabilised. It also rejected the family’s claim that they had tried to move the patient to a state hospital.

POLICY FAILURE

Private hospitals have largely failed to comply with the government’s Emco scheme, with most demanding patients or their relatives bear responsibility for treatment costs.

Despite the Emco law, no organisation exists to check whether hospital costs are appropriate.

Hospitals in other countries also typically do not have a detailed price list understandable by customers. Even though it is mandatory in an advanced country like Singapore for hospitals to openly display a price list, often these prices do not correspond with the actual bill due to the complexity of charges.

One solution, would be to set a reasonable price range for services and better communication between doctors and patients about the possibilities of treatment, suggests John Lee, healthcare consultant and former executive vice-president of Bangkok Dusit Medical Services.

[According to Thai law Section 32 of the 1998 Sanatorium Act made it mandatory for all private healthcare facilities to openly display rates for medical treatment, service charges and the rights of patients. Section 33 also prohibits hospitals from demanding a treatment fee or service charge other than those displayed.  In practice, most clinics and hospitals have not complied, instead claiming they can refer patients to look up the price in a book that they keep, notes Preeyanan Lorsermvattana, president of the NGO Thai Medical Error Network. ]

MEDICAL TOURISM

The rise of medical tourism in Thailand as well as the lack of transparency in medical fees is driving the rising hospital fees, according to Viroj NaRanong at the Thailand Development Research Institute (TDRI).

Over the past decade or so, the healthcare sector has been driven largely by a surge in medical tourism, where Thailand has been ranked as a top global destination by several sources including Bloomberg in 2013.

"Most policymakers see medical tourism only as a lucrative foreign exchange generator and do not realise its adverse effects, which are increased healthcare fees and a shortage of doctors," Mr Viroj said.

"A decade ago, you would pay just a few hundred baht per visit for a simple ailment like a common cold, whereas now you will be paying at least 1,000-1,500 baht. Spending a night at leading hospitals now could cost you almost 100,000 baht."

With the foreign cash flowing in, doctors have increasingly been drawn to the bloated salaries offered by private hospitals. State hospitals saw doctors moving away and have been forced to pay extra money to keep them, straining the national health budget.

In effect, the influx of medical tourists has caused not only higher treatment fees but also increased operating costs at state hospitals, meaning more taxpayer money is needed to run the universal coverage scheme...

...Thai hospitals showed decent financial results last year, with medical tourism picking up nicely in the fourth quarter on the back of an improved political situation, according to a CIMB Research report.

[Patients from Myanmar were the top group of foreign patients last year for Bumrungrad Hospital, which saw the highest EBITDA (earnings before interest, taxes, depreciation and amortisation) margin of 28% last year, up from 26% in 2013.]

http://www.bangkokpost.com/news/special-reports/556363/the-big-business-of-saving-lives

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