OP Anywhere: Change an existing rule for better healthcare access
 
Dr Jadej Thammatacharee
Secretary-General of National Health Security Office (NHSO)
 
The National Health Security Office (NHSO) has regularly organized public hearings to gather feedback from the Universal Coverage Scheme (UCS) beneficiaries.
 
Hearing from them has provided us with an opportunity to understand the healthcare gap and improve the UCS to answer the people's needs.
 
One of the most heard feedback is the patient's difficulties accessing healthcare services under the hospital-based registration system.
 
When we launched the UCS in 2002, we set up the rule that patients can request free healthcare services only from public hospitals they are registered with.
 


If they want to get services in other hospitals, the health staff must approve by issuing inter-hospital transfer papers.
 
Without the green light, the patients must pay medical fees from their own pockets.
 
This rule first came with good intention. We wanted to distribute patients to different health units, meaning they wouldn't crowd in big or famous hospitals and delayed treatment for overall patients.
 
It also helped the NHSO pay medical fees to hospitals easier when each UCS beneficiary's health record stayed in one place. (We used a paper-based claim system because our ICT system was not advanced when introducing the scheme.) 
 
However, society and technology have largely changed since the UCS establishment.
 
More people have moved across cities and provinces today in seeking education and job opportunities.
 
Some people rarely settle down in one place, especially in the post-COVID-19 era, where unemployed workers must move around to find jobs.
 


But the hospitals they are registered with don't move with them, while illness can happen anywhere regardless of health facilities' locations.
 
We heard similar stories of UCS beneficiaries who couldn't benefit from free healthcare after resettling in new places.
 
We thought this could be fixed, especially when ICT has far improved today  allowing us to share health records online, adopt electronic claim systems, and pay the hospitals within a day.
 
After a series of discussions with the NHSO's executives, Ministry of Public Health and the National Health Security board chairman Anutin Charnvirakul took a bold step last year to pilot 'Outpatient Everywhere' in some public hospitals.
 
Shortly called 'OP Anywhere,' the new policy allows UCS beneficiaries to access free primary care services at any health unit regardless of hospital registration status.
 
These health units include public health centers, subdistrict health promotion hospitals, primary care units under hospitals, community health centers, and community clinics partnering with the NHSO.
 
The services cover preventive care, health promotion and disease prevention, physical rehabilitation, and primary care for any illness. The patients will be transferred to higher capacity hospitals if they need specialist or intensive care.   
 
The policy was piloted in Health Region 9th (centered in Thailand's northeastern Nakhon Ratchasima province) and Health Region 13th (centered in Bangkok) early last year.
 
It soon was adopted by hospitals in the other three health regions in the northeast.
 
More than 950,000 inter-hospital visits were recorded at 436 health units implementing the policy throughout 2021.
 

We received positive feedback from both patients and hospitals, prompting the NHSO and Ministry of Public Health to apply the policy to public hospitals in the whole country.
 
Some hospitals reported that OP Anywhere had improved patients' access to care, especially those from low-income families or are migrant workers.

It was reported that they had avoided visiting the hospital because they couldn't afford the medical fees before the policy implementation.
 
For patients with chronic diseases, the policy has encouraged them to continue medication because they could request free medicines without traveling back to registered hospitals in their home provinces.
 
Importantly, there is no record of hospitals being exhausted by OP Anywhere.
 
Many hospital staff initially feared that allowing patients to get healthcare services anywhere would influx patients in famous hospitals. But that is not the case.
 
Phra Nakhon Si Ayutthaya Hospital, the main hospital of Ayutthaya Province north of Bangkok, has adopted the policy since its beginning and found a minor increasing number of patients despite its popularity among patients in central Thailand. 
 
Between Jan and Mar, 279 visitors who were not registered at the hospital received free health services a small number compared to its 1,900 daily visitors.
 
Most of them are seasonal migrants who temporarily worked in Ayutthaya.
 

Their common symptoms are gastroenteritis, stomachache, and rash.
 
They visited the hospitals twice on average, which did not increase the hospital staff's workload or seize healthcare resources from existing patients.
 
This case study also proves that people are unlikely to visit hospitals aimlessly despite having free healthcare services. In fact, most people don't want to visit hospitals if it's not necessary. 
 
Therefore, we shouldn't fear initiating free healthcare policies just because of the false belief that patients want to tap healthcare resources greedily for their own benefits.
 
Instead, we should be bold to move forward with any free healthcare policy with the awareness of patients' rationality.
 
In addition, many hospitals reported back to us that OP Anywhere had not increased their administration tasks.
 
They could record healthcare costs in the NHSO's online database system (the result of ICT improvement) and claim medical fees with electronic documents.
 
However, we still need to keep monitoring the outcome and impact of the policy.
 
It's also possible that the small number of visitors is a result of the COVID-19 pandemic, which discourages patients from visiting hospitals.
 
OP Anywhere is considered a big move for us as it has changed our existing rule, meaning we must adjust our attitude and ways of work.
 
But the outcome is satisfactory, encouraging us to look for more gaps in the UCS and find ways to close them.
 
We believe that there will be more challenges, emerging gaps, and patients' new needs in the future.
 
Our job is to detect them as early as possible, try to understand them, and take action for the benefit of the scheme's beneficiaries.