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Bangkok’s primary care needs to upgrade
Bangkok’s primary care needs to upgrade
Dr Jadej Thammatacharee
Secretary-General of National Health Security Office (NHSO)
Bangkok is the most crowded city in Thailand. Around 5.5 million people are registered residents. The other three million are non-registered and pulled into the capital by the abundance of work and education opportunities.
The capital is also the base for advanced health facilities ― from prestige universities and tertiary private hospitals to excellent centers for high-cost treatment.
Ironically, the access to healthcare services, especially primary health, is lower than in other parts of the country.
Our data shows that average outpatient visits in Bangkok are 1.7 times per person in a year, lower than the national rate of 3.4 times.
One of the major reasons is the resident’s inability to access primary care units. Patients who get the services are likely to pay from their pockets, discouraging low-income people to seek healthcare services when needed.
The Ministry of Public Health's record shows that around 2,000 private clinics are located in Bangkok.
But only small shares of them are integrated into universal health coverage, which ensures quality and timely healthcare for everyone regardless of their financial status.
Only 300 state primary care units are available despite nearly 10 million of populations residing in the capital.
Though the Thai government covers healthcare for 99% of the population, the locations of these state health units are clumped in busy districts.
Moreover, most state-run clinics are open during official hours, conflicting with the working hours of most employees who can only visit hospitals after hours.
The capital also lacks secondary hospitals which act as the connectors between primary care units and tertiary hospitals. This type of health unit provides both outpatient and inpatient care associated with non-complex treatment, which helps reduce crowding in both primary and tertiary hospitals.
In this context, we must implement a strategy to increase the inefficiency of the primary care system, making it accessible and convenient for patients and fitting Bangkok people’s lifestyle.
The good news is that the new Bangkok governor Chadchart Sittipunt has included primary care upgrades in his policy. Our organization, the National Health Security Office (NHSO), agrees with his policy and will certainly support his team to make it happens.
To fill up the access gap, the NHSO is recruiting private clinics to provide free healthcare services to beneficiaries of the Universal Coverage Scheme (UCS). The clinic operators can claim medical fees about 4,200 services and items from the NHSO.
From Oct 1 onward, we plan to identify partnered clinics in all 50 districts of Bangkok so patients can access primary care at any entry point. Currently, around 200 clinics have partnered with us. We need at least 300 more.
We have also increased access to outpatient care through the Public Health Ministry’s piloted program called “OP Anywhere.”
According to the existing rule, UCS beneficiaries can only request outpatient services from hospitals they are registered with. They couldn't access health services in other hospitals unless the doctors issue inter-hospital transfer papers for them.
OP Anywhere broke this rule by allowing patients to request primary care services from any health unit partnering with the NHSO. Bangkok is one of the piloted areas for this program.
Under the program, UCS beneficiaries can get a variety of primary care services, including preventive care, health promotion and disease prevention, and physical rehabilitation. They will be transferred to advancing hospitals if they require intensive care.
We named the overall primary care strategy mentioned above “Model 5” ― an upgrade of the primary care network from Model 1 and 2 (which patients get health services from the network of hospitals they registered with) and Model 3 and 4 (which patients get additional care from pharmacies partnering with the NHSO.)
In addition to Model 5, we have included telemedicine and mobile clinic in our strategy to enhance primary in the capital.
The adoption of telemedicine has been accelerated since the beginning of the Covid-19 pandemic. Both patients and health providers had a chance to experiment with online medical consultancy and found its effectiveness while living under social distancing.
For the mobile clinic, the Bangkok Metropolitical Administration (BMA) led by governor Chadchart has been working on a strategy to make mobile clinics available and accessible to Bangkok residents.
Mobile clinics can be set up at petrol stations, where patients can consult with doctors online and get basic medicines. Petrol stations are a common sight in Bangkok and often have parking spaces, making them suitable locations for a mobile clinic vehicle.
If we achieve this new primary care strategy, we believe that Bangkok’s healthcare will not be the same again. It will lead to a positive change, in which people from all spectrums can access healthcare services and maintain their good health.
It’s also worth noting that private and public health systems can’t exist in the different entities. They must be integrated and collaborated to ensure health for all.
We’ve learned from the pandemic that the impact of the health crisis spilled over to every sphere of health system. Only when we join hands, the health system can become resilient and protect people's health in a long run.
Dr Jadej Thammatacharee
Secretary-General of National Health Security Office (NHSO)
Bangkok is the most crowded city in Thailand. Around 5.5 million people are registered residents. The other three million are non-registered and pulled into the capital by the abundance of work and education opportunities.
The capital is also the base for advanced health facilities ― from prestige universities and tertiary private hospitals to excellent centers for high-cost treatment.
Ironically, the access to healthcare services, especially primary health, is lower than in other parts of the country.
Our data shows that average outpatient visits in Bangkok are 1.7 times per person in a year, lower than the national rate of 3.4 times.
One of the major reasons is the resident’s inability to access primary care units. Patients who get the services are likely to pay from their pockets, discouraging low-income people to seek healthcare services when needed.
The Ministry of Public Health's record shows that around 2,000 private clinics are located in Bangkok.
But only small shares of them are integrated into universal health coverage, which ensures quality and timely healthcare for everyone regardless of their financial status.
Only 300 state primary care units are available despite nearly 10 million of populations residing in the capital.
Though the Thai government covers healthcare for 99% of the population, the locations of these state health units are clumped in busy districts.
Moreover, most state-run clinics are open during official hours, conflicting with the working hours of most employees who can only visit hospitals after hours.
The capital also lacks secondary hospitals which act as the connectors between primary care units and tertiary hospitals. This type of health unit provides both outpatient and inpatient care associated with non-complex treatment, which helps reduce crowding in both primary and tertiary hospitals.
In this context, we must implement a strategy to increase the inefficiency of the primary care system, making it accessible and convenient for patients and fitting Bangkok people’s lifestyle.
The good news is that the new Bangkok governor Chadchart Sittipunt has included primary care upgrades in his policy. Our organization, the National Health Security Office (NHSO), agrees with his policy and will certainly support his team to make it happens.
To fill up the access gap, the NHSO is recruiting private clinics to provide free healthcare services to beneficiaries of the Universal Coverage Scheme (UCS). The clinic operators can claim medical fees about 4,200 services and items from the NHSO.
From Oct 1 onward, we plan to identify partnered clinics in all 50 districts of Bangkok so patients can access primary care at any entry point. Currently, around 200 clinics have partnered with us. We need at least 300 more.
We have also increased access to outpatient care through the Public Health Ministry’s piloted program called “OP Anywhere.”
According to the existing rule, UCS beneficiaries can only request outpatient services from hospitals they are registered with. They couldn't access health services in other hospitals unless the doctors issue inter-hospital transfer papers for them.
OP Anywhere broke this rule by allowing patients to request primary care services from any health unit partnering with the NHSO. Bangkok is one of the piloted areas for this program.
Under the program, UCS beneficiaries can get a variety of primary care services, including preventive care, health promotion and disease prevention, and physical rehabilitation. They will be transferred to advancing hospitals if they require intensive care.
We named the overall primary care strategy mentioned above “Model 5” ― an upgrade of the primary care network from Model 1 and 2 (which patients get health services from the network of hospitals they registered with) and Model 3 and 4 (which patients get additional care from pharmacies partnering with the NHSO.)
In addition to Model 5, we have included telemedicine and mobile clinic in our strategy to enhance primary in the capital.
The adoption of telemedicine has been accelerated since the beginning of the Covid-19 pandemic. Both patients and health providers had a chance to experiment with online medical consultancy and found its effectiveness while living under social distancing.
For the mobile clinic, the Bangkok Metropolitical Administration (BMA) led by governor Chadchart has been working on a strategy to make mobile clinics available and accessible to Bangkok residents.
Mobile clinics can be set up at petrol stations, where patients can consult with doctors online and get basic medicines. Petrol stations are a common sight in Bangkok and often have parking spaces, making them suitable locations for a mobile clinic vehicle.
If we achieve this new primary care strategy, we believe that Bangkok’s healthcare will not be the same again. It will lead to a positive change, in which people from all spectrums can access healthcare services and maintain their good health.
It’s also worth noting that private and public health systems can’t exist in the different entities. They must be integrated and collaborated to ensure health for all.
We’ve learned from the pandemic that the impact of the health crisis spilled over to every sphere of health system. Only when we join hands, the health system can become resilient and protect people's health in a long run.
