Extra billing unallowed in the UCS
 
 
The National Health Security Office requests that health providers cooperation to avoid charging patients with extra medical fees, as most health services and items are covered by the Thai government’s healthcare scheme.
 
Extra billing is prohibited under the National Health Security Act B.E. 2545 (A.D. 2002), the legal instrument that ensures Thai people’s access to universal health coverage.
 
The Universal Coverage Scheme (UCS) is established under this law, which emphasizes the right to affordable health services.
 
Hospital operators are not allowed to charge any patients registered under the scheme. But they can reimburse the medical fees with the National Health Security Office (NHSO), which oversees the UCS.
 
However, some hospital operators have charged patients due to their lack of understanding about the scheme’s benefits package.
 
The NHSO’s recent survey points out that 3,329 cases of extra billing were reported between 2018 and 2022, costing 35.6 million baht in total to the patients. 
 
The common health services items being charged were medicines, emergency care, laboratory and after-hour medical consultant services.
 
According to the survey, hospital operators misunderstood that the fees for some health services and medicines were not covered by the UCS.

They were uncertain about what could and could not be charged.
 
Many of them must deal with increasing demands for health services, they said, pushing them to make prompt decisions to charge the fees despite their confusion about the scheme’s benefits package.
 
 
Undermine the universal health coverage
 
Extra billing — from small medical fees charged during the after-hours services or high-cost medication for diseases like cancer — is one of the challenges that prevent people from accessing affordable healthcare.
 
The NHSO secretary-general Jadej Thammathataree said that extra billing could undermine universal health coverage in the long term as it puts financial pressure on patients, especially those from low- and middle-income households.

It may also lead to catastrophic health expenditure, he said.
 
The UCS benefits package covers all essential health services and items, such as medical treatment, health promotion and disease prevention services, rehabilitation and palliative care.
 
Treatment for high-cost diseases is also covered, including cancer, and heart and kidney diseases. Many orphan drugs and emergency care are part of the benefits package.
 
There are very few items that are not covered by the UCS, including medical aesthetic services and health services and medicines that are in the experimental stages.
 
At first, all patients must pay 30 baht, or around $US 1, for each hospital visit. But this rule has been revoked since 2008, allowing low-income patients to access free healthcare.
 
“We can say that the UCS covers health services and items required from birth to the final stage of life. There is little chance for patients to be charged with extra billing,” said Dr Jadej.
 
“The challenge lies in the gap in understanding. Hospital operators collect the fees from patients because they fear that the fees can’t be reimbursed.

The NHSO is tasked with making them understand the UCS benefits package.”
 
On the other hand, some patients misunderstand that extra billing is allowed under the scheme.

Some mistakenly believe that the UCS requires co-payment while the NHSO has inadequate funds for health coverage.
 
 
Ensure medical fee reimbursement
 
The NHSO sets up the quality and standard control board to review the extra billing complaints, most of which end up with the money returned to the patients, plus interest payment from hospital operators. 
 
The Board issued a guideline and regulation that lists free and non-free health services and items under the UCS, aiming for building the hospital operators’ confidence to provide free services to the patients and claim the fees from the NHSO afterward.
 
The free services include after-hour health services, emergency care and high-cost medicines — which many hospital operators falsely believe are not free.
 
Health providers may negotiate with the NHSO on non-free services and items, including orphan and new-release medicines.

If the NHSO finds these are necessary for the patients, it will reimburse the cost for the hospitals. 
 
The NHSO has also developed a claim system that accelerates the process of reimbursement and transaction, ensuring that the hospitals will receive medical fees within two weeks after the claim submissions. 
 
“We hope health providers will cooperate with us by not charging the patients, and send the claim to the NHSO instead.

Our organization will reimburse the medical fees based on the agreed rate,” said Dr Jadej.
 
Patients charged with extra billing can complain to the NHSO 1330 contact center.