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Vol 25, No. 03, March 2021   |   Issue PDF view/purchase
COLUMNS
Improving Healthcare Access Sustainability in Thailand Through Closer Collaboration
by Joseph Saba
One of Asia’s greatest growth stories, Thailand has moved from a low-income to an upper-middle-income nation in less than a generation. In the process, the country has invested in their healthcare ecosystem and introduced a universal healthcare coverage (UHC) program that makes it possible for a large part of the population to access basic health services at little to no cost, contributing to higher life expectancies and lower birth rates. However, like many upper-middle-income countries, Thailand’s society is aging, financially straining the healthcare sector. The strain has been made more significant by rising rates of non-communicable diseases (NCDs), which account for 74 percent of all deaths in Thailand annually, or around 400,000 people.

While universal healthcare improves basic healthcare access for most Thais, it is not adapted to chronic or non-communicable conditions like cancer or respiratory illnesses that require costly life-long specialized treatments with close follow up. Basic healthcare access includes primary care medications, like antihypertensives, which are needed by millions of patients and are typically covered by UHC at significantly discounted prices – often no more than a few hundred Baht. In contrast, specialized treatments for complex conditions cost tens of thousands of Baht, are needed by a much smaller group of patients and are typically not covered by UHC.

So why not just reduce the price of these specialized medications? Simply put, it’s not sustainable. When the price of a primary care medication is decreased, many more patients can pay for the treatment at a lower cost. The larger volume of patients makes it cost-effective for the government and the manufacturers, despite the price cuts. For specialized, higher cost medications however, the price would have to be reduced so significantly to be affordable to most patients that it would not be financially sustainable for the government or the manufacturers, making long-term patient access impossible.

As scientists continue to make progress in the field of personalized, increasingly specialized medicines for the treatment of NCDs, the cost of these treatments will be a challenge for the foreseeable future. Thailand’s healthcare stakeholders must hence collaborate to explore alternative access solutions that go beyond the traditional price-volume logic and are adapted to the growing number of patients with complex conditions in order to build an ecosystem that can sustainably provide equitable access to the nation’s evolving society.

The Treatment Affordability Challenge

In Thailand, many patients are bearing the cost of specialized treatment by themselves, pressuring them to make difficult decisions about their future.

Take, a 49-year-old Thai business owner, was diagnosed with metastatic colorectal cancer in 2016. The family breadwinner decided that the amount he would have to pay to continue his treatment was not worth the toll it would take on his family, as it meant dipping into his children’s education fund. “I decided to put my family’s needs before my own,” he told us. “I could not be selfish and focus on myself.”

Take’s situation echoes across Thailand; people like him are facing the dilemma of forgoing their health, as they are priced out of the treatment options currently available. How can we make the situation more bearable for them? This is a task that none of us can go about alone.

A Collaborative Approach to Access

Many of us are familiar with the traditional bonus schemes (i.e., ‘buying X and getting X for free’) that intend to make specialized, costlier medications more affordable to patients. But what often happens instead is that patients run out of money after paying for a few rounds of medication, are unable to finish their full course of treatment and therefore cannot achieve the expected medical benefits. They effectively waste their money and physicians waste their time.

The reality is that broadening sustainable healthcare access is not a one-size-fits-all approach and focusing only on price reductions is a myopic view of the problem. Specialized and increasingly personalized treatments require personalized solutions that are tailored to the specific needs of the patient and their country. In an environment that is increasingly becoming a self-pay market for specialty treatments, healthcare stakeholders must find alternative access solutions to improve patient outcomes in chronic disease management. Cost-sharing models, for example, can help widen access to specialized medications for a broader range of patients in Thailand. However, these models require the involvement of a wide range of ecosystem partners.

Over the last decade, as part of a cost-sharing model, Axios has utilized a unique confidential assessment tool in Thailand, called the Patient Financial Eligibility Tool (PFET), to assess how much assistance a patient needs to afford their full treatment course.

Taking into consideration the unique needs of countries with prominent informal economies, like Thailand, PFET integrates income, assets and living standards to develop a plan that details how much help the patient will need to complete their treatment course based on their economic conditions - and how much will be covered by other parties, such as pharmaceutical companies, insurers, and the government.

By splitting the cost of treatment across multiple parties, cost-sharing makes it possible for a patient to afford their full course of treatment. As a result, patients get the most medical benefit from their treatment, and physicians have a viable alternative option to offer their patients experiencing affordability issues. It can also help minimize demand on government healthcare budgets.

The key lesson that we learned over the years in Thailand and in many other countries is the importance of focusing access solutions on treatment completion rather than on the box and its price. The real win-win situation is achieved when patients take their treatment continuously and doctors see positive results. Take is one of the patients we are helping. After a doctor enrolled him in one of our treatment access programs, he managed to receive his medication at a cost aligned with his economic conditions, enabling him to balance the financial commitments of his health and his family.

Sustaining Thailand’s Future

Cost-sharing is a good example of how closer ecosystem collaborations can be leveraged to deliver better healthcare access at scale. With the government prioritizing healthcare ecosystem development as a key area for public-private partnerships (PPPs), there will be more areas where collaborations can be explored to help support Thailand’s healthcare sector sustainably.

Thailand 4.0 will usher in the next stage of the nation’s development, of which a key part is to build healthier communities, since having good health correlates with a nation’s ability to sustain its growth. Hence, now more than ever, Thailand’s healthcare players must work together to think outside the box and leverage alternative solutions to continue broadening healthcare access nationwide.

References:

  • https://www.worldbank.org/en/country/thailand/overview
  • https://www.iseas.edu.sg/images/pdf/ISEAS_Perspective_2019_32.pdf
  • https://www.who.int/thailand/activities/catalyzing-multisectoral-actions-to-reduce-ncds-risk
    --factors#:~:text=Today%2C%20NCDs%2C%20primarily%20heart%20disease,hitting%
    20the%20national%20economy%20hard.
  • https://axiosint.com/accessinthailand
  • https://www.liebertpub.com/doi/abs/10.1089/pop.2012.0049?journalCode=pop&
  • http://www.ppp.sepo.go.th/tinymce/plugins/filemanager/thumbs/PPP/2561/ppp-strategi-
    %20plan-2560-2564-updated-Feb-2018.pdf
  • https://www.oecd-ilibrary.org/economics/oecd-observer/volume-2004/issue-2_observer-v2004-2-en

About the Author

Dr. Joseph Saba is the Co-Founder and Chief Executive Officer of Axios International (Paris, France). A French Lebanese medical doctor specializing in infectious diseases, health management and statistics while being internationally known for his expertise in the prevention of mother-to-child transmission of HIV and has led numerous discussions with pharmaceutical companies, governments and other key players across the healthcare community.

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