SMALL HOSPITALS FEAR EXTRA COSTS, SUPPLY SHORTAGES
ANXIETY runs high among small hospitals as uncertainties loom over how the universal healthcare scheme will handle some necessary medical items from October 1 onward.
The National Health Security Office (NHSO), which has long procured key medical supplies for facilities operating the scheme across the country, has just lost its power to procure. A few days ago, the Public Health Ministry insisted that this power was now in its hands.
This means the procurement of orphan medicines to treat rare medical conditions, antidotes, vaccines, anti-retroviral drugs, stents, artificial knees, supplies for continuous ambulatory peritoneal dialysis (CAPD) and things that are best bought in bulk for the universal scheme may soon change. This has caused concern among participating hospitals, especially small ones.
“If we are told to make procurements ourselves, we may have financial problems. When the NHSO handles the procurement through a central system, it has huge bargaining power. The prices come down significantly,” a doctor at a small hospital in the South said on condition of anonymity.
For more than a decade, the NHSO has done remarkably well in terms of central procurement. It has been credited for saving the country from Bt5-7 billion a year by getting big discounts when buying medical supplies in large amounts.
The NHSO also helped with procurement of medical supplies requiring centralised storage and distribution for efficiency.
But because a government-spending committee established by the National Council for Peace and Order (NCPO) pointed out that the NHSO was not legally allowed to make drug procurements, the Public Health Ministry has stepped in to take over.
Several experts suggest that the new National Health Security Bill, going through the legislative process, should shift the procurement power to the NHSO. The draft law does not allow that. Given that this bill has not yet been introduced as an effective law, the Health Ministry has said recently that it will handle procurement itself.
But NHSO spokesman Athaporn Limpanyalers says it’s still unclear how medical items that have long been on the central procurement list will be bought in the coming fiscal year.
The 2018 fiscal year will start on October 1.
Sureerat Treemanka, who sits on the committee vetting the National Health Security Bill, expressed concern about the ministry’s imminent move to handle some medical supplies in place of the NHSO.
“We have seen before that the ministry just helped negotiate the price but let hospitals decide whether to buy,” she said. “So what if hospitals decide to buy some other medical supplies – but not anti-retroviral drugs or cancer medicines that patients need?”
According to Sureerat, it is possible that some hospitals may not have sufficient necessary drugs if the number of patients suddenly increases.
“This problem may occur. When new patients show up, hospitals may then order drugs but sometimes patients just can’t wait,” she said.
These kinds of problems did not exist while the NHSO was in charge, because it keeps a stock of necessary drugs and delivers them when needed.
Sureerat emphasised that if the ministry wants to truly exercise its power to buy medical supplies, it should run things the way the NHSO did.
Speaking on condition of anonymity, a doctor said he was convinced the Public Health Ministry would allow the NHSO to handle the central drug procurement for one more year.
“The ministry may not have enough time to plan procurement for the new fiscal year that will start pretty soon,” he said.