As one of the speakers for keynote panel discussion of The Price of Policy at Healthcare Forum: War on Cancer, Dr. Pannet Pangputhipong shared about the healthcare systems and cancer control policies in Thailand.
Pannet Pangputhipong, MD.
Deputy Director General, Department of Medical Services,
Ministry of Public Health, Thailand
Dr. Pangputhipong has been assigned to supervise Thailand's National Cancer Institute and Regional Cancer Hospitals which responsible for Cancer Control, Cancer Care and Policy Advocacy.
(E-mail/social media links: firstname.lastname@example.org)
1. What different methods and approaches does your country use in promoting health policies to increase awareness from people about healthcare, how to prevent cancer and so on?
In Thailand, in the past we paid our attention for the treatment but now we try to put more efforts to the prevention and promotion. But the issue is lack of budget for Prevention and Promotion (PP). We have to use budget for treatment, so it only has little budget for PP. We try to do more for Prevention and Promotion because we realized it is will save cost in long term and bring happier and healthier life to our people.
We also have different departments which looking after different parts. For example for PP, we have Department of Health taking care of health education, promoting exercise and food. Whereas for screening (early detection), we have another department, Department of Disease Control. For treatment we have another department, Department of Medical Services. In the Department of Medical Services, we have National Cancer Institute that should look into the whole spectrum of care starting from prevention, promotion, screening and treatment. We have to work collaboratively, so we do not have direct control.
Starting a few years back, we have a service development plan, we have the national committee for cancer to look for the whole range starting from information, prevention, promotion, screening, treatment, palliative care, and research. So this community will collaborate each department, helping to plan and execute the action for cancer control.
2. How is the budget distribution for healthcare sectors?
We try to separate the budget for policy maker, providers and purchasers. The purchasers control the budget. The purchasers are coming from the Universal Coverage (UC), like 600 million US dollar a year for PP, but that is not only for cancer. We also have the sin tax from tobacco and alcohol. This is another source of about 100 million US. Sin tax is used for PP but different departments have to apply budget from Thai Health Promotion Foundation to run the projects.
3. Given that your country has the cancer care control program, what is the survival rate for the cancer patients in recent years?
We have national cancer care control program for almost 2 decades, and we started to see some improvements. We see some declining in mortality for example for breast cancer and decline in mortality rate because of early detection. Thus, the program is effective. Also, we have the hepatitis B vaccination starting about 20 years ago and the coverage is more than 90%, and we see the drop in number of Hepatitis B carriers. These are just some examples of the control program. For the treatment, we try to use the cost-effective treatment from the data of HTA to reduce the mortality. Last year, we put targeted chemotherapy like Trastuzumab for some indication of breast cancer for UC reimbursement scheme because the HTA coming out that it prolongs life from 9 to 14 years with good quality of life. So in the future we may see some drop of mortality, but we have to think about the ageing population that will cause the rising incidence and also mortality, and also think about the changing of the environment that will cause more cancer and its mortality. Therefore, it’s a balance between good control program and the changing of the trend.
4. Are there any health policies to reduce financial burden of your people because poverty may be one of the main issue for people to get the issue on time?
UC stands for Universal Coverage scheme, is a national health insurance system free for people. In Thailand, we have three major schemes. UC is for everyone who doesn’t have the other two. The other two is Social Security Scheme for private company for their employees and the last one is the CSMB (Civil Servant Medical Benefit) for public sectors and relatives. So everyone in Thailand will have one kind of insurance scheme. Not overlapping.
Thailand started Universal Health Coverage in 2003. The philosophy or the objective is to prevent people from bankruptcy when they have high-cost diseases like cardiovascular and cancer. They may be bankrupt to get treatment or they cannot access to the care because they have no money to pay. In the past, many of them sell their house to get treatment so the main objective of UC is to prevent people from becoming bankrupt. Starting from that, we look at the burden - which diseases or problems that cost more for the people. I think we improved a lot by preventing our patients to pay too much from their pockets. UC helps the low and middle income people to pay for their medical treatment. This scheme is for all kind of people that do not have any other kind of insurance. I think the reimbursement scheme is not the best but it is good.
5. Is there free cancer screening for early detection?
We have about 10 years of the cervical cancer national screening, it is the only official national screening, but we also have opportunistic for breast cancer screening. For self-breast exam, if it is positive, you come to doctor, and then doctor sends you for mammogram, the mammogram is free. But we will change a bit for breast cancer screening, from self-breast exam to the clinical breast exam by doctor, because it is very difficult to educate people to do self-breast exam. We will also start colorectal cancer screening maybe next year. For stool occult blood testing and colonoscopy testing will also be free, so basically every screening that we put into the benefits can be accessed free-of-charge (FOC).
6. Are there any challenges and obstacles that prevent you to implement healthcare policies in your country? Any steps to overcome the problems?
I think the budget will be one of the big issues. And also the manpower in healthcare industry, because everyday screening program will be implemented through health assistants, mostly at the lower level at the health promoting hospitals or community hospitals. Every kind of programs (not only the cancer) will have to go through them, so they have a lot of workloads. If we have to improve the quality of screening, we have to think of all factors/inputs like budget, manpower, health infrastructures, etc. The manpower wise, we try to use workload calculation, try to add new positions to the system, so in the future they can do more prevention and promotion which are at lower level.
7. Is there any digital health program in Thailand, like using modern technology?
We have started some telemedicines through tele-consultants with some cancers and diseases like cardiovascular, some primary level community hospitals may want to consult doctors in regional hospital. We are starting some kind of these tele-consultations.
8. What are your future plans for better implementation of health policies?
We try to improve the PP part. I think that is the most important to raise awareness of people, and also the screening programme. While for the treatment we try to look for the advanced treatments that are less costly like targeted therapy and immunotherapy. I think the burden is the cost of drugs and treatment for cancer is very high, so the cost should be cut down. We have the national list of essential drugs. The drugs that can put into the list will pass the process of HTA and expert partner to put any kind of drugs. Hence if the drug is in that list, it will be reimbursed through UC or other schemes FOC. In the list we have a few targeted drugs for cancer and we try to add more when data assessment comes out. It is also up to the budget that are available.
This interview was conducted by APBN, Catherine D. Ong and Carmen Jia Wen Loh at Healthcare Forum: War on Cancer on 17th March 2016.