Current Situations and Factors Influencing Access to Radiation Therapy under Universal Coverage in Thailand - สถานการณ์และปัจจัยที่มีผลต่อการเข้าถึงบริการรังสี รักษาในประเทศไทยภายใต้ระบบหลักประกันสุขภาพถ้วนหน้า

Abstract

The aim of this study was to describe current situations and factors influencing access to radiation therapy in Thailand after implementation of the policy on Universal Coverage. Findings of this study are intended to be a case study for improving efficiency in health resource allocation and equitable access to expensive health services in Thailand.

Several research methods included literature review on prevalence and incidence of cancer patients and minimum requirements for radiation therapy services, a census of 25 radiation therapy units (both public and private facilities) and 72 radiation therapists around the country in terms of workload and types of services provided. Semi-structured interviews with 1,555 sampled cancer patients in 20 units permitted to engage and purposively in-depth interviews with 12 selected radiation therapists were conducted during January - December 2002.

Results revealed that lacking of vital human resources, both radiation therapists and medical physicists, was a serious and urgent problem of the radiation therapy facilities under the supervision of the Ministry of Public Health (MOPH), while the shortage of radiation therapy devices was trivial. Nine out of ten public facilities under MOPH could not achieve the minimum requirements in terms of the number of radiation therapists, and only 20 percent of them met the minimum standard of medical physicists. Geographical barriers to radiation therapy, inability to pay for travelling costs, lacking of health insurance among poor cancer patients, and mal-distribution of radiation therapy facilities favouring Bangkok and big cities, were crucial factors influencing inequitable access to radiation therapy services. Interviews of radiation therapists supported an urgent need to solve the shortage of human resources for radiation therapy services and improve the quality of care. The expansion of radiation therapy services to capable regional and provincial hospitals, and improving prevention as well as early detection of cancer are also suggested.