Government facilities

Health care in Thailand is mainly provided by the government’s Ministry of Public Health. In the late 1990s, when palliative care became incorporated into the national cancer control programme, amid growing interest from health professionals,¹¹ the Thai economy was seriously affected by the Asian Financial Crisis of 1997-98. A government paper (1999) outlining its plan for ‘health promoting hospitals’ indicates the state of Thailand’s health care system around this time: ‘The fragmented funding and provision of health care makes it difficult to provide equitable services.’¹²

As the economy recovered, the 30 baht universal health insurance scheme was introduced in 2001 and formalised in the National Health Security Act of 2002. This provision assimilated the Low Income Card Scheme introduced in the 1970s and the Social Security Scheme of the 1980s and extended protection to 18.5 million previously uninsured people - many of them belonging to the rural poor – which produced a newly-covered group of 45 million. Under this scheme, the cost to an individual for any one hospital visit or admission, including treatment, is 30 baht (US $0.98, GB £0.47). Each insured person receives a universal health card and may access care at government or private sector health services that are registered with the scheme.¹³

The introduction of the universal insurance policy coincided with a shift in funding away from the major hospitals towards primary care. This, in turn, influenced the hospitals’ operational effectiveness and produced large deficits in many institutions. To gauge the effect of the 30 baht scheme, a study was conducted of 640 public hospitals for financial year 2002. The subsequent report highlights a widespread culture of financial loss, much of it identified with manageable factors. According to the authors, the ramifications of the study were ‘to help policy-makers understand the hospital loss situation … and design policy to resolve the hospital loss problems’.¹⁴

In such a scenario, further compounded by Thailand’s emphasis on curative care, it is unsurprising the nascent palliative care movement stalled, or that leaders of palliative care services in government facilities found difficulty sourcing funds. Yet importantly, funding for hospital-based palliative care has become accessible to a large section of Thailand’s population, although domiciliary care falls outside of the scheme. Tanadej Sinthusake explains how this affects provision at Mahavajiralongkorn Cancer Centre:

‘Our home care programme is supported by the Cancer Centre. But we must make a profit from the radiotherapy unit and give the home care nurse a car to go see the patient at home. If [a benefactor] can pay it is no problem, we can go see every terminal cancer patient. But if we lack the money, the frequency of seeing the cancer patient is less, because no-one supports us.’¹⁵

Faith-based community facilities

The Christian (Catholic) organisations – the Camillian Social Centre, St Clare’s Hospice and the Mercy Centre AIDS Hospice - are all charitable institutions supported mainly by fundraising and private donations. A small amount of money is supplied by the Thai government. The Camillian Social Centre is run by the Camillian Foundation of Thailand and has been supported by Caritas Switzerland since 1996. St Clare’s Hospice is run by the Franciscan Foundation of Thailand and Mercy Centre by the Human Development Foundation.

Since 2004, the Mercy Centre has also been able to support its patients through a USAID scheme that provides loans to teams of two people where one party is HIV positive, the other HIV negative. Named ‘Positive Partnership’ the scheme is designed to reduce the stigmatization of people living with HIV/AIDS by associating HIV-positive people with successful businesses and encouraging cooperation between those with the disease and others in the community. The loans range from 3,000 baht to 12,000 baht (about $100 to $400). Typically, participants develop some type of handicraft or food business; others have invested in a sewing machine or raw materials. Re-payment plans are tailored to each partnership and loans are repaid at 5%.¹⁶

Wat Phrabat Nampu AIDS Hospice is supported by the Dharmarak Foundation and is solely dependent on charitable donations to meet its required sum of 60 million baht (US $1.96 million) per year. Monks and Foundation members seek funds on a daily basis. Members of the international community also provide support, such as the US-based Buddhist Council of the Northwest.