Southeast Asia's healthcare landscape has evolved considerably over the last decade, led by shifts in disease patterns, population trends, an improvement in universal healthcare plans as well as a rise in scientific breakthroughs.
The H4U (Health for You) mobile app developed by the Ministry of Public Health creates personal health profiles of patients that can be accessed from anywhere. Photo: Ministry of Public Health
Within the region, Thailand's Universal Healthcare Coverage (UHC) system has made significant strides to achieve better results for its population. Ranked sixth globally on the Global Health Security Index for its robust healthcare ecosystem, it entitles every citizen to essential services in preventive, curative and palliative care.
Yet, despite its significant achievements over the past decades, UHC remains limited in its ability to cover costly life-long specialised treatments for non-communicable diseases (NCDs) and chronic illnesses.
On top of that, its dependence on government funding means the programme is vulnerable to declining tax revenue -- especially as nearly 7 million citizens live no more than 20% above the poverty line and that Thailand is projected to have aged society by 2025.
Hence, medical expenses are rising despite improved access -- making the need for sustainable healthcare solutions particularly important. To achieve that, public and private stakeholders must innovate and collaborate to build on Thailand's existing infrastructure. The following five trends influencing healthcare access across Southeast Asia might be useful to consider:
- Access is being reconceptualised from a short-term strategy to a long-term solution: Thailand targeted UHC as a central pillar of the health-related targets of its United Nations Sustainable Development Goals (SDGs). It has also rolled out telemedicine and is developing other digital health initiatives to improve access.
However, the World Health Organization (WHO) notes that much more can be done to enhance and sustain the UHC effort, which remains largely focused on essential medicines rather than specific, expensive chronic treatments.
There is scope for the private sector to play a role in supporting public health initiatives. For instance, the Patient Financial Eligibility Tool (PFET) developed by Axios is used in all the Asian countries we operate in to assess the true financial capability of patients.
Our cost-sharing programmes use this tool extensively to determine the extent of financial help patients need to access healthcare services, which in turn are funded by pharmaceutical companies and other stakeholders. This collaboration ensures sustainable access to healthcare, leading to enhanced patient outcomes.
- Access not only includes affordability, but long-term adherence: In Thailand, this has been reflected in a shift from paternalistic models of care and compliance in treatment adherence toward family and community support. A 2020 case study relating to Type 2 diabetes conducted in Chiang Mai revealed that while UHC offered adequate medical management, less than half of patients achieved optimal control.
Symptoms, understanding and acceptance in taking medication, the presence of family support and the perception of concern by the doctor -- all affected adherence with the latter creating greater trust. This, with family support, helped deepen patients' understanding of their disease, acceptance of its chronic nature and engendered a positive attitude toward taking medication. The human support factor is especially important in an ageing populace.
Our organisation develops programmes where, after an individual patient needs assessment, services continue to optimise adherence including call centres, diagnostic support, counselling and disease management.
- A growing focus on reaching patients outside the hospital: Hospitals and health facilities have long served as the core pillar of health systems. However, the world is radically changing and the healthcare sector has not kept pace.
In Thailand, the country's telemedicine programme recognised the challenges in healthcare access for rural areas, even before the pandemic struck us. Community hospitals or primary medicine clusters can serve patients in remote areas utilising a system combining local health volunteers, a mobile app, as well as a medical information and management support system.
Additionally, Smart ID cards facilitate patient visits to any hospital or clinic without treatment interruptions. The H4U (health for you) app developed by the Ministry of Public Health further supports the process and creates personal health profiles of patients that can be accessed from anywhere on a mobile device.
Such initiatives allow other stakeholders to expand their services and reach a larger target segment to support public health facilities that are at capacity. For example, Bangkok's Bumrungrad International Hospital launched Bumrungrad@Home service in March 2020 during the pandemic. It provides not just access to doctors, but an entire medical ecosystem, reducing the need to travel to receive care.
To help boost such efforts, our organisation has developed digital tools that allow consistent engagement between patients and healthcare stakeholders. These tools complement Patient Support Programmes (PSP) and give patients greater agency in tracking and managing their treatment.
- Companies are exploring new ways to engage with governments on access: Sustainability cannot be achieved without governments, and creative collaboration can lead to a more effective health ecosystem. Thailand's commitment to digital technology creates a unique and welcoming business environment that drives medical investment and innovation.
To illustrate, Thailand's Department of Consular Affairs teamed up with a MedTech startup during the pandemic to provide consultations for Thais living overseas -- connecting them with specialist doctors, pharmacies, hospitals, insurers and other medical services. It highlights how public-private collaborations can be instrumental in building sustainable healthcare access.
- More relevant data is needed: As the healthcare industry continues to innovate, there is a need to understand the impact of access solutions so that they can be consistently improved for better patient outcomes.
While Thailand has been digitally progressive, the healthcare sector can use more data to improve decision-making. There is a need to capture access-related, real-world insights to gauge the impact of access interventions and their effectiveness.
Our organisation uses data regularly to understand the impact of access solutions and what changes are required to make them more effective.
Access is no longer just "good to have": The ongoing pandemic has highlighted inefficiencies in current healthcare systems, and a long-term concerted approach will be required to address them sustainably. All stakeholders need to collaborate to build a unified healthcare system primed to address any public health challenge that confronts us in the future.
Roshel Jayasundera is Senior Director for Global Consulting with Axios International, a healthcare access specialist.
