Summary
Cancer rates are rising in Thailand, and while over 99% of the population has access to universal healthcare, there are still long delays in accessing cancer care.1 2 Travel distances, disjointed records systems, and patient management of healthcare data are cited as reasons for care delays.3 In 2022, the National Health Security Office introduced the Cancer Anywhere (CA) programme, which enables those covered by the Universal Coverage Scheme to choose where they want to receive cancer care.3 The CA programme was accompanied by the introduction of digital patient information and management systems, which help reduce administrative delays and errors.3 Since implementation, CA has provided care to more than 200,000 patients, increased access to treatments for select cancers, and improved survival rates for all cancers.4
Challenge
The number of people diagnosed with cancer each year in Thailand is rising, with over 180,000 new cases diagnosed in 2022 and a predicted 50% increase in incidence by 2045.2 Forty percent of these cancers were diagnosed at a late stage, leading to poor outcomes and high mortality rates.5 Access to cancer treatment has been available for all Thai citizens since 2002, when the government introduced universal health coverage.6 While this means that over 99% of the Thai population has access to healthcare, there are still issues that limit access to, and delivery of, cancer care.1
People may have to travel far to access cancer care, and the cost of this can be prohibitive.7 And the process for patients to move to a closer facility is inefficient and complicated. Participants of the Universal Coverage Scheme (UCS) – the largest of the universal healthcare programmes in Thailand – are assigned a ‘primary hospital’ that controls their care and medical records; changing this primary hospital requires patients to complete many referral forms, attend in-person processing meetings that are only available at limited times, and personally request data each time they are required by a different healthcare facility.3 There is also a 15-day treatment delay when patients do move hospitals.3 All of these factors can cause delays in accessing cancer care, leading to worse clinical outcomes; and require patients – who have limited to no medical data knowledge – to manage their own medical records. Any errors in this already drawn-out process require patients to start over again.3
Solution
In 2021, the National Health Security Office (NHSO) announced the implementation of the Cancer Anywhere (CA) programme.8 This enabled people covered by the UCS – an estimated 72% of Thailand’s population – to access cancer care in all 192 public hospitals, including across regional health borders.1 6 8 9 CA offers chemotherapy, radiotherapy, diagnosis and staging, complications treatment and follow-up treatment, and patients can receive care away from their primary hospital without a 15-day delay.3 The programme aims to cut waiting times for diagnosis and treatment, reduce medical-record errors and the delays they cause, and improve outcomes due to earlier-stage diagnosis.3
The following tools have been developed to aid the implementation of CA:3
- Thai Cancer Based online (TCB) Plus Program – a centralised digital system that is filled out by a healthcare provider (HCP) at the time of cancer diagnosis, and contains a patient’s treatment history.
- Cancer Anywhere Application – a mobile app that all patients must install once registered under TCB Plus. It allows people to access their personal information and treatment history, and produces codes that authorise HCPs to access information.
- The One Program – a booking system that allows HCPs to access and reserve cancer-specific equipment for patients at different healthcare facilities. It also provides virtual appointment cards for patients.
These tools will reduce health-record errors, remove the need for patients to amend their medical records and treatment requests in person, and reduce waiting times for diagnosis and treatment.
What has been achieved?
In 2022, the first full year of its implementation, CA allowed over 200,000 people to access treatment at 176 of the 192 participating centres.4 9 This is an increase of over 70,000 patients from 2021.4 10 Only 15% of cancer patients are accessing care at their primary hospital; more than 50% access care at other hospitals in their province, 18% access care outside their province but within their health region, and 17% access care outside their health region.4
The programme has increased access to radiotherapy and chemotherapy, especially among those with stomach, colon, liver and lung cancers. CA has also reduced surgery waiting times for stomach and colon cancer patients. The survival rate for all cancer patients was also found to have increased.4The programme has caused efficiency gains by improving digital health infrastructure, reducing patient waiting times for treatment, and enabling patients to access a wider range of specialist treatment centres.
Next steps
In May 2024, the chairman of the Medical Committee Social Security Fund announced an expansion of the CA programme. The eligibility criteria will be expanded to all those with universal health coverage, and an improved centralised communication and tracking system will allow the easy exchange of information between medical centres. A full set of eligibility guidelines are expected to be published by the Social Security Office later in the year.11
References:
- Reungwetwattana T, Oranratnachai S, Puataweepong P, et al. 2020. Lung Cancer in Thailand. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 15(11): 1714-21 [accessed: May 2024]
- International Agency for Research on Cancer. 2024. Cancer Tomorrow: Estimated number of new cases from 2022 to 2045, Both sexes, age [0-85+] All cancers. Available from: Available here: https://gco.iarc.fr/tomorrow/en/dataviz/bars?populations=764 [accessed: June 2024]
- Thai Cancer Society. 2023 [Cancer Anywhere]. Available here: https://thaicancersociety.com/rights-to-health-care/cancer-anywhere [accessed: May 2024]
- National Health Security Office. 2023. NHSO Annual Report: Fiscal Year 2022. Bangkok
- Potaya S, Thongcharoen V, Raungratanaamporn S, et al. 2024. A Scenario for a Model of Excellence in Comprehensive Cancer Care. Asian Pac J Cancer Prev 25(1): 273-79 [accessed: May 2024]
- Sumriddetchkajorn K, Shimazaki K, Ono T, et al. 2019. Universal health coverage and primary care, Thailand. Bull World Health Organ 97(6): 415-22 [accessed: May 2024]
- Rittitit A, Promthet S, Suwanrungruang K, et al. 2020. Factors Associated with Time Intervals for Diagnosis of Colorectal Cancer: A Hospital Based Study in Khon Kaen, Thailand. Asian Pac J Cancer Prev 21(6): 1835-40
- Mahajan A. 2023. Improving access to global cancer services. The Lancet 401(10385): 1338-39
- National cancer i. 2022. Cancer Anywhere. Journal of The Department of Medical Services 47(4): 5-9
- National Health Security Office. 2022. NHSO Annual Report: Fiscal Year 2021. Bangkok [accessed: May 2024]
- Hfocus. 2024. [The insured is happy! Cancer can be treated anywhere. made an agreement with Social Security]. Available from: Available here: https://www.hfocus.org/content/2024/05/30453 [accessed: April 2024]