Factors influencing inequitable access to radiation therapy of cancer patients in Thailand

Abstract

Objective: To describe factors influencing inequitable access to radiation therapy among cancer patients in Thailand by exploring the current situation and problems of both demand and supply sides after the implementation of the policy of universal coverage. The study aimed to improve efficiency in health resource allocation and equitable access to expensive health services by using radiation therapy as a case study. Materials and Methods: Both quantitative and qualitative approaches were employed. A census of 25 radiation therapy units (both public and private facilities) and 72 radiation therapists around the country was carried out. Semi-structured interviews with 1}500 sampled cancer patients and in-depth interviews with 12 purposively selected radiation therapists were conducted. Results: lacking vital human resources including both radiation therapists and medical physicists, was a serious and urgent problem of the radiation therapy service under the Ministry of Public Health (MOPH). There was no public radiation therapy unit of the MOPH achieving the minimum standard in terms of the appropriate number of radiation therapists, and only 20% of them passed the minimum standard for medcial physicists. Mal-distribution of radiation therapy facilities favoring Bangkok and big cities, inability to pay for traveling costs for patients, and lack of health insurance among poor cancer patients, appeared to significant factors influencing equitable access to radiation therapy services. Interviews of radiation therapists support that there is an urgent need to solve the shortage of human resources for radiation therapy services and improve the quality of care. Conclusion: Factors from both demand and supply sides influence the problems of inequitable access to radiation therapy in Thailand. The removal of initial financial barriers under universal coverage can not solely solve the problem of inequitable access to such expensive health care. Effective short-term and long-term measures require the active participation and concerted efforts of various stakeholders.