Factors Influencing Inequitable Access to Radiation Therapy: The Case Study of Cancer Patients in Thailand

Abstract

OBJECTIVES: 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 on 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. 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 services 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 medical physicists. Mal-distribution of radiation therapy facilities favoring Bangkok and big cities, inability to pay for traveling costs and lacking of health insurance among poor cancer patients were illustrated as significant factors influencing equitable access to radiation therapy services. Interviews from 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. CONCLUSIONS: Factors of both demand and supply sides influenced the problems of inequitable access to radiation therapy in Thailand. The removal of 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.