Drugstore plan worth a try

The National Health Security Office (NHSO) and the Medical Council of Thailand are at odds over a project that allows people with common illnesses to seek free medicines from drugstores without a prescription instead of going to see a doctor at hospitals.
The project which was launched in 2022 is a joint venture between the NHSO and the Pharmacy Council of Thailand. The scheme is designed to ease over-crowdeding at state hospitals, while ensuring access to basic care for people with common illnesses.
Eligibility is limited to members of the 30-baht universal healthcare scheme (UHS) who develop any of 32 listed conditions and obtain free medicines from drugstores registered under the project. The 32 conditions, an increase from the initial list, include headache, joint pains, cough, fever, nausea, and allergies, to name but a few.
However, the MCT frowned on the project, saying some medicines on the list are dangerous and require a doctor’s examination. It insisted the service should be limited to over-the-counter drugs.
As the fallout continues, the MCT has refused to budge. The council sought help from the Administrative Court which initially rejected its petition because of the 90-day statute of limitations. However, the Medical Council refused to give up, appealing to the Supreme Administrative Court which eventually agreed to accept the case.
In defending its project, the Pharmacy Council insisted the scheme has proper guardrails to protect the public.
Drugstores participating in the project must carry a good pharmacy practice (GPP) certificate and have certified pharmacists on duty. The council insisted that while the court ruling is pending, people with the 32 conditions are still able to seek free medicines from designated drugstores.
At the same time, the NHSO has downplayed the MCT’s concerns, insisting the scheme benefits the public and helps reduce the workload of medical staff at state hospitals.
In reality, many sick people already seek medicines from drugstores, instead of going to hospital. The scheme mainly helps ensure the public gets quality medicine from certified pharmacists.
Citing a survey, the NHSO said more than 17% of people who fall ill go to drugstores in the first few weeks and only go to see a doctor when symptoms persist. The NHSO also cited another survey in which more than 51% of UHS members say they avoid hospitals because of the long queues.
In addition, the NHSO said that while the project may appear a novel idea, the NHSO and the council launched pilot projects during 2004-2016 before making the scheme public in 2022.
It said the project was helpful during the Covid-19 pandemic as drugstores helped fill the gap when some patients had no access to hospitals.
In principle, drugstores joining the project are required to adopt a follow-up system and have a database linked with the NHSO.
Pharmacists will call those receiving medicines in the first 3-5 days. If they don’t feel better, the pharmacists will encourage them to see a doctor.
Given that the service is limited to people with mild symptoms, the project seems to be an acceptable option.
The NHSO and Medical Council should seek a compromise for the sake of the public interest, re-examine the lists of medicines and reserve only extremely dangerous medicines for prescriptions.
Another advantage of the project, as mentioned by the NHSO, is that it caters to some UHS members who previously had no access to state hospitals.
Over-crowding at state hospitals is a big problem, not to mention the scarcity of health services in the provinces.
The country needs a stronger primary care system, with more general practitioners serving in the community.
These GPs should help diagnose and treat people with common diseases. Efficient screening means only people with serious illnesses go to large hospitals, which would reduce the burden on the healthcare system.
The two agencies, instead of fighting for a bigger role, should work together to promote and invest in an awareness-raising campaign so people pay more attention to preventive care. They should ensure that people strictly follow the adage that prevention is better than a cure.