February 27, 2017

Referral Programme

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The Referral Programme is the longest running programme at Mae Tao Clinic. Before we had the supplies and capacity to treat many of the patients that we saw, they were referred to Mae Sot Hospital. Currently, approximately 1-3% of patients that present at Mae Tao Clinic are referred.

 

History

The Referral Programme is the longest running programme at MTC. Before the clinic had the supplies and capacity to treat many of the patients that we saw, they were referred to Mae Sot Hospital (MSH). In 1988, student camps were established along the border, mainly by students who had come from central Burma, and were not from Karen State or border areas. In the beginning, the cases that couldn’t be treated in the student camps were referred to MSH through coordination at MTC. At this time, MTC was more like a patient house, sending 20-25 cases per month to Mae Sot Hospital. Today, the clinic is able to treat malaria cases, and deal with more severe injuries, but there are still patients that require services beyond the clinic’s capacity.

The Current Programme

Approximately 1–3% of patients that come to MTC for treatment are referred to Mae Sot Hospital, as we are unable to treat them for a variety of reasons. Patients referred by the clinic are case-managed by a team of medics. Due to the high cost of referrals, we recently carried out a review of the referral process, and a new referral policy is now in place. We also held advanced training for some senior medics which has reduced the need to refer many patients, which, in turn, saves MTC money in the long-term.

The majority of the patients that enter the Referral Programme have crossed the border from Burma for medical services. Some of the most common cases seen for referral are congenital heart disease and severe fractures in children, and myoma, uterine prolapse and ovarian cysts in adult cases.

Not all cases that go beyond the services of the clinic will actually enter the Referral Programme. MTC allocates a monthly budget that is used to pay for treatment at larger service providers such as Mae Sot Hospital. Emergency and the most severe cases are referred first, but non-emergency cases are not often referred. Most referred cases are surgical cases, as medical cases can be treated at the clinic, with exceptions being chronic diabetes cases, and HIV positive pregnant women.

Referrals in 2016

In 2016, a total of 862 referrals were sent to Mae Sot hospital with 458 admissions to the inpatient departments and 404 consultations in the out patient departments. For patients for whom we are unable to provide further assistance we give cash to facilitate their treatments options. Of the 404 OPD referrals to Mae Sot Hospital 65% came from Burma. Of the 458 IPD referrals to Mae Sot Hospital 57% came from Burma. Part of our strategic plan is for a standardised referral policy for cross border referral system. This will significantly reduce our referral budget.

Causes of Referral Numbers of Referral Total Cost (THB) Average Referral Cost per Patient (THB)
Delivery Complications 164 2,600,867 15,859
Neonatal Cases 84 1,003,716 11,949
Trauma / Surgical Cases 85 1,721,760 20,256

Mae Tao Clinic is receiving a continuously rising number of patients with complex pathologies either self-referred or referred by hospitals inside Burma. This process is adding to the referral related costs that are already an unequal burden on the total budget available. We currently looking into developing different pathways to reduce the growing costs of our referral system. Part of this approach is our continuous collaboration with Burma Children Medical Fund.MTC referred a total of 234 patients to BCMF. BCMF is historically able to take over referral cases and costs for none-emergency cases as: congenital conditions such as heart diseases and neurological malformations, gynecological cases and others. However recently our collaboration in specific cases has expanded to covering costs for diagnostic CT-scans and excepting specific surgical emergency referral cases. Another pathway in reducing referral costs is the development of a referral system to the Burmese government healthcare system, mainly Myawaddy hospital, with a significantly lower price level. In the past semester, we have been starting with a case by case approach referring none emergency obstetric cases to Myawaddy hospital. In total, we have referred 3 cases to Myawaddy in this semester. This approach will need a thorough follow-up, further collaboration with Myawaddy hospital and in time development of an official referral pathway with preferably a referral team onside in Myawaddy hospital.

The MTC referral team continuously supports referral patients with translation during consultations and with assistance in understanding the Thai government hospital system. The referral team further plays a vital role in daily follow-up of the referral patients that are admitted in Mae Sot GH and in retrieving results and information from the outpatient referrals.

(Updated on August 23, 2017)