Inequitable Access to High-Cost Diagnostic Radiology under the Universal Health Coverage in Thailand

Abstract

The provision of public health services is a state core duty by constitution, it is citizens’ health rights to fair and equitable service delivery. Realizing these rights depends not only on legal recognition but also on governance, resource allocation, and administrative practices. Structural constraints are evident in high-cost specialized diagnostic radiology services, such as computed tomography (CT), which require advanced technology, skilled personnel, and complex financing and service arrangements. This study examined how administrative discretion of public health service units affected access to emergency CT scans. Using a public law–informed health systems perspective, it analyzed interactions between legal entitlements, service organization, and decision-making. A comprehensive literature review and a case study of disputes over emergency CT access illustrated gaps between policy intent and operational practice. Findings indicated that limitations in infrastructure, procurement processes, and financial incentives within insurance schemes and service contracts contributed to unequal access. Restrictions on emergency CT scans without medical justification reflected administrative discretion rather than clinical need, undermining equity, continuity of care, and accountability. The study proposes a “public law architecture for emergency CT services” as a governance framework integrating constitutional principles, health legislation, administrative regulations, service contracts, and policy oversight. This framework aims to align legal obligations with health system operations, constrain discretion, strengthen accountability, and promote equitable and sustainable access to emergency diagnostic radiology services.