Co-payments near reality as universal healthcare system reformed: minister

By CHULARAT SAENGPASSA 
THE NATION

 

Public Health Minister Dr Piyasakol Sakolsatayadorn.

 

LIKE IT OR NOT, indications are that patients will have to pay a portion of their medical expenses if and when the proposed National Health Security Bill is passed under the junta government.

 

“After we push through this bill, we will hold serious discussions on co-payments,” Public Health Minister Dr Piyasakol Sakolsatayadorn said during a recent exclusive interview with The Nation. 

 

He added that there had already been extensive studies on co-payment options. 

 

The draft National Health Security Bill has long been a subject of debate and controversy, with at least two groups clashing fiercely over its contents. Most critics worry that the bill would change the essence of the very popular universal healthcare scheme that now offers most medical services to about 48 million citizens for free. 

 

Their concerns are not unwarranted, given that advocates of co-payments have been persistent in pushing their belief over the years. 

Several health economists and experts have argued that without co-payments, the much-praised universal healthcare scheme – and Thailand – will collapse if the public insists on government shouldering the full financial weight of the scheme. 

 

“Even rich countries have limited healthcare budgets,” Piyasakol said in arguing for co-payments. “You have to understand that not all services can be free.” 

 

However, Piyasakol is quick to claim that healthcare reform is not intended to reduce people’s rights to healthcare. 

 

“We will ensure your right to basic healthcare services is not affected. But if you want more than the basic, you will have to pay,” Piyasakol said. 

 

When he had eye surgery, Piyasakol said, he had to pay out of his own pocket for extra services even after exercising his right under the medical scheme for civil servants and their family members. 

 

He added that healthcare reform was inevitable for the sake of sustainability and long-term efficiency. 

 

He said conflicts over the bill had already been reduced as relevant parties worked to reconcile their differences. There was also tangible cooperation from the National Health Security Office (NHSO), which manages the universal healthcare scheme, and the Public Health Ministry, which is mainly in charge of the scheme’s operation, he added. 

 

Although some topics remained divisive, Piyasakol said he was confident that compromises were possible and the bill would sail through, while still emphasising that co-payments were in the current National Health Security Act.

 

“I trust that there will be no big conflict,” he said. 

 

He added that the provision of health security would need to keep pace with the future contexts. 

 

Piyasakol said healthcare reform would also focus on easing overcrowding at big, well-equipped hospitals.

 

One reform would see 12 types of surgery performed on a one-day basis at no fewer than 15 per cent of major hospitals by the end of this year, according to the plan.

 

After several surgeries, such as those for haemorrhoids and biliary tract stones, most patients can leave hospital almost immediately after the operation.

 

“When patients can go back home within the same day of their surgery, it means there will be no problems finding a bed or a room for other patients who need to stay in the hospital,” Piyasakol said.

 

Another reform would see specialised clinics operating beyond normal working hours at major hospitals, including large and crowded ones, and not limited to facilities at medical schools. “Patients using the services beyond normal hours will have to pay more but they will get fast services,” he said. 

 

Overcrowding could also be eased with the implementation of a referral system that allowed large hospitals to transfer patients back to smaller hospitals for recuperation and rehabilitation, he said. Another change could see an increase in the number of family-medicine units.

A collections centre had also been established to help hospitals collect money, Piyasakol said. 

 

“This is meant to ensure that hospitals receive money owed to them,” he said. 

 

Sometimes doctors were so busy that they failed to double-check payment amounts and their hospitals ended up receiving less than what they were owed, he said. “The centre has helped with such cases,” he added. 

 

The Public Health Ministry has tried to help hospitals increase income and lower expenses in other ways as well. “For example, specialised clinics working beyond normal hours can generate income,” he reiterated. “Efficient use of electricity and resources can save utility bills.” 

 

Executives at the 120 hospitals that were reported to be operating with serious deficits had already received additional training so that they could better manage resources and improve work efficiency, Piyasakol said.

 

The government, he added, had allocated Bt5 billion in the budget last year to help address the problem. 

 

Source: http://www.nationmultimedia.com/detail/national/30335227

 

-- © Copyright The Nation 2018-01-03

40 minutes ago, webfact said:

LIKE IT OR NOT, indications are that patients will have to pay a portion of their medical expenses if and when the proposed National Health Security Bill is passed under the junta government.

 

40 minutes ago, webfact said:

When he had eye surgery, Piyasakol said, he had to pay out of his own pocket for extra services even after exercising his right under the medical scheme for civil servants and their family members. 

 

Health care systems, and ever-rising health care costs, are issues faced by governments around the planet and is one of the most difficult to get right.

 

I simply don't know enough to argue intelligently 'in the weeds' of this article. However, I do have one question...

 

A truly vital element of any health care system is that the administrators MUST have the same system as the general populace. Does the general populace have the same rights and privileges as the civil servants? 

 

If the answer is 'no', then this is just a way to cut assistance to poor people.

12 minutes ago, Samui Bodoh said:

 

 

Health care systems, and ever-rising health care costs, are issues faced by governments around the planet and is one of the most difficult to get right.

 

I simply don't know enough to argue intelligently 'in the weeds' of this article. However, I do have one question...

 

A truly vital element of any health care system is that the administrators MUST have the same system as the general populace. Does the general populace have the same rights and privileges as the civil servants? 

 

If the answer is 'no', then this is just a way to cut assistance to poor people.

Are you suggesting that all all employer provided health schemes should be banned? Just here, or in the rest of the world?

Are you suggesting that all all employer provided health schemes should be banned? Just here, or in the rest of the world?

No, whilst I am sure that SB can speak for himself, he is suggesting that senior administrators in the health services should not, as a result of their position, have access to a better standard of care than those who have to rely on that health service.

 

On a wider note, there are a number of ducks that have and are being lined up in a row. This is one of the "biggies".

 

Does anyone really believe that it will be seriously debated, let alone challenged or heaven forbid overturned, in the "National Legislative Assembly". No doubt there will be the usual handful of abstentions to give it democratic legitimacy...

 

Sent from my KENNY using Thailand Forum - Thaivisa mobile app

 

 

 

 

 

1 minute ago, JAG said:

No, whilst I am sure that SB can speak for himself, he is suggesting that senior administrators in the health services should not have access to a better standard of care than those who have to rely on that health service.

On a wider note, there are a number of ducks that have and are being lined up in a row. This is the "biggie".

Does anyone really believe that it will be seriously debated, let alone challenged or heaven forbid overturned, in the "National Legislative Assembly". No doubt there will be the usual handful of abstentions to give it democratic legitimacy...

Sent from my KENNY using Thailand Forum - Thaivisa mobile app
 

Why should public servants be denied health care services as part of their remuneration package? If the service provided isn't superior to that available to the public, what is the point of it?

Healthcare is the biggest money earner and large private mega business families and groups owning or controlling the majority of the private hospitals in the capital and other big cities will be the biggest gainers if the free healthcare system is abolished.

46 minutes ago, halloween said:

Why should public servants be denied health care services as part of their remuneration package? If the service provided isn't superior to that available to the public, what is the point of it?

Thanks JAG- you are correct.

 

The point that I am making is that the civil servants should have the same health care as the general public. When the civil servants have the same package, there is a MUCH greater tendency to ensure that everyone has as good health care as possible/feasible. If civil servants don't have the same health care, then their administering of the process is cold-blooded accountancy and (inevitably) the poor will lose out as they simply don't have much/any influence on the process.

 

No one is denying health care services to public servants; the public servants and the general public should have the same access to health care.

 

And if there is a need for better remuneration policies for public servants, raise their salaries and (try to) justify it to the public.

 

1 hour ago, Samui Bodoh said:

Thanks JAG- you are correct.

 

The point that I am making is that the civil servants should have the same health care as the general public. When the civil servants have the same package, there is a MUCH greater tendency to ensure that everyone has as good health care as possible/feasible. If civil servants don't have the same health care, then their administering of the process is cold-blooded accountancy and (inevitably) the poor will lose out as they simply don't have much/any influence on the process.

 

No one is denying health care services to public servants; the public servants and the general public should have the same access to health care.

 

And if there is a need for better remuneration policies for public servants, raise their salaries and (try to) justify it to the public.

 

So much fir Utopia. do you know of anywhere in the real world where this happens?

Many hospitals in Thailand have effectively been operating a co-pay system for years, as Piyasakol in the article suggests and as the experiences of my family also confirm - the bill is nothing more than a means of formalising the practice and making it more widespread.

Will need Toon to do another run to raise the shortfall since the junta will unlikely to reduce the defense budget for healthcare. 

I suppose you cannot have both,a nearly free health system and 

a massive war weapons procurement,so one has got to give,and

it's the healthcare system and its the people that lose.

regards worgeordie

1 minute ago, worgeordie said:

I suppose you cannot have both,a nearly free health system and 

a massive war weapons procurement,so one has got to give,and

it's the healthcare system and its the people that lose.

regards worgeordie

I disagree, Eric likes to call foul on the defence budget at every opportunity but in fact, it remains at less than 2% of GDP, lower than other regional countries and lower than international guidelines set for such things. If the government wanted to make budget cuts there are other areas they could do it successfully, without appearing to compromise on defence.

25 minutes ago, halloween said:

So much fir Utopia. do you know of anywhere in the real world where this happens?

The Netherlands where everybody has the same basic healthcare coverage. Billionaires and unemployed peole go to the same hospitals.

 

You can get more coverage but it comes at an extra costs which makes statistical sense.

25 minutes ago, halloween said:

So much fir Utopia. do you know of anywhere in the real world where this happens?

Utopia?

 

This is generally known as Universal Health Care. I believe that you are British (apologies if I am mistaken) and so you know it as the NHS. It is common in many countries, and more and more are looking at how to do it for their populace(s).

 

Respectfully, you seem to be arguing that public servants should have better health care than the public they serve. This is nonsense to me. 

 

Public policy always works better when the administrators and/or implementer have the same benefits as the people they serve- they have every incentive to make the system work. It isn't rocket science. 

5 minutes ago, simoh1490 said:

I disagree, Eric likes to call foul on the defence budget at every opportunity but in fact, it remains at less than 2% of GDP, lower than other regional countries and lower than international guidelines set for such things. If the government wanted to make budget cuts there are other areas they could do it successfully, without appearing to compromise on defence.

Problem is that the defence spending were for duds like the GT200, aircraft carrier, airship, submarines, tanks, planes and what goes into the generals pockets. What about the 1,500 generals salaries. Shouldn't the make defense spending more accountable and justify the 2% GDP. After all the shenanigans full of unexplained wealth, I am sure there are lots of fats that the budget can be trimmed for the all important healthcare. 

Just imagine the healthcare system Thailand could have without having to pay for submarines and other vast military expenses, a hugely overstaffed bureaucracy, lavish lifestyles for the elite etc etc etc

55 minutes ago, Bob12345 said:

The Netherlands where everybody has the same basic healthcare coverage. Billionaires and unemployed peole go to the same hospitals.

 

You can get more coverage but it comes at an extra costs which makes statistical sense.

I am from the Netherlands and I can assure you there is co payment in the form of the extra insurance plus that not everything is paid for and people have to pay out pocket if the come over an amount. I know for sure as my brother is now a diabetic and he has to pay certain things himself.

 

The reality is the health budget in Thailand is limited so co payment for extra services is normal, now the only discussion is what is basic and what is extra. That is a good discussion, not that people have to pay extra for services. 

10 minutes ago, edwinchester said:

Just imagine the healthcare system Thailand could have without having to pay for submarines and other vast military expenses, a hugely overstaffed bureaucracy, lavish lifestyles for the elite etc etc etc

Just imagine if there was no corruption in the Thai system, like you i love to dream. The education budget is one of the highest in the world per capita but does not deliver much. Corruption is a big problem, the submarines were a bad plan but the total defense budget is still lower as the countries around it in % of GDP. Sure it can be trimmed but so can things in the health budget as for sure there is a lot of corruption there too.

59 minutes ago, Bob12345 said:

The Netherlands where everybody has the same basic healthcare coverage. Billionaires and unemployed peole go to the same hospitals.

 

You can get more coverage but it comes at an extra costs which makes statistical sense.

 

Really. And when I worked in the Netherlands, for an American MNC, we had private health insurance as part of our package, for ourselves and our families.

 

Same in the UK. BUPA hospitals and medical facilities do rather well.

Just now, Baerboxer said:

 

Really. And when I worked in the Netherlands, for an American MNC, we had private health insurance as part of our package, for ourselves and our families.

 

Same in the UK. BUPA hospitals and medical facilities do rather well.

Bearboxer, it has changed but it might be different for people working part time in the Netherlands. Now anyway you would have to pay taxes and take out an health insurance (extra one) to pay for it and yes everyone goes to the same hospitals there are no private ones and maybe you can pay out pocket for extra service but not sure. I am quite sure its now quite fair over here. 

3 minutes ago, robblok said:

Just imagine if there was no corruption in the Thai system, like you i love to dream. The education budget is one of the highest in the world per capita but does not deliver much. Corruption is a big problem, the submarines were a bad plan but the total defense budget is still lower as the countries around it in % of GDP. Sure it can be trimmed but so can things in the health budget as for sure there is a lot of corruption there too.

 

Rob, the British NHS is wracked with inefficiency, ineffectiveness, poor management and administration. Successive governments answers have been to increase the management hierarchies, employ numerous consultants, invest in one of the most expensive integrated IT systems which flopped before ever going live and turn a blind eye to corruption.

It's the poison chalice of every new government - trying to get it back to how it was first an envy of other countries.

 

By comparison, the Thai system ain't so bad.

3 minutes ago, robblok said:

Bearboxer, it has changed but it might be different for people working part time in the Netherlands. Now anyway you would have to pay taxes and take out an health insurance (extra one) to pay for it and yes everyone goes to the same hospitals there are no private ones and maybe you can pay out pocket for extra service but not sure. I am quite sure its now quite fair over here. 

 

Interesting change Rob. That sort of system was also proposed in the UK a while back. But it's been lost in the current political turmoil. Tories want to privatize and Labor want to nationalize and neither has the wit for considering other models.

1 minute ago, Baerboxer said:

 

Interesting change Rob. That sort of system was also proposed in the UK a while back. But it's been lost in the current political turmoil. Tories want to privatize and Labor want to nationalize and neither has the wit for considering other models.

However you fund it funding will never be enough anyway as people want cutting edge healthcare but are unwilling to pay the extra taxes to fund. Now with ever increasing methods and medicine we can treat more then ever but at an ever increasing price. So budgets will never be enough all over the world. That is why certain things are just not paid for even in the Netherlands or UK (experimental drugs / treatment or they wont give a new hip to a 85 year old ect)

2 minutes ago, robblok said:

However you fund it funding will never be enough anyway as people want cutting edge healthcare but are unwilling to pay the extra taxes to fund. Now with ever increasing methods and medicine we can treat more then ever but at an ever increasing price. So budgets will never be enough all over the world. That is why certain things are just not paid for even in the Netherlands or UK (experimental drugs / treatment or they wont give a new hip to a 85 year old ect)

 

I don't know about the Netherlands today. But there are massive amounts of waster and corruption within the NHS. A former academic friend wrote a report in the early 90's after being commissioned by government to do research. Her comments were scathing and mainly aimed at senior managements culture of ineffectiveness and lack of accountability. Her report was largely ignored and if anything things have gotten worse. Large numbers of people on very high salaries for very little work and once in that click, job for life. Some have been found out and simply moved sideways or into created positions. The NHS Procurement has been poor for years. I know the person whose been appointed to address it. Quite frankly, he'll fit in nicely!

 

Health care will always be emotive and it should never be about the bottom line. Forcing decisions to be taken on financial considerations will always impact the less well off. But no country as ever managed to solve it so far.

1 hour ago, Eric Loh said:

Problem is that the defence spending were for duds like the GT200, aircraft carrier, airship, submarines, tanks, planes and what goes into the generals pockets. What about the 1,500 generals salaries. Shouldn't the make defense spending more accountable and justify the 2% GDP. After all the shenanigans full of unexplained wealth, I am sure there are lots of fats that the budget can be trimmed for the all important healthcare. 

The real problem Eric is that you have a problem with military spending, that and the fact that all we know is the headline figure plus what we pick up in the newspapers. What we don't know is the detail behind the expense, the threats or the reasons behind the expense. I'll ignore the salaries and unexplained wealth part!

Look at the free train service. There's no money to update carriages, no money for safety checks. Look at the free bus services. the buses are falling apart, there are no safety checks. 

Similar to the health service, all functioning on the bare minimum to get by. They are not good public services. They put people's lives at risk everyday. The public should have a way to contribute a small portion to have good services. Even the poor need to contribute. It's just plain common sense. 

22 minutes ago, Baerboxer said:

 

I don't know about the Netherlands today. But there are massive amounts of waster and corruption within the NHS. A former academic friend wrote a report in the early 90's after being commissioned by government to do research. Her comments were scathing and mainly aimed at senior managements culture of ineffectiveness and lack of accountability. Her report was largely ignored and if anything things have gotten worse. Large numbers of people on very high salaries for very little work and once in that click, job for life. Some have been found out and simply moved sideways or into created positions. The NHS Procurement has been poor for years. I know the person whose been appointed to address it. Quite frankly, he'll fit in nicely!

 

Health care will always be emotive and it should never be about the bottom line. Forcing decisions to be taken on financial considerations will always impact the less well off. But no country as ever managed to solve it so far.

In the Netherlands there are similar problems, don't believe your the only country with that problem. People love to become managers and in government run organisations things quickly get out of hand. On the other hand privatize it and you will have higher cost as a profit has to be made. There is no perfect system.

25 minutes ago, simoh1490 said:

The real problem Eric is that you have a problem with military spending, that and the fact that all we know is the headline figure plus what we pick up in the newspapers. What we don't know is the detail behind the expense, the threats or the reasons behind the expense. I'll ignore the salaries and unexplained wealth part!

Why ignore the salaries of the bloated number of generals and the unexplained wealth. They are part and parcel of the mistrust in the way the military spend. Zero transparency and zero accountability.

3 minutes ago, Eric Loh said:

Why ignore the salaries of the bloated number of generals and the unexplained wealth. They are part and parcel of the mistrust in the way the military spend. Zero transparency and zero accountability.

Thailand is known to be rife with corruption, the fact that it is means it probably extends to many corners of government. The fact that it does shouldn't be a barrier to prevent Thailand allocating 2% of GDP on military spending, after all, corruption almost certainly exists in the medical field also so why not stop spending money on hospitals also!

 

As for the number of generals: I'm sure wiki or similar tells us there's 1,500 generals, how many there are actually are may be another story. Regardless of how many there really are, that's the business of the people who organise the military structure and again, the number of different ranks should not be a barrier to defence budget spending, just because you think the number is too high.

This is not about the NHS but as a comparison ( I apologise if I have wrong figures) I read that the NHS spends about 95.000 baht per capita p.a. whilst Thailand spends 7.800 baht pc pa. I actually read somewhere it was much lower as I'm not sure if the Thai figure includes the civil servants system.

I will state straight away that in this country my sympathies generally lie with the poor and working class because of the obscene disparity in wealth and privilege which these changes will exacerbate.

I have heard so many sad stories of people being forced selling land and homes under the old pre Thaksin introduced system. A system which the elite hate and Thais love.

The author says " I trust that there will be no big conflict" Time will tell.