Limiting universal healthcare to those who earn less than Bt100,000 unfair, says activist

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Limiting universal healthcare to those who earn less than Bt100,000 unfair, says activist

By CHULARAT SAENGPASSA 
THE NATION 

 

File photo

 

A PROMINENT health activist yesterday attacked the government over reports that it plans to provide free medical service under the universal healthcare scheme to only those earning less than Bt100,000 a year.

 

This idea made the headlines earlier this week, causing widespread concern. The scheme currently covers more than 48 million Thais who are not covered by the social security scheme and the medical benefit programme for civil servants, state-enterprise employees and their family members.

 

“This plan, if implemented, will only prove that the government does not want to take care of people,” Nimit Tien-udom, director of the Aids Access Foundation, said. 

 

Nimit, who was previously a member of the National Health Security Office (NHSO) board, spoke after some media outlets quoted Suttirat Rattanachot, director-general of the Comptroller General’s Department, as suggesting that people earning more than Bt100,000 a year would likely be required to pay 10 to 20 per cent of medical expenses under the universal healthcare scheme. She said this new regulation could be implemented next year.

 

 

If the new criterion is put in place, the number of Thais entitled to free treatment under the universal healthcare scheme will likely drop to just 11.4 million.

 

Suttirat, however, denied this plan had been prepared by her agency. “It’s just a topic of a study conducted by the Finance Ministry’s Fiscal Policy Office,” she said yesterday. 

 

Meanwhile, a source close to Deputy Prime Minister Somkid Jatusripitak, who oversees economic affairs, said the government does not have any policy to curb the number of people who can use the universal healthcare scheme. 

 

However, discussions about the co-payment concept have been going on in Thailand for a while now. Supporters of the idea say those who can afford it should shoulder part of the bill or the country could collapse under the weight of free healthcare. 

 

But Nimit reminded the government yesterday that providing healthcare to citizens was not a financial burden. 

 

“Healthy people contribute to the country’s economy,” he pointed out.

 

Besides, he said, if the government really wanted to control its budget, it should focus on the medical benefits provided to civil servants, state-enterprise employees and their family members. Though this programme only has about 4.9 million beneficiaries, it consumes as much as Bt73 billion yearly. In comparison, the universal healthcare scheme looks after 48.1 million people under a yearly budget of Bt166.44 billion. 

 

A recent survey by the Suan Dusit Rajabhat University has found that 93.9 per cent of more than 5,300 respondents were extremely satisfied with the universal healthcare scheme. 

 

Meanwhile, Dr Soumya Swaminathan, deputy director-general of the World Health Organisation, said Thailand was a good model for people’s comprehensive access to healthcare services. He was recently here for a meeting with the NHSO. 

 

However, Sakchai Kanjanawattana, NHSO secretary-general, pointed out that the budget earmarked for the country’s three major healthcare schemes was only equivalent to 4.3 per cent of the country’s gross domestic product (GDP). “Other countries allocate much bigger budgets compared to their GDP,” he said. 

 

Source: http://www.nationmultimedia.com/detail/national/30353748

 

-- © Copyright The Nation 2018-09-05

[ukrules]

100k Baht per year is slightly less than the minimum wage based on a 26 day working month.

 

 

[Samui Bodoh]

"...if the government really wanted to control its budget, it should focus on the medical benefits provided to civil servants, state-enterprise employees and their family members. Though this programme only has about 4.9 million beneficiaries, it consumes as much as Bt73 billion yearly. In comparison, the universal healthcare scheme looks after 48.1 million people under a yearly budget of Bt166.44 billion...|" 

 

The above is the issue; it is NOT universal healthcare if there is one program for the general population and a better, higher-funded scheme for the bureaucracy. And, I assume, a separate program for the military.

 

If you want to have universal healthcare, and there are many studies to support the idea that this is the best way forward, you need to have equal access for all. When you have a separate program for the Bureaucrats who administer things, it is inevitable that they will give themselves greater options, more funding, and better access to the highest level of service; I don't say that to 'slam' the Bureaucracy (although they DO deserve it) but simply to point out that this is what happens, inevitably. 

 

The concept of Universal Healthcare is that all citizens are equal and should be treated as such under the guise of receiving medical care. Creating 'special' benefits for the select few harms the entire program, leading to 'second-class' or 'third-class' citizens. Thailand ALREADY has gross inequalities; creating more just makes Thailand a worse place for huge swathes of the population, namely the poor.

 

Thailand; do the right thing and treat all citizens the same. Cancer and other illnesses do not discriminate, neither should the Health Care provided to the people.

 

 

 

[gk10002000]

Oh you mean some sort of socialized medicine schema as Obamacare in the USA?  And then forcing people to buy only certain types of medical plans and then fining them if they don't comply? 

[Scott]

Off-topic post reported and removed.   Let's stick to Thailand.   The topic isn't about Obamacare, although comparisons on how types of care could be implemented is permissible.  

 

[JAG]

I've long held the opinion that one of the measures of the junta's feeling of being secure in power would be acting to remove or curtail universal healthcare, which was one of the main pillars of Thaksin's electoral appeal.

 

Interesting to see if this is background noise, or the start of a move to do so.

[Samui Bodoh]

47 minutes ago, JAG said:

I've long held the opinion that one of the measures of the junta's feeling of being secure in power would be acting to remove or curtail universal healthcare, which was one of the main pillars of Thaksin's electoral appeal.

 

Interesting to see if this is background noise, or the start of a move to do so.

I can't argue with your post; I think it is correct. However, I think there is more to the Junta's actions than simply trying to discredit Thaksin.

 

The Junta has been on a massive spending spree; the submarines, other military hardware, raises for the Bureaucracy, raises for the military, Bangkok infrastructure, the "If We Build It, They Will Come" EEC, the Thai Ni Yom, subsidies for rubber planters, etc etc etc. This all has to be paid for. 

 

How is it being paid for? That is an excellent question. As near as I can tell (it is opaque as hell), there has been massive borrowing on the part of the Junta. That said, it is still likely not enough to cover all the costs of the Junta's plans, so monies have to be found elsewhere.

 

The best place to cut spending, from the Junta's point of view, is to limit the spending on programs which widely cover the voiceless poor; under the Junta, where is the voice of the less fortunate (hint: there isn't one)? If you have a program that covers 48 million people who can't/won't complain too much, it is easy money. Further, next year when the bills start to come in, the precedent has been set of setting an upper cap on the program; put a limit of 95,000 for next year and use the windfall to pay bills. If the Junta is not in power next year, blame the 'civilian' government and say that the military ALWAYS took care of the poor (a lie, but they are politicians).

 

This looks to me like both an attempt to discredit Thaksin and wipe out his legacy as well as taking money from the poor to spend on the rich;

 

Thai-style Robin Hoodism.

 

 

[loong]

A friend of mine works 6 days a week and gets a little over 10,000 Baht per month, so a bit more than minimum wage. A mother of 2 (father long gone) she struggles to take care of her family.

It is totally disgusting that she would be excluded from free healthcare!

[DPKANKAN]

3 hours ago, JAG said:

I've long held the opinion that one of the measures of the junta's feeling of being secure in power would be acting to remove or curtail universal healthcare, which was one of the main pillars of Thaksin's electoral appeal.

 

Interesting to see if this is background noise, or the start of a move to do so.

Don't worry!! Uncle Too will knock this back same as driving fines going up.

Stage 2 the people love me!!

 

[wwest5829]

4 hours ago, gk10002000 said:

Oh you mean some sort of socialized medicine schema as Obamacare in the USA?  And then forcing people to buy only certain types of medical plans and then fining them if they don't comply? 

I’m thinking an expansion of the 30 baht existing plan? And the Social Security existing plan. And the government employees existing plan. You know, having a universal plan to cover the citizens as exists in most “advanced” nations....the U.S. excepted of course. We Americans want to be free to spend more of our national resources on healthcare/pharmaceutical products.

[mfd101]

Why can't you have a 'progressive' health benefits scheme, in the same way as income tax is or should be 'progressive'?

 

That is: 'the poor' - however defined, and the devil is always in the detail - are fully covered by 'the taxpayer' for all health costs; the inbetweens are partly covered (say, 40% of costs are refunded); 'the rich' pay 100%.

 

The principle of that seems fine to me. The government can't and shouldn't have to pay for everyone. It therefore has to make choices. The problem is that, in a progressive system like that, EVERYONE other than the poor complains.

 

As usual in this country the one essential element that is almost always lacking is government LEADERSHIP - educating all the people about the options & what they mean & what the constraints on government expenditure are. Also explaining to people that, if they don't pay their taxes as required by law, then the government doesn't have the money to pay for their health care, or roads, or airports, or sewerage, or water, or flood relief ...

[robblok]

I get it that people don't like it that they want to economize on the budget of health but this guy does omit a few facts to get a stronger response.

 

First off there are 2 ways in how the money is aquired for healthcare, one by taxes 2 by people who pay. The people who now earn more then 100.000 don't pay a thing besides taxes. However those in the other 2 healthcare packages (civil servants and people in normal employment) pay around 400 bt per month. So to be fair that amount should be deducted from budget expenditure first.

 

I seen figures before that showed that those who have normal jobs are not getting enough in comparision to what they pay while the "free" people get all the benefits for nothing. What I mean is that if you take the amount of people with a job paying into the system at 400 bt and check how much is spend on them its less then what they put in themselves. So those are the people who should complain. Not those who get it for free and still have income over 100.000

 

Civil servants also pay in the system and accept a lower salary as in the private world but get benefits like health.. so its a bit unfair to compare the way this guy does. But its a common thing here I saw it with the teachers who also did not tell the full story to give their arguments more power.

 

I am all for healthcare.. but free healthcare is not free and those paying into the system should always get more rewards then those who don't. I would be royally pissed of if I was paying 400 bt in the system while others paid nothing and still got a free ride. I am talking about those on minimum wages who DO pay the 400 baht (gets deducted from their salary) while others make the same money but not pay... how fair is that. 

 

You can also spend your money just once.. even in the west they cap treatments at certain levels because of budget restraints. So co payment is normal as long as that does not mean the normal funding will go down. (otherwise its just stealing)

[robblok]

4 hours ago, JAG said:

I've long held the opinion that one of the measures of the junta's feeling of being secure in power would be acting to remove or curtail universal healthcare, which was one of the main pillars of Thaksin's electoral appeal.

 

Interesting to see if this is background noise, or the start of a move to do so.

The 30 baht plan was a good plan.. too bad that nobody ever funded it properly. Hospitals need charity runs for funding. It just does not work this way.. something has to give.. and the budget has to come from somewhere. The money spend on subs and the rice program would have been better spend at healthcare.

 

At least the junta is not ignoring the problem like all the previous governments, there is just not enough money in the healthcare budget. They should not have increased the military budget , but previous governments were just as bad for not funding the healthcare budget enough.

 

So now something has to be done.. seems they go for cutting costs instead of adding money. 

[connda]

As long as there is universal healthcare, then private companies can't profit from sucking the wealth out of the poorest segments of Thai society which is exactly why functional universal healthcare systems globally are always under attack.  Eventually the government will fold to private corporate interests <cha-ching> and force the poor to purchase costly healthcare that they can not afford 'for their own good.'  Wait for MSM 'hit pieces' to be published saying how terrible Thai universal healthcare coverage is.  Then the government will make it sound like forcing Thais into paying for costly health insurance is in their own best interests.  This is what evil people do whether they are government or corporate execs:  they feed off the suffering of the poorest and most vulnerable segments of society in order to amasses more wealth from themselves. 

[JAG]

1 hour ago, DPKANKAN said:

Don't worry!! Uncle Too will knock this back same as driving fines going up.

Stage 2 the people love me!!

 

That is possible, but one should bear in mind that "Uncle Too" is to a considerable extent answerable to, or at least "influenced" by some very "influential" people, some of whom undoubtedly have interests in commercial healthcare provision, and all of whom have views on how government should spend it's money. Universal healthcare is perhaps unlikely to be one of their favoured ideas...

 

U turns on high traffic fines and laws banning riding in pickup truck cargo space (for example ) whilst also popular don't cost. Universal healthcare does.

[BobBKK]

I know many, many ordinary Thais who have been saved by Thaksin's healthcare scheme and the evil junta will seek to destroy anything related to him. Thais won't forget who gave them this scheme or the educational scheme that helped so many.

[lapamita]

 

something worng longtime in that system

- the 30 b scheme , is subverting/undermine the  social security system

-The officals healthcare system is 5x time higher costs than  for indivudals

 

Best solution

- free healthcare for people aged lower than 18 and over 65,for others only on request with proof of low/no income,illnes and others

-like you see  11mio in social security system , and over 40mio on socual benefit, hence, there are a minimum of 20-30mio who normaly must pay into the social security system ,due to working. The baserate of NSH is low, and could be collected by local authoritys , due to lack of payment ,if orderd  by central gov by mail.

 

This system was introduced by taxsin,as a populist measure,and was undermine the NSH since than. and lead to heavy problems in hospitals and other facilitys  due to underfunding

 

[JAG]

1 hour ago, loong said:

A friend of mine works 6 days a week and gets a little over 10,000 Baht per month, so a bit more than minimum wage. A mother of 2 (father long gone) she struggles to take care of her family.

It is totally disgusting that she would be excluded from free healthcare!

Ah, but think of the reflected glory in which she can bask, from the awe inspired amongst Thailand's neighbours by it's ever increasing martial potential!

[JAG]

20 minutes ago, robblok said:

I am all for healthcare.. but free healthcare is not free and those paying into the system should always get more rewards then those who don't. I would be royally pissed of if I was paying 400 bt in the system while others paid nothing and still got a free ride. I am talking about those on minimum wages who DO pay the 400 baht (gets deducted from their salary) while others make the same money but not pay... how fair is that. 

This is one of those areas in which you and I will, I suspect "Roblock" , always disagree.

 

I am firmly of the opinion that the provision of universal healthcare, free at the point of delivery, and not delineated by the individuals financial position, job status or political or social alignment, is a fundamental function of any government which has pretensions to any sort "developed" status for it's country.

 

I fully accept that such a scheme has to be funded. That must be achieved through taxation, some form of progressive national insurance scheme or similar; not through charging the poorer sectors of society at the point of treatment. Nor do I agree that one's job, with or without a payroll deduction, should entitle you to better treatment.

 

Before I am accused of "socialism", I have no objection to people "going private" if they have the money or the wish, but that should be entirely separate from any universal provision.

[GarryP]

3 hours ago, Samui Bodoh said:

I can't argue with your post; I think it is correct. However, I think there is more to the Junta's actions than simply trying to discredit Thaksin.

 

The Junta has been on a massive spending spree; the submarines, other military hardware, raises for the Bureaucracy, raises for the military, Bangkok infrastructure, the "If We Build It, They Will Come" EEC, the Thai Ni Yom, subsidies for rubber planters, etc etc etc. This all has to be paid for. 

 

How is it being paid for? That is an excellent question. As near as I can tell (it is opaque as hell), there has been massive borrowing on the part of the Junta. That said, it is still likely not enough to cover all the costs of the Junta's plans, so monies have to be found elsewhere.

 

The best place to cut spending, from the Junta's point of view, is to limit the spending on programs which widely cover the voiceless poor; under the Junta, where is the voice of the less fortunate (hint: there isn't one)? If you have a program that covers 48 million people who can't/won't complain too much, it is easy money. Further, next year when the bills start to come in, the precedent has been set of setting an upper cap on the program; put a limit of 95,000 for next year and use the windfall to pay bills. If the Junta is not in power next year, blame the 'civilian' government and say that the military ALWAYS took care of the poor (a lie, but they are politicians).

 

This looks to me like both an attempt to discredit Thaksin and wipe out his legacy as well as taking money from the poor to spend on the rich;

 

Thai-style Robin Hoodism.

 

 

I think you're wrong if you believe the Junta will reduce or take away the current scheme from the poor (upcountry folk). It has become entrenched in a very short period of time and taking it away from the very people the junta wants to woo is counterproductive (the junta already has support from a large part of the middle class, but those numbers don't match the numbers of people who are not so well off).  The junta is doing what it can by both carrot and stick to get support from those areas that have become PT stomping grounds.   

[GarryP]

24 minutes ago, JAG said:

This is one of those areas in which you and I will, I suspect "Roblock" , always disagree.

 

I am firmly of the opinion that the provision of universal healthcare, free at the point of delivery, and not delineated by the individuals financial position, job status or political or social alignment, is a fundamental function of any government which has pretensions to any sort "developed" status for it's country.

 

I fully accept that such a scheme has to be funded. That must be achieved through taxation, some form of progressive national insurance scheme or similar; not through charging the poorer sectors of society at the point of treatment. Nor do I agree that one's job, with or without a payroll deduction, should entitle you to better treatment.

 

Before I am accused of "socialism", I have no objection to people "going private" if they have the money or the wish, but that should be entirely separate from any universal provision.

Exactly, if people have the money, many will opt for private care and that is their right. However, those that don't and elect to go with treatment under the universal healthcare scheme, that is fine too. The bottom line is that the system is available to everyone. 

[robblok]

25 minutes ago, JAG said:

This is one of those areas in which you and I will, I suspect "Roblock" , always disagree.

 

I am firmly of the opinion that the provision of universal healthcare, free at the point of delivery, and not delineated by the individuals financial position, job status or political or social alignment, is a fundamental function of any government which has pretensions to any sort "developed" status for it's country.

 

I fully accept that such a scheme has to be funded. That must be achieved through taxation, some form of progressive national insurance scheme or similar; not through charging the poorer sectors of society at the point of treatment. Nor do I agree that one's job, with or without a payroll deduction, should entitle you to better treatment.

 

Before I am accused of "socialism", I have no objection to people "going private" if they have the money or the wish, but that should be entirely separate from any universal provision.

My problem JAG is with the lies in this story, comparing the civil servant budget that is funded by their payments AND taxation with a part that is only paid by taxation is not fair. If I am paying EXTRA into a system like what you said going private I should get extra. 

 

I find it unfair for those working at minimum wages who do pay the 400 per month for their healthcare that others don't have too. 

Especially if the incomes are almost the same. Tell me why would some get it free if they have the same income as others who pay into the system ?

 

Nothing socialist about your opinion of universal healthcare.. I just feel it should be funded fairly, not that some people with similar incomes pay different amounts. 

[robblok]

2 minutes ago, GarryP said:

Exactly, if people have the money, many will opt for private care and that is their right. However, those that don't and elect to go with treatment under the universal healthcare scheme, that is fine too. The bottom line is that the system is available to everyone. 

Garry,

 

I know you work and pay at least the 400 bt per month like so many. I just find it unfair that others with a similar income (self employed or otherwise) don't pay the 400 bt but get exactly the same care. IMHO that is unfair.. i see the extra payment you make as entitlement to extra care. 

 

They should make the system in a way that everyone with similar incomes pays the same.. or that those who pay extra get extra care.

[GarryP]

25 minutes ago, robblok said:

Garry,

 

I know you work and pay at least the 400 bt per month like so many. I just find it unfair that others with a similar income (self employed or otherwise) don't pay the 400 bt but get exactly the same care. IMHO that is unfair.. i see the extra payment you make as entitlement to extra care. 

 

They should make the system in a way that everyone with similar incomes pays the same.. or that those who pay extra get extra care.

I agree with you about the self employed.  They should be paying into the system too. How they are going to police that though is another problem. Perhaps catching a few people out every now and then and fining them may send a message. 

[robblok]

3 minutes ago, GarryP said:

I agree with you about the self employed.  They should be paying into the system too. How they are going to police that though is another problem. Perhaps catching a few people out every now and then and fining them may send a message. 

People with similar incomes should pay similar costs.. now the people who earn legal wages are screwed in comparison with those who either are self employed or those who work for wages that are not registered. I am all for healthcare but I hate it if people who follow the rules have to pay more. 

 

The injustice is build into the system, because I believe only those that earn wages have to pay the 400 bt. Others retired / self employed ect don't. How is it fair that those who pay more at similar incomes get the same care.

Fix that and other problems and fund this whole thing better.

 

 

[Pedrogaz]

Not surprisingly, the civil servant medical care is the most expensive part of the equation.....73 billion to treat 4.9 million....vs 166 billion to treat 49 million ordinary folk. So it costs about 14 billion to treat 1 million civil servants and only 3 billion to treat a million ordinary folk (numbers rounded to take out decimals),....so per capita about 5 times as much. And it is the civil servants (who demand bribes to do their jobs into the bargain) who are recommending limiting the care for ordinary folk. Disgusting, in a word, totally disgusting.

[ukrules]

8 hours ago, connda said:

As long as there is universal healthcare, then private companies can't profit from sucking the wealth out of the poorest segments of Thai society which is exactly why functional universal healthcare systems globally are always under attack.

 

I don't know about that. In Europe many people have additional health insurance that either comes with their job or they pay for it privately like I've been doing for the last 15 years or so.

 

With additional insurance you get the best of both worlds and you can choose to go to any of the many private hospitals all over the UK should you need some kind of treatment, or you can have it done on the NHS scheme.

 

So there are many massive private hospitals in the UK even though they have a universal healthcare system.

 

When the NHS runs out of capacity they often send the patient to a private hospital which helps them meet their targets. My father had a hip replacement done this way a couple of years ago, the wait was going to be too long (in weeks) so they sent him to a private hospital and it was done there instead, all paid for by the government.

 

The main point being that there's room for both private and state funded systems to work alongside and even with each other and this is in reality what happens.

[rickudon]

The reality is that many of the 40 million plus who are on the 30 baht scheme earn a fluctuating income, if any, and rarely over 10,000 baht per month. Yes they do not pay into the system but many could not afford to do so anyway. Also remember these casual labour/self employed people will get no income while unfit to work, and then you expect them to pay 10-20% of the bill for treatment? What do you expect them to do, borrow money from a money lender at an extortionate interest rate? No-one else will pay for it, apart from Family pawning their gold or land. Reality, if they do not pay upfront, many will be unable/unwilling to pay the bill, so will either be chased by the government for debt, or will just not go to hospital in the first place.

 

Also, you now have another incentive to lie about your income .....

 

Countries with universal health care systems have much better life expectancies than those which don't - because everyone can get treated, not just the ones with money.

[the guest]

if Thailand want social care (universal is the wrong word) for everybody, then everybody working and making money must pay tax. The solution is very simple, but this is Thailand of course.