Thailand's universal welfare 'at risk'

[webfact]

Universal welfare 'at risk'

By Chularat Saengpassa 
The Nation

 

File photo

 

Ideal of national coverage hangs in balance as junta and political allies accused of plotting to undermine schemes

 

A PROMINENT activist has urged every political party to express a clear stance on the country’s universal healthcare scheme and other state welfare issues ahead of the upcoming election.

 

The call surfaced yesterday amid growing concerns that influential groups intend to be selective in their provision of state help and would not be providing welfare for all members of society. 

 

The universal healthcare scheme now offers most types of medical services for 48 million people in Thailand for free. Any change would affect the majority of Thais. 

 

“We will organise a forum to hear political parties’ policies on the universal healthcare scheme, the country’s healthcare and problems facing the poor,” Nimit Tien-udom said yesterday on behalf of the People’s Network for State Welfare.

 

The Pheu Thai and Future Forward parties have expressed support for the universal healthcare scheme but Nimit said he was not sure what stance other political parties would take. 

 

“As for the Palang Pracharat Party, I believe it will take the same stance as the current government,” he said. 

 

In line with many other activists, Nimit suspected that the current government was moving Thailand away from the “state welfare” vision. 

 

State welfare involves the state playing the core role in the protecting and promoting economic and social well-being for all its citizens.

 

The universal healthcare scheme, which has received international recognition, is widely seen as a solid example of how the country can take care of its people. 

 

“The current government views people as a burden. It focuses only on financial figures,” Nimit said. 

 

He said that his network’s concerns about the current government’s viewpoint were not unwarranted. 

 

He pointed out that the government had already started implementing a Welfare Card project, which entitled registered low-income earners to state aid in the form of a living and travel allowance worth more than Bt1,000 a month. To be eligible for the project, one must earn no more than Bt100,000 yearly. 

 

 

Moreover, the National Health Policy Board Bill sailed through the Cabinet last week. If the bill gets the green light from the National Legislative Assembly, people will have less representation in creating public-health policies. 

 

In the eyes of Nimit, the latest developments suggest the junta government and powerful groups are working to change the essence of the universal healthcare scheme. 

 

“Apparently, there are efforts to destroy the scheme,” he said. 

 

There are now widespread concerns that it may reduce the scope of its benefits or allow only registered low-income earners to stay in the universal healthcare scheme. 

 

 

Khunying Sudarat Keyuraphan, a popular politician affiliated with the Pheu Thai Party, has lately attacked both the Welfare Card project and the National Health Policy Board Bill. 

 

Prime Minister Prayut Chan-o-cha is downplaying the criticism and insists that the Welfare Card project was implemented with good intentions.

 

“We aim to boost their income and their happiness,” he said. 

 

Prayut said his government had started several initiatives to solve the country’s problems and everyone should stop politicising them. 

“Let’s not fall back into the old cycle of politics where various sides keep attacking one another,” he said.

 

Sustarum Thammaboosadee, a co-founder of the Future Forward Party and a lecturer at Thammsat University, previously warned that the Welfare Card Project would eventually promote the concept of giving out of pity. 

 

He belives the implementation of the project will hurt people’s dignity and camouflage the fact that big gaps exist because the elite have monopolised the economy and taken too much from it.

 

Source: http://www.nationmultimedia.com/detail/national/30356570

 

-- © Copyright The Nation 2018-10-17

[stud858]

Free 4g Internet access?  I'm sorry, I'm a big advocate for helping the less well off but that is a big no no in my book.

 

Set up a system for recognizing the poorest and give them basic shared  accomodations, food, and training.  

 

It's not hard.

[Samui Bodoh]

"...The call surfaced yesterday amid growing concerns that influential groups intend to be selective in their provision of state help and would not be providing welfare for all members of society. 

 

The universal healthcare scheme now offers most types of medical services for 48 million people in Thailand for free. Any change would affect the majority of Thais..." 

 

Good on them; this issue has profound implications for any country, but given Thai culture and politics, it has even more implications here.

 

There are two basic approaches to a welfare scheme. One, delineate what services are available and permit anyone who meets the criteria to use them. Or two, make people register their ill-circumstances and then provide services based on that registration.

 

I strongly favour the first, 'Universal' approach as it removes the opportunity for government (any government) to play favourites, rather it states what services are available and allows all citizens the opportunity to access/use them.

 

I dislike the second approach as it is open to manipulation and abuse by government (any government) as it could specifically decide who has access to services and also provide a different level and/or types of services based on factors other than general need.

 

The above is a massive over-simplification; entire doctorates can and have been written on the subject, but it gives the general idea. In Thailand, with its polarized geographical differences, 'Kreing Jai" culture, horrible governing ethos, frequent political upheavals, etc etc etc should remove (as much as possible) the government's ability to manipulate who gets what in favour of a system whereby whomever meets the criteria gets what is available. If they don't, in another massive over-simplification, under a 'Red' government most services could go to the North and under a 'Yellow' and/or 'Green' government most could go to the South/Bangkok.

 

I think everyone agrees that Thai politicians are somewhere on the level of 'Pond Scum', so a 'Universal' approach to government services is better as it removes, as much as possible, the 'Pond Scum'.

 

 

[Samui Bodoh]

2 hours ago, stud858 said:

Free 4g Internet access?  I'm sorry, I'm a big advocate for helping the less well off but that is a big no no in my book.

 

Set up a system for recognizing the poorest and give them basic shared  accomodations, food, and training.  

 

It's not hard.

Hmm...

 

I was having a discussion a while back with my 20 year old niece, and she posited that Internet access ought to be considered a public utility such as water or electricity as it is no longer possible to function in the world without access. Initially, I argued with her, but now... I think she had a point.

 

Some questions to Members;

 

Is it possible to function in the modern world without access to the Internet?

Should Internet access be governed as a utility?

Should Internet access be a 'right' in the same manner as health care, electricity, water, etc?

 

 

[Lungstib]

3 hours ago, webfact said:

“The current government views people as a burden. It focuses only on financial figures,”

Absolutely true but could be said about most countries in the world. The poor not only dont matter but are about to be replaced by robots that dont get dengue or diabetes.

[RichardColeman]

Welfare or new Submarine ? Think welfare is on to a loser there.  

[4evermaat]

Hmm...
 
I was having a discussion a while back with my 20 year old niece, and she posited that Internet access ought to be considered a public utility such as water or electricity as it is no longer possible to function in the world without access. Initially, I argued with her, but now... I think she had a point.
 
Some questions to Members;
 
Is it possible to function in the modern world without access to the Internet?
Should Internet access be governed as a utility?
Should Internet access be a 'right' in the same manner as health care, electricity, water, etc?
 
 

I think@Scott should make this into a survey.

Sent from my ASUS_X00ID using Thailand Forum - Thaivisa mobile app

[Scott]

2 minutes ago, 4evermaat said:

I think@Scott should make this into a survey.
 

 

Thanks for the suggestion.  

[robblok]

I like universal welfare but people should really pay into the system. The PTP and futureforward support the system. That is great... however the PTP has never funded the system enough, proof of this is how bad hospitals are funded.. just look at Toon his run. So its all good to support a system but then they should also increase spending. Problem is then they can't give away other fun things.

 

Future forward, i hope the guy is smart enough to understand that supporting the system means more funds towards it. Maybe people should be taxed higher to get it.  Free healthcare is not free someone needs to pay for it. 

[Esso49]

1 minute ago, robblok said:

I like universal welfare but people should really pay into the system. The PTP and futureforward support the system. That is great... however the PTP has never funded the system enough, proof of this is how bad hospitals are funded.. just look at Toon his run. So its all good to support a system but then they should also increase spending. Problem is then they can't give away other fun things.

 

Future forward, i hope the guy is smart enough to understand that supporting the system means more funds towards it. Maybe people should be taxed higher to get it.  Free healthcare is not free someone needs to pay for it. 

Trebling the tax on cigarettes and other tobacco products would go some way towards additional funding.

[robblok]

4 minutes ago, Esso49 said:

Trebling the tax on cigarettes and other tobacco products would go some way towards additional funding.

Don't forget to tax alcohol a bit more.. that would help a lot too..

 

all of a sudden I hear big sigh from all the foreigners who are for are pre healthcare but realize now they have to pay too... Its always easy to let someone else pay.

[exemplary21]

2 hours ago, Samui Bodoh said:

 

 

Is it possible to function in the modern world without access to the Internet?

 

 

 

I've never had access to the internet and it hasn't done me any harm...

[hansnl]

5 hours ago, stud858 said:

Free 4g Internet access?  I'm sorry, I'm a big advocate for helping the less well off but that is a big no no in my book.

 

Set up a system for recognizing the poorest and give them basic shared  accomodations, food, and training.  

 

It's not hard.

That idea is exactly what several political parties are afraid of.

[Eric Loh]

Thailand is not exactly a poor country and can afford the healthcare cost for the poor majority in the scheme as a social responsibility and to help narrow the income inequality. Compare to our ASEAN peers, Thailand healthcare expenditure as a percentage of GDP is 3.76% in 2015 while Malaysia spends 4.06% and Indonesia spends 3.7%. Around 75% of the healthcare costs are financed by the public and the rest funded by social security and civil servant schemes. The latter 2 actually cost more proportionately. 

 

As some posters mentioned, problem with funding has to do with poor tax structure and need to tax the rich more. Also got to do with education and prevention of the increase of people seeking healthcare from modern diseases like heart problems, stroke and hypertension and traffic accidents. 

 

Healthcare and education spending is not a zero sum game. Betterment of both will improve the country productivity and efficiency. Government should look at healthcare spending in a holistic social contract and not as a expenditure. 

[robblok]

17 minutes ago, Eric Loh said:

Thailand is not exactly a poor country and can afford the healthcare cost for the poor majority in the scheme as a social responsibility and to help narrow the income inequality. Compare to our ASEAN peers, Thailand healthcare expenditure as a percentage of GDP is 3.76% in 2015 while Malaysia spends 4.06% and Indonesia spends 3.7%. Around 75% of the healthcare costs are financed by the public and the rest funded by social security and civil servant schemes. The latter 2 actually cost more proportionately. 

 

As some posters mentioned, problem with funding has to do with poor tax structure and need to tax the rich more. Also got to do with education and prevention of the increase of people seeking healthcare from modern diseases like heart problems, stroke and hypertension and traffic accidents. 

 

Healthcare and education spending is not a zero sum game. Betterment of both will improve the country productivity and efficiency. Government should look at healthcare spending in a holistic social contract and not as a expenditure. 

There is no doubt that universal healthcare is good, only 3 world countries are against universal healthcare (and a first world country). The problem is always funding it and cutting things off. Because you can spend unlimited amounts of money in healthcare as it gets better and better and with it more expensive.

 

So even universal healthcare needs to be limited and maybe let people insure themselves extra for extra care. Giving a 75 year old a new hip so he / she can go on for a few more years or spending that money on younger people giving more care. You can't spend money twice.. so some rules will always have to be in place. You can't expect universal healthcare include the most expensive procedures as it would drain the budget at the cost of other people. Choices will always have to be made as to what is allowed and what is not to keep the system good.

 

Back in my country people pay through taxes and through an insurance and not everything will be done some real expensive drugs / treatments are just out of it. Its hard but that is how it is otherwise the budget would be burned fast.. Same applies to other countries of course.

[Eric Loh]

31 minutes ago, robblok said:

There is no doubt that universal healthcare is good, only 3 world countries are against universal healthcare (and a first world country). The problem is always funding it and cutting things off. Because you can spend unlimited amounts of money in healthcare as it gets better and better and with it more expensive.

 

So even universal healthcare needs to be limited and maybe let people insure themselves extra for extra care. Giving a 75 year old a new hip so he / she can go on for a few more years or spending that money on younger people giving more care. You can't spend money twice.. so some rules will always have to be in place. You can't expect universal healthcare include the most expensive procedures as it would drain the budget at the cost of other people. Choices will always have to be made as to what is allowed and what is not to keep the system good.

 

Back in my country people pay through taxes and through an insurance and not everything will be done some real expensive drugs / treatments are just out of it. Its hard but that is how it is otherwise the budget would be burned fast.. Same applies to other countries of course.

Individual countries adopt different funding methods but all countries still have to spend a substantial amount of public funding. Even in Singapore who has been hailed as a having the best system still spend a high percentage of GDP on healthcare (4.9% in 2009). I think Holland spend the most among high income countries on healthcare.

 

Thailand will have to find their own funding method based on affordability of its people to pay for some sort of healthcare insurance. Singapore has a two-tier system - 2/3 private and 1/3 public spending. They can because of their high contribution of employees and employers to a central providence fund (CPF) which is channeled to various kinds of medicare insurances. Thailand 48 million that use the UHC don't have that structure and ability to pay for similar scheme. The low minimum wage is a challenge. Maybe they can introduce new form of taxes like making betting legal and taxing that for healthcare. 

[robblok]

3 minutes ago, Eric Loh said:

Individual countries adopt different funding methods but all countries still have to spend a substantial amount of public funding. Even in Singapore who has been hailed as a having the best system still spend a high percentage of GDP on healthcare (4.9% in 2009). I think Holland spend the most among high income countries on healthcare.

 

Thailand will have to find their own funding method based on affordability of its people to pay for some sort of healthcare insurance. Singapore has a two-tier system - 2/3 private and 1/3 public spending. They can because of their high contribution of employees and employers to a central providence fund (CPF) which is channeled to various kinds of medicare insurances. Thailand 48 million that use the UHC don't have that structure and ability to pay for similar scheme. The low minimum wage is a challenge. Maybe they can introduce new form of taxes like making betting legal and taxing that for healthcare. 

Yes funding is always a problem, everyone wants healthcare but nobody wants to pay for it. 

 

I like your betting idea personally I never bet not my thing, maybe should legalize marijuana and tax it to pay for healthcare. 

 

Anyway many people who work are already paying into the system but a lot of people still don't pay into the system that do make enough money. So that should change too (self employed ect don't pay tax unless they file it themselves). 

 

I am for a basic healthcare and then people can insure themselves more to keep things affordable. 

 

Anyway whoever is in power next will have to either fund the universal healthcare a lot better or limit access (i prefer option one) because the way its going the system will break down.

[sammieuk1]

Another universal embezzling opportunity no doubt ???? 

[micmichd]

5 hours ago, Samui Bodoh said:

Hmm...

 

I was having a discussion a while back with my 20 year old niece, and she posited that Internet access ought to be considered a public utility such as water or electricity as it is no longer possible to function in the world without access. Initially, I argued with her, but now... I think she had a point.

 

Some questions to Members;

 

Is it possible to function in the modern world without access to the Internet?

Should Internet access be governed as a utility?

Should Internet access be a 'right' in the same manner as health care, electricity, water, etc?

 

 

Internet access should be a right for everyone. Even kids use it for training purposes sometimes.

The question whether kids should be allowed unlimited surfing when at school is a different issue.

[Megasin1]

I'm a great advocator of universal healthcare at the coal face, especially at the primary care point, the issue with it always is the amount of money that's wasted and doesn't reach the primary care stage. As to the question of 4g, I can't agree that its a critical necessity, it's not. A country should consider what is necessary to nurture it's citizens, rather than what is nice to have and to me that's a good free education system, a good free primary care treatment (including an ambulance system to get them there) and a good and fair welfare support system for those that fall on bad times. Unfortunately the more bureaucrats you have in place to try and achieve a good system, the more money gets wasted. You can start by asking "would more people suffer with or without 4G?" to help resolve whether or not you consider it a utility, because if you apply that question, to electricity, clean water, free primary healthcare, and ambulance service or even a fire brigade the answer is pretty straight forward.

[GarryP]

A lot of money could be saved by education. The figures for those visiting hospital for very minor ailments that could be treated at home, such as colds, diarrhea, itchy bum holes, mouth ulcers, etc. is very high. Teach people to care for themselves and not waste doctors' time and hospital resources.   

[robblok]

26 minutes ago, GarryP said:

A lot of money could be saved by education. The figures for those visiting hospital for very minor ailments that could be treated at home, such as colds, diarrhea, itchy bum holes, mouth ulcers, etc. is very high. Teach people to care for themselves and not waste doctors' time and hospital resources.   

Garry, people could also just go to a pharmacy for minor ailments. Its not as if there are no stops before going to a hospital. Maybe they go to a hospital because if they go to a pharmacy they have to pay for medicine (or is medicine not included in the universal healthcare program)

[micmichd]

2 hours ago, robblok said:

There is no doubt that universal healthcare is good, only 3 world countries are against universal healthcare (and a first world country). The problem is always funding it and cutting things off. Because you can spend unlimited amounts of money in healthcare as it gets better and better and with it more expensive.

 

So even universal healthcare needs to be limited and maybe let people insure themselves extra for extra care. Giving a 75 year old a new hip so he / she can go on for a few more years or spending that money on younger people giving more care. You can't spend money twice.. so some rules will always have to be in place. You can't expect universal healthcare include the most expensive procedures as it would drain the budget at the cost of other people. Choices will always have to be made as to what is allowed and what is not to keep the system good.

 

Back in my country people pay through taxes and through an insurance and not everything will be done some real expensive drugs / treatments are just out of it. Its hard but that is how it is otherwise the budget would be burned fast.. Same applies to other countries of course.

Back in my country I had to fight a professor's opinion who suggested a knee replacement, and I'm quite happy in Thailand with my knee although it looks a bit damaged. So, the most expensive treatment is not always the best. 

 

Not so sure what is actually needed in Thailand. The majority of the people here look quite healthy as compared to some Western countries. 

Not so sure either how much the new economic corridors in Thailand will raise the national welfare. 

Right at the moment I would prefer the German system of contribution-based social security, with individual contributions based on individual incomes. Just as an option, not necessarily mandatory. 

 

10,000 THB limit to get access to free medical treatment is certainly too low, taking into account how many family members are normally dependent on an active Thai worker. The high level of social integration within Thai families is a high value for the country and should not be given up so easily. 

[GarryP]

21 minutes ago, robblok said:

Garry, people could also just go to a pharmacy for minor ailments. Its not as if there are no stops before going to a hospital. Maybe they go to a hospital because if they go to a pharmacy they have to pay for medicine (or is medicine not included in the universal healthcare program)

Medicine is included, but only those on the National List of Essential Medicines (which covers most everyday medications).. 

[Sonhia]

This report makes me wonder when taking into consideration that a third world progressive country, that is one of the biggest importers of high end spec motor vehicles and possibly watches too 555, in south east Asia, has such issues.

 

I'd better not wear my red, white and blue coloured shoes...

 

 

[MaxYakov]

10 hours ago, Samui Bodoh said:

Hmm...

 

I was having a discussion a while back with my 20 year old niece, and she posited that Internet access ought to be considered a public utility such as water or electricity as it is no longer possible to function in the world without access. Initially, I argued with her, but now... I think she had a point.

 

Some questions to Members;

 

Is it possible to function in the modern world without access to the Internet?

Should Internet access be governed as a utility?

Should Internet access be a 'right' in the same manner as health care, electricity, water, etc?

 

 

Do rights come with an implication that someone else will pay to allow exercise of the rights?

 

UN Universal Declaration of Human Rights.

[Stargeezr]

I thought that there are some European countries that have free healthcare,

am I wrong?  I think that is why these countries are in such bad financial

shape as well.

Geezer

[MaxYakov]

4 hours ago, Stargrazer9889 said:

I thought that there are some European countries that have free healthcare,

am I wrong?  I think that is why these countries are in such bad financial

shape as well.

Geezer

Reminds me of the false advertising in Thailand (and everywhere):

 

Buy one, get one [not free].  (equals two for the price of one, not get one free, BTW)

 

Free healthcare? I don't think so. Means only no immediate out-of-pocket costs to the consumer. Somebody's paying - taxes (current generations) or debt (future generations). I don't think healthcare workers work for free and that healthcare equipment and consumables are free. Do you?

[Stargeezr]

I wonder how much the French, German, Italian, Spanish, and especially

the Greeks pay for their doctor visits?  Hmmm any good quality answers?

Geezer

[robblok]

5 hours ago, Stargrazer9889 said:

I thought that there are some European countries that have free healthcare,

am I wrong?  I think that is why these countries are in such bad financial

shape as well.

Geezer

You are a funny guy, the Dutch have a far lower public debt than the Americans and free healthcare. Its you guys who are out of touch. 105 % for the US in its 56% for the Dutch..

 

SO next time you spread misinformation check your facts.