Thai Govt Looks To Rein In Budgets: Healthcare Schemes

[webfact]

HEALTHCARE SCHEMES

Govt looks to rein in budgets

CHULARAT SAENGPASSA,

PONGPHON SARNSAMAK

THE NATION

BANGKOK: -- The government will likely limit the budget for its medical insurance schemes this year after healthcare costs ballooned over the past few years.

The freeze on the National Health Security Fund has already caused hardship for some state hospitals as they cannot expand services, acquire advanced equipment or even hire staff to meet growing demand.

This year, nearly Bt200 billion will be spent to operate the three main health insurance plans - the National Health Security Fund (NHSF), Social Security Fund (SSF) and Civil Servant Medical Benefit Fund (CSMBF).

The NHSF will get the lion's share of Bt109 billion, or Bt2,755.60 per head, to serve 48 million people. The SSF will get Bt27 billion, or Bt2,500 per head, to serve 11 million subscribers, and the CSMBF Bt60 billion, or about Bt12,000 per head, for 5 million bureaucrats and their families.

Among the three national welfare funds, the CSMBF enjoys the biggest healthcare budget.

During the past three years, the government tried to limit the budget for the schemes, but their health expenses rose drastically and were not reduced to a satisfactory level.

The government tried to clamp down on the CSMBF by controlling expenses for glucosamine sulphate, which is used to treat arthritis. A regulation issued last year succeeded in cutting glucosamine reimbursements from Bt600 million to Bt10 million.

This year, the government plans to implement more measures to limit the CSMBF's total budget to Bt60 billion.

The government will also rein in the NHSF by keeping its per-head budget at Bt2,755.60 for three years from 2012-14.

"The government did not give us a clear answer for why it had to cut the budget," Dr Winai Swasdivorn, secretary-general of the National Health Security Office, said yesterday.

"It might have its own reasons. Maybe it wants to spend more on other things rather than healthcare," he said.

The healthcare budget for the NHSF has been ramping up dramatically, averaging 10 per cent each year, he said. The NHSF's per capita healthcare budget rose from Bt1,200 in 2002 to Bt2,755.60 last year.

Healthcare costs are accelerating faster than gross domestic product (GDP). They now account for 12-13 per cent of the government's total expenditures.

Only 32.8 million of the 48 million people covered by the NHSF have received medical services under the universal healthcare scheme.

However, the government's measure to contain the NHSF's budget would not affect medical services under the universal healthcare scheme. It might affect the government's expenditures instead, Winai added.

Public Health Minister Pradit Sinthawanarong said the budget cap for the NHSF would not undermine the quality of medical services.

"We'll adjust mindsets and improve work processes to become more effective," he said.

The government will implement measures to curb the exploding cost of healthcare schemes, such as managing human resources, managing medical services like the private sector, increasing income for the NHSF by providing medical services for 400,000 local administration officials and migrant workers, and creating a centre of excellence in medical care.

Due to the tight budget, hospitals must learn to share medical resources among themselves, said Dr Narong Sahamethaphat, permanent secretary of the Public Health Ministry.

Prince of Songkla University's hospital is one of many state hospitals that has had to freeze projects and services.

Dr Sutham Pinjaroen, dean of the medical school, said that since the measure to limit the per capita budget of the NHSF took effect last year, the hospital lacked enough money to extend medical services for local people, purchase medical devices and construct more buildings for patient wards.

It could not hire doctors and nurses. At least 80 nurses have resigned and applied for new medical jobs at private hospitals.

"The government must put more money into the fund to end this problem. State hospitals can't shoulder this burden alone," he said.

To cope with medical inflation in the future, the government should set uniform standards for the basic care offered by these three funds, said Dr Samrit Srithamrongsawat, director of the Health Insurance System Research Office.

Then if patients need additional care or treatment such as expensive medicine or a special room, they would be asked to pay for their own expenses and could not get reimbursed.

For example, his office recently found that most pregnant women who subscribe to the CSMBF had asked for a caesarean operation instead of giving birth naturally.

"Since a caesarean is more expensive than spontaneous vaginal delivery, if the government wants to save money, it must think about what kinds of medical treatment patients should pay for on their own," he said.

"Remember we can't use taxes to please everyone," he added.

-- The Nation 2013-01-03

[Pib]

Sounds like the govt figured out how to round-up more money for their rice pledging scheme.

[Thaddeus]

"Remember we can't use taxes to please everyone," he added.

Wait for it.

[canopus1969]

Why not just cut the Civil Servants hangers on (family) out of it and let them us the other funds like everyone else - after all they do nothing

[whybother]

"Remember we can't use taxes to please everyone," he added.

Wait for it.

Wouldn't using taxes for healthcare help more people than using taxes for the rice scheme?

[Bagwan]

Those making the decisions can well afford to utilise the services of the private hospitals who seem to spend an inordinate portion of their budget on providing wall to wall state of the art TV screens and recruiting far more ancillary staff than they really need. Why should they care about the proletariat? A classic case of 'I'm alright Jack'.

If the Government really cared about the nation's health and the escalating budget they would crack down, and I mean really crack down on the poisons that Thais throw down their necks to excess, strictly impose traffic laws and introduce domestic hygiene onto the school curriculum would help. Many of the causes of ill health can be avoided by taking appropriate positive action. Fixing it before it's broke? Mission impossible?

[Chao Lao Beach]

The average Thai can't see bacteria and Viruses, so they don't exist. How many bathrooms actually have soap in them and people use it if it does.

This is evident as most Thais believe you get sick from rain and have no understanding of viral infections.

This comes down to education.

Edited January 3, 2013 by Chao Lao Beach

[rubl]

Surely the NHSF situation has improved tremendously since the re-introduction of the 30 Baht scheme?

BTW the "first year only" policy

"1.14 Further develop the health insurance system - Increase the efficiency of the 30 Baht universal healthcare system; find cures for diseases; ensure that all citizens receive access to quality, convenient, timely and equitable healthcare; integrate the various rights of patients under different systems into the health insurance system; integrate the work plans of relevant agencies to ensure consistency; promote the widespread use of modern and cost effective technologies; establish measures that will reduce health-risk factors and malnourishment that may lead to protracted illnesses such as diabetes, high blood pressure, heart diseases, stroke and cancer, as well as monitor emerging diseases and safeguard against traffic accidents."

Mind you, it might be more of longer term wait-and-be-amazed approach

"4.3.7 Make Thailand Asia's leader in heath care product and service provider by cooperating with all relevant sectors in advancing capacity without compromising the overall level of service provided to Thai citizens; encourage the private sector to set up health rehabilitation centers that meet required standards; and, amend relevant laws and regulations to allow sharing of medical personnel between the private and public sectors."

http://www.thailandtoday.org/node/512

[belg]

a few months ago we could read here how civil servants were abusing the system each month going to the doctor many times unneeded and selling their medications bringing in 15.000-30.000 extra baht of "fraud" money each month over and over again ...

than here when you see 60 billion baht for "only" 5 million civil servants... do they get medicine costing 5x or 6x more ?

last month i was in the hospital for out patient checkups ... the only people paying overthere, were farangs like me ... up to 3000 baht for a 3 minute doctor visit / update and expensive medicine at 100 baht per pill (cheap pharmacy pills costing 10 baht each or less)

but what choice do you have ?

thai people they just signed a paper, no money, no credit card, nothing...

i also do pay taxes, 15% from the first baht of intrest i get from the bank as intrest, and that is in my eyes much much more than most people who pay 0 taxes all year long

[Bluespunk]

The average Thai can't see bacteria and Viruses, so they don't exist. How many bathrooms actually have soap in them and people use it if it does.

This is evident as most Thais believe you get sick from rain and have no understanding of viral infections.

This comes down to education.

Not just Thais who think this. Are a fair number of westerners who also think this. Stupid I know but stupidity is a world wide phenomena.

[fareastguy]

I'm sure the good and kind hearted people at the top end will dip into their "rice pledging scam" funds to help pay their way.. and let the poorer people have the benefit of the health scheme ??

[stoli]

I think it is great that Thailand, unlike the US, has an affordable healthcare program for its citizens. At what most Thais earn, they would be in deep trouble without this great program. I wouldn't want to have a surgery done in a Government hospital, but for small things, it does work well, and very inexpensive. I did notice the Thai's paying their 30 baht, and getting their drugs for free. I hope the above poster is wrong that they then sell them on the black market, but I can easily see how there are always some people looking for an easy way to get money.

[khunken]

"It might have its own reasons. Maybe it wants to spend more on other things rather than healthcare," he said.

Yes, underfunding the various healthcare schemes in Thailand has been the name of the game since they started. No doubt there are abuses of the scheme such as over-prescribing drugs to patients (happens in private hospitals too), allowing caesarian sections for no good reason (giving birth on an 'auspicious' day) and drugs going missing (big money there).

[dcutman]

Half of the rice scam scheme is the health care budget. 1.4 million farmers benefit from the rice scam scheme(mostly the rich). 50 million use the health care.

Yep. better increase funding for the rice scam . Can we all hear from the Red PTP fan club on this.

Edited January 3, 2013 by dcutman

[peergin]

”The Nation” reports the following:

(1) the National Health Security Fund gets Bt109 billion or Bt 2,755.60 per head, for 48 million people;

(2) the Social Security Fund gets Bt27 billion, or Bt 2,500 per head, for 11 million people;

(3) the Civil Servant Medical Benefit Fund gets Bt60 billion, or about Bt 12,000 per head, for 5 million bureaucrats and their families.

Bt 12,000 per head? Amazing! Thai people: seems to me that this is where enormous savings can be realized.

[caughtintheact]

”The Nation” reports the following:

(1) the National Health Security Fund gets Bt109 billion or Bt 2,755.60 per head, for 48 million people;

(2) the Social Security Fund gets Bt27 billion, or Bt 2,500 per head, for 11 million people;

(3) the Civil Servant Medical Benefit Fund gets Bt60 billion, or about Bt 12,000 per head, for 5 million bureaucrats and their families.

Bt 12,000 per head? Amazing! Thai people: seems to me that this is where enormous savings can be realized.

The amount that a government agency gets per head is not the point, it is the amount it costs per head to provide the health care that determines whether or not the system can work. Anyone with a fundamental knowledge of very basic economics knows that when people run to doctors because it is cheap, those doctor visits are paid out of the allocated money, which reduces the money that is left for treating others.

[OzMick]

”The Nation” reports the following:

(1) the National Health Security Fund gets Bt109 billion or Bt 2,755.60 per head, for 48 million people;

(2) the Social Security Fund gets Bt27 billion, or Bt 2,500 per head, for 11 million people;

(3) the Civil Servant Medical Benefit Fund gets Bt60 billion, or about Bt 12,000 per head, for 5 million bureaucrats and their families.

Bt 12,000 per head? Amazing! Thai people: seems to me that this is where enormous savings can be realized.

How would you feel if it was decided to reduce your salary package because others were given an underfunded health scheme?

Anyway, PTP has found a way to fix the problem, reduce taxes.

[Thai at Heart]

”The Nation” reports the following:

(1) the National Health Security Fund gets Bt109 billion or Bt 2,755.60 per head, for 48 million people;

(2) the Social Security Fund gets Bt27 billion, or Bt 2,500 per head, for 11 million people;

(3) the Civil Servant Medical Benefit Fund gets Bt60 billion, or about Bt 12,000 per head, for 5 million bureaucrats and their families.

Bt 12,000 per head? Amazing! Thai people: seems to me that this is where enormous savings can be realized.

it is absolutely ludicrous that they have a three tiered system laid out like this. Beyond that, lets not ask why there are even this many bureaucrats, but this gravy train has to stop.

[Pib]

”The Nation” reports the following:

(1) the National Health Security Fund gets Bt109 billion or Bt 2,755.60 per head, for 48 million people;

(2) the Social Security Fund gets Bt27 billion, or Bt 2,500 per head, for 11 million people;

(3) the Civil Servant Medical Benefit Fund gets Bt60 billion, or about Bt 12,000 per head, for 5 million bureaucrats and their families.

Bt 12,000 per head? Amazing! Thai people: seems to me that this is where enormous savings can be realized.

it is absolutely ludicrous that they have a three tiered system laid out like this. Beyond that, lets not ask why there are even this many bureaucrats, but this gravy train has to stop.

Only three!!!!....durn good. In the U.S. they have many more govt health plans which are fully or partially funded by the federal govt: Medicare (Social Security), Medicaid, Civil Service, Veterans Administration, Tricare (military), and the list goes on. And in the private world many companies offer medical retirement plans. I don't think it's the "number" of systems but how efficiently each system runs and the benefits/coverage each system offers.

[Thai at Heart]

”The Nation” reports the following:

(1) the National Health Security Fund gets Bt109 billion or Bt 2,755.60 per head, for 48 million people;

(2) the Social Security Fund gets Bt27 billion, or Bt 2,500 per head, for 11 million people;

(3) the Civil Servant Medical Benefit Fund gets Bt60 billion, or about Bt 12,000 per head, for 5 million bureaucrats and their families.

Bt 12,000 per head? Amazing! Thai people: seems to me that this is where enormous savings can be realized.

it is absolutely ludicrous that they have a three tiered system laid out like this. Beyond that, lets not ask why there are even this many bureaucrats, but this gravy train has to stop.

Only three!!!!....durn good. In the U.S. they have many more govt health plans which are fully or partially funded by the federal govt: Medicare (Social Security), Medicaid, Civil Service, Veterans Administration, Tricare (military), and the list goes on. And in the private world many companies offer medical retirement plans. I don't think it's the "number" of systems but how efficiently each system runs and the benefits/coverage each system offers.

Well to have a system that is so obviously skewed and rumoured to be a fountain if corruption through reimbursements it is a joke.

No wonder functional food supplement s sell so well here. i wouldn't be surprised if half the quack pills are claimed.

[Skywalker69]

"Remember we can't use taxes to please everyone," he added.

Only to be used for our election promises.