NHSO a shining example of what can be done if we join hands

[webfact]

BURNING ISSUE
NHSO a shining example of what can be done if we join hands
Pongphon Sarnsamak
The Nation

BANGKOK: -- Given the People's Democratic Reform Committee does not have a clear method to reform political and social inequality, the setting up of the National Health Security Office stands as a shining example of what can happen when stakeholders join hands for the good of the country.

The NHSO, one of Thailand's main health insurers, was set up in 2002 as a public organisation in a bid to eliminate inequality in accessing healthcare services by developing health security and providing universal healthcare coverage.

Establishment of the NHSO stemmed from an attempt by a small group of doctors to spark healthcare reform and provide adequate medical services to everyone.

Dr Sa-nguan Nitayarumphong, a former secretary-general of the NHSO, played a prominent role in establishing universal healthcare coverage. He spent over 30 years of his life developing the healthcare system.

Before the establishment of the NHSO, he had conducted several studies since 1990 to find a proper way to set up an equal healthcare system and deliver reform.

At that time the government, led by former Democrat prime minister Chaun Leekpai, had drafted the National Health Security Bill and Sa-nguan was part of a working group that drew up the bill.

The House of Representatives did not approval the bill. But Sa-nguan continued looking at ways to set up a National Health Security Fund by running pilot projects at hospitals in several provinces, and learning from his mistakes to develop a successful model.

Before the general election in 2001, Sa-nguan delivered a yellow paper explaining the concept of national health security and the possibility of setting up the fund with a budget of Bt30 billion.

In trying to sell the idea he talked to several political parties, including the Democrats and Thai Rak Thai.

His national health security policy was rejected by the Democrats but welcomed by Thai Rak Thai, which won the election with Thaksin Shinawatra at the helm. Thai Rak Thai then developed the proposal into its populist policy as the 30 baht health scheme, which provides universal healthcare.

The policy was welcomed by health officials including Dr Mongkol Na Songkla, a former permanent secretary of the Public Health Ministry.

The project started in 2001 as a pilot project in six provinces and expanded to 15 provinces and then nationwide.

During the first three years of the NHSO, it was strongly opposed by several groups of doctors and medical workers, as they had to shoulder more work.

Moreover, many healthcare units, especially the Public Health Ministry, were worried that they would have no budgetary control over funds allocated by the government, as the NHSO would be designated as the authorised agency to manage funds.

The NHSO has slightly improved its management and services over the past 12 years but is still not perfect.

Sa-nguan died of lung cancer in 2008 but his legacy lives on.

The NHSO welcomed all stakeholders to participate and develop a universal healthcare scheme that benefits all Thais.


-- The Nation 2014-02-18

[ChrisY1]

Great...this article above the slavery article......where foreign workers on Thai fishing fleets are thrown overboard if they get sick!

[Morakot]

Absurd logic... The NHSO has not come about because of some imaginary unity, but is the result of a persistent long-term effort driven by compromise and pragmatic thinking, beyond populist sound-bits and entrenched hatred.

Edited February 18, 2014 by Morakot

[rogerdee123]

The current Govt will probably gut the finances of the NHSO to pay for their rice scheme corruption.

[DirtFarmer]

The current Govt will probably gut the finances of the NHSO to pay for their rice scheme corruption.

The sepia tone in your icon fails to veil the effect of the geographic location of your head... most ridiculous statement so far today... get out the stick... beat the dead horse some more...

hard working people from both sides engineered that plan and the Dems rejected it though it was supported by Leekpai.... but guess who made it happen...? And I can tell you every Thai that I have ever met is grateful for it... and most of the farangs from America wish they had the same there... or similar to Canada... Thaksin made it happen... duh.... but the narrow view of all of this allows for the continued bowel vacating.. so carry on!!! Cheers!

[Morakot]

The current Govt will probably gut the finances of the NHSO to pay for their rice scheme corruption.

What's the indication for this?

[Fryslan boppe]

A not-so-subtle attempt to distance Mr. Thaksin from his signature universal healthcare program.

Won't work.

Their are many. many reasons elections go the way they do.

The roots of that electoral phenomenon will not be easily deep-sixed and obscured by the Opposition.

When the street-based coup-mongers were on about a "Thaksin legacy that they needed to destroy', spoke differently to different people. It merely reinforced the electoral majority and re-focussed them. reminded them of why they voted the way they have....a most unwelcome, unintended consequence for the coup-mongers.

No wonder they quickly got off that kick, and moved to trying to avoid elections, and then blew all that self-serving smoke about reform before elections...Hoping they could diddle electoral systemics in their favour.

[rogerdee123]

The current Govt will probably gut the finances of the NHSO to pay for their rice scheme corruption.

The sepia tone in your icon fails to veil the effect of the geographic location of your head... most ridiculous statement so far today... get out the stick... beat the dead horse some more...

hard working people from both sides engineered that plan and the Dems rejected it though it was supported by Leekpai.... but guess who made it happen...? And I can tell you every Thai that I have ever met is grateful for it... and most of the farangs from America wish they had the same there... or similar to Canada... Thaksin made it happen... duh.... but the narrow view of all of this allows for the continued bowel vacating.. so carry on!!! Cheers!

And on the 1st day ... Lord Thaksin created the heavens and the earth and the ....... NHSO ... !!!!

[noitom]

before the rice pledging fiasco, the establishment and PAD referred to the national health scheme as Thaksin's "populist" programs. The Thai news was bad mouthing it for years as a "populist" program enacted to garner votes in the rural north. The Thai elite considered health coverage for the Thai poor a "vote buying" scheme.

[smileydude]

The NHSO is a noble idea started by medical professionals and supported and initiated by the Thaksin led government.

Has it been hijacked for the use of populist policies and votes?

Problem is the funding of the NHSO is in dire straits.

It is unsustainable and hospitals under the Ministry of Public health are losing money.

Most private hospitals who previously participated in the scheme saw it as a black hole so they withdrew from the program cutting their loses.

Unfortunately government hospitals have no choice but to trudge along despite their losses.

University hospitals who have a choice have opted out or minimized their treatment for NHSO patients to tertiary care because primary and secondary care is where the loss is mainly at.

Why is it unsustainable?

Because the main group of recipients of the NHSO are the elderly and children.

Most of the healthier working population are covered under the Social security program.

30% of the elderly have chronic diseases which account for 80% of the programs costs because they require visits of at least once/month with a bill of 3000 baht/visit on average.

Because the program is free for all and their is no copayment patients don't really have any incentives to take care and be responsible for their own health. Uphill battle for preventive medicine.

The payment also covers costs for accidents and most accidents are due to motorcycles and drunk driving. Again no copayment so no incentive to correct drinking behavior because its free.

Most of the thai public distrust the quality of healthcare from the NHSO as substandard and complain but they have no choice as free care is better then none. Those that can afford the bill go to private healthcare providers.

The NHSO tries to maintain sustainability by lowering the fee rates it reimburses to providers but with rising health costs (equipment, supplies and medication, health personnel etc.) but this is illogical as providers will drop dead one by one and the system will go bust.

Best way is to allow for co-payment so that everyone has to chip in but that would create an uproar and be extremely unpopular. Which government would dare lose voters?

Edited February 18, 2014 by smileydude

[gamini]

The current Govt will probably gut the finances of the NHSO to pay for their rice scheme corruption.

The sepia tone in your icon fails to veil the effect of the geographic location of your head... most ridiculous statement so far today... get out the stick... beat the dead horse some more...

hard working people from both sides engineered that plan and the Dems rejected it though it was supported by Leekpai.... but guess who made it happen...? And I can tell you every Thai that I have ever met is grateful for it... and most of the farangs from America wish they had the same there... or similar to Canada... Thaksin made it happen... duh.... but the narrow view of all of this allows for the continued bowel vacating.. so carry on!!! Cheers!

If you read the article it was the Democrats that initiated the health scheme. Taksin only followed it ythroughand then took credit for it.

[ericthai]

A not-so-subtle attempt to distance Mr. Thaksin from his signature universal healthcare program.

Won't work.

Their are many. many reasons elections go the way they do.

The roots of that electoral phenomenon will not be easily deep-sixed and obscured by the Opposition.

When the street-based coup-mongers were on about a "Thaksin legacy that they needed to destroy', spoke differently to different people. It merely reinforced the electoral majority and re-focussed them. reminded them of why they voted the way they have....a most unwelcome, unintended consequence for the coup-mongers.

No wonder they quickly got off that kick, and moved to trying to avoid elections, and then blew all that self-serving smoke about reform before elections...Hoping they could diddle electoral systemics in their favour.

absolutely correct many many reasons elections go the way they do and for Taksin is was simply purchased votes.