Thailand: Co-payment scheme for medical visits?

[webfact]

STATE BUDGET
Co-payment scheme for medical visits?
Chularat Saengpassa
The Nation

With state hospitals teetering under high costs, experts discuss new system and vow to protect the poor

BANGKOK: -- THERE HAS been talk for a while now that the National Council for Peace and Order (NCPO) is planning to scrap the universal healthcare system - which offers free medical services to most Thais - in favour of a co-payment scheme.

Should this really happen, some 49 million Thais would be affected.

According to Nimit Tien-udom, a member of the National Health Security Commis-sion, it was recently proposed that people should start shouldering some 30 to 50 per cent of their medical costs.

This subject has been raised every now and then over the past several years as so many state hospitals and medical workers regularly complain about how the scheme is a huge financial burden.

Dr Prachumporn Booncharoen, president of the Thai Federation of Medical Centre and General Hospital Doctors, said the free service was being overused, and as a result, some 300 hospitals were collapsing under the weight of the scheme.

Professor Udom Kachintorn, dean of Mahidol University's Faculty of Medicine for Siriraj Hospital, said his hospital, which is part of the scheme, had lost about Bt400 million in providing these free services, adding that it had been surviving on government subsidies and public donations.

Critics say the universal healthcare scheme is populist in nature, which is why people in power seem reluctant to change it.

This scheme, which initially began as a Bt30-per-visit deal, has been in place for about eight years.

Launched during Thaksin Shinawatra's reign, the Bt30 medical programme was warmly welcomed by people who used to dread seeking treatment out of concern that hospital bills would bankrupt their families.

With the programme in place, ill people felt confident enough to see the doctor as they could afford the Bt30 fee.

In reality, the Bt30 fee can be considered a co-payment scheme. However, in practice, the sum is far too small to help with the expense, and some hospitals have complained that issuing receipts for the tiny contribution only added to their work.

Eventually, taking all the costs - including the ink and paper used for the receipts - the Bt30 fee was scrapped by the interim government put in after the 2006 coup and the universal healthcare scheme was born.

Under the current healthcare system, Thais who are not covered by Social Security or the Civil Servants Medical Benefit programme can get free treatment at designated hospitals.

The universal healthcare programme follows Article 40 of the Health Security Act, which stipulates that all Thais have the right to a comprehensive range of healthcare services without any financial obstacles.

National Health Security Office secretary-general Dr Winai Sawasdiworn explained that funds for a public healthcare system like this could either come from taxpayers or from a co-payment system like the Social Security programme.

However, Article 5 of the same act says that a patient shall co-pay medical fees except in the event that he or she is poor or is exempted from these fees.

Hence co-payment should be possible in providing public healthcare.

Dr Tawatchai Kamoltham, who heads the Department for the Development of Thai Traditional and Alternative Medicine, said getting people to contribute would encourage them to take better care of themselves.

"Co-payment is based on the idea that people should be responsible for their own health," he said.

He said that even if the co-payment initiative were implemented, poor patients would not be refus-|ed treatment or be forced to pay what they could not afford - only those |who can afford to pay would be charged.

"This will also help reduce the gaps in society," he claimed.

Prachumporn echoed Tawatchai's words, saying people who can afford to wear gold should not be allowed free treatment. Both of them also agreed that the co-payment system would help improve the services offered, cut down on crowds and ease budget constraints.

Nimit, meanwhile, pointed out that only 7 per cent of the national budget was allocated to the universal healthcare system every year.

"Obviously the scheme will not threaten the country's financial security any time soon," he said.

He said he did not agree with the idea of forcing patients to pay for medical treatment, though he added that he would not oppose efforts to develop a co-payment system because it would encourage people to save for future health costs.

Source: http://www.nationmultimedia.com/national/Co-payment-scheme-for-medical-visits-30239213.html


-- The Nation 2014-07-23

[Suriya4]

Please remove your gold wedding ring before your next hospital visit.

[ramrod711]

Nimit, meanwhile, pointed out that only 7 per cent of the national budget was allocated to the universal healthcare system every year.

"Obviously the scheme will not threaten the country's financial security any time soon," he said.

This does not sound like an unreasonable amount of money, I wonder what percentage of the budget the armed forces receive.

[chainarong]

This chesnutt is the bane of every country, to offer free medical service cost billions, unless the wages and tax structure are high ,this is not an option in Thailand, being a poorly paid country, lets face it there are more that earn ten thousand BHT a month than sixty, you are in a bind, to look after the poor is admiral, Thailand has no choice but to look after the poor, thats the majority , to meet health fund payments or co-payments the country would need to introduce means testing patients on income tests or come out of the dim dark ages and start a resonable wages system , this will meet with distaste and most of the free loaders that are only in Thailand because of cheap labour, nothing else, will pack up and go else where,placing Thailand back into third world status, looks like catch 22 all over again , no easy answers to this one.

[chainarong]

You could introduce assets testing for patients for co-payment , although most of the country is poor in the wages area, so nothing will get changed much, doing a assets, lifestyle test will involve some rich people trying to avoid their responsibilities , I wouldn't believe most of them anyway and how many Thai's actually are paying income tax., there would need to be a big shake up in the incomes earned and registrations of taxpayers.

[Time Traveller]

The military might want to reconsider. This could be the downfall in their popularity.

[robblok]

This chesnutt is the bane of every country, to offer free medical service cost billions, unless the wages and tax structure are high ,this is not an option in Thailand, being a poorly paid country, lets face it there are more that earn ten thousand BHT a month than sixty, you are in a bind, to look after the poor is admiral, Thailand has no choice but to look after the poor, thats the majority , to meet health fund payments or co-payments the country would need to introduce means testing patients on income tests or come out of the dim dark ages and start a resonable wages system , this will meet with distaste and most of the free loaders that are only in Thailand because of cheap labour, nothing else, will pack up and go else where,placing Thailand back into third world status, looks like catch 22 all over again , no easy answers to this one.

I do hope they don't change it it would be crazy. Though it sounds fair that people should pay if they can afford it in reality I think it would be unworkable. 7% is not too bad I think the Dr and nurses just want a raise but cant because of the financial problems.

But as you say healthcare is the bane and problem in each country it is incredibly expensive, maybe big pharma is making too much money. Who knows.

[biplanebluey]

I wish I could join a scheme like that .I would love to only pay half for medical expenses---Farang!!!!!

[robblok]

I wish I could join a scheme like that .I would love to only pay half for medical expenses---Farang!!!!!

You can if you go back home.. just not here we made our choice its not up to the Thais to pay for us.

(does not mean I would not like it but it understandable)

Edited July 23, 2014 by robblok

[aussieinthailand]

Ahhh now last week I was being shot to bit's and having some TV members accusing me of attempting to cause outrage amongst TV members, after suggesting this was being talked about and becoming a more serious issue,

I hate to say but I TOLD YOU SO!!! where are you now?

Means testing is the way to go with a limit on ownership of land say 20 rai if a farmer and index the co-payment after that.

If it were to come in it should be in line with personal income, Most that can afford health insurance do have it already, unfortunately some that have a good salary are also supporting elderly parents, sibling, cousins and so on, this also must be taken into account.

My wife had a reasonable income but she supported a very sick mother, and niece, and nephew, so could not afford health insurance for herself, her family are just rice farmers with small plot of land, and now we are paying through the nose for her treatment and medicine, without my help financially no way could she cold afford to pay the monumental cost, so far well over a million baht in the last three months, without treatment life expectancy is less that 4 weeks.

NONE of her treatment or medicines is on the 30 baht system so ALL costs are out of pocket which is destroying the back balance, she has had to sell her business and she refuses to ask family for help as it would put them into financial ruin. her's is not a isolated case it happens a lot so removing the 30 baht system will have massive impact creating a new class that of former lower- middle class to destitute. I ask you how the hell will this benefit the country?

Edited July 23, 2014 by aussieinthailand

[gwynt]

When my wife's grand mother needed medical care under the "free health care" system she had to pay 14000Baht for the surgery, being over ninety, she is not sure how far over, she told her daughter that she should have left her die instead of paying all that money, she is not short of a few baht. but when told that I had paid half she was much happier that the "Farrang" had contributed.

I think she is great.

The point being the "Free" health care is not that free.

Many of the government hospitals have specialists who work in private hospitals, providing assistance when needed.

[VINCENT2012]

like breathing or needing to drink water for living, health care, hospital and surgery should be free for everybody all around the world.

it should be a human right given by our modern society.

government and people thinking only in money , always forget that they could have an accident, a hart failure or whatever suddenly critical, that they are going to get old, get also sick and will die for sure.so what happened when you are in the wrong side of the line?

today we have enough technologie to have a better life so why keeping it only for a few.

poors build the entire world never kings...!

[TallGuyJohninBKK]

This article, and the people quoted in it, seem to have quite a few seemingly unwieldy assumptions:

--that implementing a co-pay system would encourage Thais to save for their own health care. Anyone see any likelihood of that?

--that implementing a co-pay system would encourage Thais to take more responsibility for their own health. Meaning, like not riding 4 to a motorcycle with no helmets against the traffic flow, or not drinking and smoking to excess?

--that the government could have some reasonably accurate or fair way of determining a patient's income/wealth as a way of deciding their co-payment status. Just how would they ever be able to do that? The government either can't or won't even collect the taxes its owed, and so many Thais earn money in off-the-books ways.

--And, who's to say that if the government actually implemented a co-pay system that said government would actually plow those funds back into the public healthcare system to improve its services and quality? They managed to spend/lose what, 500 billion or so, of public funds on the rice subsidy scam, but all the while, left public health starving in relative terms.

There probably should be a more substantial co-payment system for public healthcare in Thailand. But Lord only knows who it could ever be implemented here in a fair way, without really harming the truly poor, while also improving public health care services.

Edited July 23, 2014 by TallGuyJohninBKK

[pitrevie]

I was never a fan of Tony Benn but one thing he said that stuck, governments can always find money for killing people but not so much for helping people.

[robblok]

Ahhh now last week I was being shot to bit's and having some TV members accusing me of attempting to cause outrage amongst TV members, after suggesting this was being talked about and becoming a more serious issue,

I hate to say but I TOLD YOU SO!!! where are you now?

Means testing is the way to go with a limit on ownership of land say 20 rai if a farmer and index the co-payment after that.

If it were to come in it should be in line with personal income, Most that can afford health insurance do have it already, unfortunately some that have a good salary are also supporting elderly parents, sibling, cousins and so on, this also must be taken into account.

My wife had a reasonable income but she supported a very sick mother, and niece, and nephew, so could not afford health insurance for herself, her family are just rice farmers with small plot of land, and now we are paying through the nose for her treatment and medicine, without my help financially no way could she cold afford to pay the monumental cost, so far well over a million baht in the last three months, without treatment life expectancy is less that 4 weeks.

NONE of her treatment or medicines is on the 30 baht system so ALL costs are out of pocket which is destroying the back balance, she has had to sell her business and she refuses to ask family for help as it would put them into financial ruin. her's is not a isolated case it happens a lot so removing the 30 baht system will have massive impact creating a new class that of former lower- middle class to destitute. I ask you how the hell will this benefit the country?

You were right.. so I admit it I am against it anyway (changing it)

But why are you paying ? I mean the 30bt scheme was perfect and working and still you are paying. She is Thai she should have had rights to it. Ah always easier to get the farang to pay. Maybe it would have been better for you to have put her on healthcare before.. I mean I can't see you marrying so fast that you haven't known her before she became ill.

[robblok]

like breathing or needing to drink water for living, health care, hospital and surgery should be free for everybody all around the world.

it should be a human right given by our modern society.

government and people thinking only in money , always forget that they could have an accident, a hart failure or whatever suddenly critical, that they are going to get old, get also sick and will die for sure.so what happened when you are in the wrong side of the line?

today we have enough technologie to have a better life so why keeping it only for a few.

poors build the entire world never kings...!

Hospitals cost money and the more advance the treatment is the more expensive it is. Even in modern countries like the Netherlands healthcare is expensive. The more advanced it is the more it cast.. it can't be free.. its a pipe dream.

[jpeg]

The military might want to reconsider. This could be the downfall in their popularity.

It had a huge impact on Taksin's popularity, so yes, if the junta starts tampering with this, goodnight nurse

BTW 7% ??? That is a disgustingly parsimonious amount from the national budge spent on people's health (cue sniping from those with BUPA). The education/brainwashing budget surpasses that, surely?

[TallGuyJohninBKK]

And an interesting related development in the news today from NCPO...

http://www.thaivisa.com/forum/topic/745264-9074-new-positions-opened-by-public-health-ministry/

[jpeg]

like breathing or needing to drink water for living, health care, hospital and surgery should be free for everybody all around the world.

it should be a human right given by our modern society.

government and people thinking only in money , always forget that they could have an accident, a hart failure or whatever suddenly critical, that they are going to get old, get also sick and will die for sure.so what happened when you are in the wrong side of the line?

today we have enough technologie to have a better life so why keeping it only for a few.

poors build the entire world never kings...!

Hospitals cost money and the more advance the treatment is the more expensive it is. Even in modern countries like the Netherlands healthcare is expensive. The more advanced it is the more it cast.. it can't be free.. its a pipe dream.

Cuba manages it. Get your priorities right. Oh and please, no snide comments about living under a dictatorship, eh?

[His Masters Voice]

I think that there should be a copayment, but the 30 to 50 per cent of their medical costs suggested in the report is to high, but a smaller fee for service is ok.

[cooked]

฿30.-doesn't even pay for the book keeping involved. There are plenty of people in this village that go to the village clinic for Paracetamol when they have a headache. Something like ฿100.- to ฿300.- should be affordable for almost everyone and seems much more reasonable. These people used to use herbal remedies, now they go to the clinic, it's easier. If anybody doesn't have even that small amount of money, there are ways....

[cmsally]

I was never a fan of Tony Benn but one thing he said that stuck, governments can always find money for killing people but not so much for helping people.

“If we can find the money to kill people, we can find the money to help people.”

Some great quotes from Tony Benn. You won't find many like him in Thailand though.

[robblok]

like breathing or needing to drink water for living, health care, hospital and surgery should be free for everybody all around the world.

it should be a human right given by our modern society.

government and people thinking only in money , always forget that they could have an accident, a hart failure or whatever suddenly critical, that they are going to get old, get also sick and will die for sure.so what happened when you are in the wrong side of the line?

today we have enough technologie to have a better life so why keeping it only for a few.

poors build the entire world never kings...!

Hospitals cost money and the more advance the treatment is the more expensive it is. Even in modern countries like the Netherlands healthcare is expensive. The more advanced it is the more it cast.. it can't be free.. its a pipe dream.

Cuba manages it. Get your priorities right. Oh and please, no snide comments about living under a dictatorship, eh?

It still is not free and the money needs to come from somewhere as medicine and labor cost money. The better and more advanced the treatment is the longer a patient can live the more costs ect. So if your healthcare gets better it gets more expensive too. Then you get stuff like should you give a new hip to a 90 year old.

Not nice at all.. and the public will always finance it and money spend on healthcare cant be spend elsewhere. So people pay into it by taxes if nobody pays into it it cant exist. I like it how it is for Thais and don't think paying into it would be good. I think there should be some land taxes to add to the tax income Thailand gets to keep paying for stuff like this.

But anyone who thinks the 30 bt scheme will give you the best healthcare there is is crazy as they just don't have the resources.

[aussieinthailand]

Ahhh now last week I was being shot to bit's and having some TV members accusing me of attempting to cause outrage amongst TV members, after suggesting this was being talked about and becoming a more serious issue,

I hate to say but I TOLD YOU SO!!! where are you now?

Means testing is the way to go with a limit on ownership of land say 20 rai if a farmer and index the co-payment after that.

If it were to come in it should be in line with personal income, Most that can afford health insurance do have it already, unfortunately some that have a good salary are also supporting elderly parents, sibling, cousins and so on, this also must be taken into account.

My wife had a reasonable income but she supported a very sick mother, and niece, and nephew, so could not afford health insurance for herself, her family are just rice farmers with small plot of land, and now we are paying through the nose for her treatment and medicine, without my help financially no way could she cold afford to pay the monumental cost, so far well over a million baht in the last three months, without treatment life expectancy is less that 4 weeks.

NONE of her treatment or medicines is on the 30 baht system so ALL costs are out of pocket which is destroying the back balance, she has had to sell her business and she refuses to ask family for help as it would put them into financial ruin. her's is not a isolated case it happens a lot so removing the 30 baht system will have massive impact creating a new class that of former lower- middle class to destitute. I ask you how the hell will this benefit the country?

You were right.. so I admit it I am against it anyway (changing it)

But why are you paying ? I mean the 30bt scheme was perfect and working and still you are paying. She is Thai she should have had rights to it. Ah always easier to get the farang to pay. Maybe it would have been better for you to have put her on healthcare before.. I mean I can't see you marrying so fast that you haven't known her before she became ill.

G'day mate, good to see you have the stones to put your hand up, well done;-) cheers.

My wife is Thai, and is resisted for the 30 baht system, her medical condition was undiagnosed, and it came in a massive failure, her condition (treatment medicines and procedures, blood work everything is NOT covered by the 30 Baht system as it is related to her condition, trust me we asked, then she asked so what do we do if we don't have the money for this? answer up to you, but not free and have no room for you anyway, strait from nurse and doctors mouth...

so like I was trying to say was if a person doesn't have the means to pay for treatment these people are saying, they will not just let you die and can be treated for free, well that was not the case before and I can't see it being different now.

If the co-payment is introduced, previously people just avoided going too the doc as just to expensive, and it will be again there for creating a smaller health issue into a much lager and more severe issue, so I say again just where is this supposed to benefit the country???

Edited July 23, 2014 by aussieinthailand

[chotthee]

Bad news for the rich.

Good news for the poor.

Keep up the good work, general P.

[Thai at Heart]

They need to sort out the two tier system that is created for civil servants and the people anyway.

My father in law, bless his soul was a civil servant and he received huge volumes of very expensive medication for Alzheimer's that I was told would not have been available to the ordinary population for free.

It is nice to be on the beneficial side but it isn't morally right.

[TallGuyJohninBKK]

A higher copayment in the 30 baht healthcare scheme is not hardly bad news for the rich.

If you're Thai and rich, you're not likely relying on the 30 baht scheme hospitals and doctors for your healthcare.

It would only be bad news for the rich if the government actually started collecting a fair share of taxes from them to support the various public needs of the nation, including public healthcare. And that's not what they're talking about here.

[northernjohn]

Ahhh now last week I was being shot to bit's and having some TV members accusing me of attempting to cause outrage amongst TV members, after suggesting this was being talked about and becoming a more serious issue,

I hate to say but I TOLD YOU SO!!! where are you now?

Means testing is the way to go with a limit on ownership of land say 20 rai if a farmer and index the co-payment after that.

If it were to come in it should be in line with personal income, Most that can afford health insurance do have it already, unfortunately some that have a good salary are also supporting elderly parents, sibling, cousins and so on, this also must be taken into account.

My wife had a reasonable income but she supported a very sick mother, and niece, and nephew, so could not afford health insurance for herself, her family are just rice farmers with small plot of land, and now we are paying through the nose for her treatment and medicine, without my help financially no way could she cold afford to pay the monumental cost, so far well over a million baht in the last three months, without treatment life expectancy is less that 4 weeks.

NONE of her treatment or medicines is on the 30 baht system so ALL costs are out of pocket which is destroying the back balance, she has had to sell her business and she refuses to ask family for help as it would put them into financial ruin. her's is not a isolated case it happens a lot so removing the 30 baht system will have massive impact creating a new class that of former lower- middle class to destitute. I ask you how the hell will this benefit the country?

My understanding is that the 30 baht system cost more to administer than it brings in. Hospitals spend more on administrative costs to administer it than it brings in.

A more sensible system for the poor would be one that does not cost more for the help and in fact returns some money to the coffers. Say a 200 baht charge. The hospitals would realize some profit rather than loss on it and it would be enough to keep the minor cases out of the hospitals.

[jpeg]

But anyone who thinks the 30 bt scheme will give you the best healthcare there is is crazy as they just don't have the resources.

Oh yes they do. They should simply redirect some of them

[Thai at Heart]

Its hardly a 30 baht payment when a patient with little wrong is pushed to buy 100 baht worth of overpriced paracetamol or penicillin for flu.

The 30 baht is an attempt to stop frivolous visits, but Thais are a little hypochondriac. 100 baht might be a little better as a disicentive. But the whole govt/private debate in Thailand needs to be had because the govt system is almost semi private anyway.