Thailand: Co-payment scheme for medical visits?

[aussieinthailand]

Here's a Question or 2.

1. There's money for submarine station, that don't have any sub's, but not for public health.

2. there money for free world cup for all Thailand but not for public health.

3. There's money for a free move, zoo visit's, and free food, but not for the public health.

4. There money for salary's to pay for inactive post's but no money for public health.

and this is a befit to the country how?

[umbanda]

Thai Social Security for self employees average cost is about 2500THB/year. I think it is afordable for most Thai mature individuals, and covers dependents benefits, and retirement benefits at 60...Can apply at any time before 60 y.o, even by foreigners with WP.

Edited July 23, 2014 by metisdead
Bold font removed again. Please stop using bold font when posting.

[Krataiboy]

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

Oh dear, how irresponsible of me - I've got cancer because of the deadly chemicals the Thai government sanctions for use in growing and preserving the food we have to eat.

Clearly I don't deserve free medical care.

[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.

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???

Crazy that she was not treated.. then in reality the 30 bt is a scam as it does not cover people. I am confused (I always thought it was there but i knew they would not do their ultimate best as it would be too expensive). My wives dad died from alcohol related stuff his liver was gone.. we did not pay a thing but could pay extra for extra blood (but it would not save him just prolong it). They had set limits as else it would become too expensive.

I made sure my wife was insured privately to avoid stuff like this I am also privately insured.. its expensive.

But really what can you expect from a 30 baht policy that puts a strain on the countries finances. They can spend a baht only once so I never expected top healthcare but I did not expect situations like your wives.

I am against co payment.. but on the other hand people should not expect too much of the scheme as is because else it gets too expensive. People just not pay enough tax.

And of course i got the balls to admit when I am wrong and its clearly proven. Everybody makes mistakes no shame in that. (at least not in my opinion)

[robblok]

Here's a Question or 2.

1. There's money for submarine station, that don't have any sub's, but not for public health.

2. there money for free world cup for all Thailand but not for public health.

3. There's money for a free move, zoo visit's, and free food, but not for the public health.

4. There money for salary's to pay for inactive post's but no money for public health.

and this is a befit to the country how?

While i agree with you its all budgeted and I don't see why all should go to healthcare. Also the more healthcare you give the more expensive it gets (people get older and it will cost more and more). So in the end it will be too much to pay. I think in the end if the poor want better service they will have to pay into it too. You cant expect everything to be grade A for free.

As for the inactive posts.. i think its stupid too but i hear its just too expensive and hard to fire them.

Hard question do you think everyone should get the best healthcare at all cost or less if your an alcoholic and your liver is gone or if your old and not long to live anyway ? Remember its not nice talking money.. but there are limits to this and there is only so much tax to go around.

[robblok]

Thai Social Security for self employees average cost is about 2500THB/year. I think it is afordable for most Thai mature individuals, and covers dependents benefits, and retirement benefits at 60...Can apply at any time before 60 y.o, even by foreigners with WP.

Could you tell me more about this, the wife is a guide and self employed currently paying 15k for extra insurance. I can afford it but what you are talking about sounds a lot better.

[samran]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

Edited July 23, 2014 by samran

[robblok]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

Of course universal healthcare is a good thing, but if i read this then Thailand is already close to 8-9% of the GDP and it still is not enough. It should of course not be unlimited because then Dr's and medicine companies can get rich. Question is should you let this percentage up up unlimited or should there be limitations.

Its a hard and complicated thing, back where i come from now they show how much it cost by having a payment go straight out of the salary (income related) and an other part you pay to an insurance (non income related). I am not sure its the best thing but people should see its not free so they use it wisely. Also there are some things you have to pay yourself to put up a bit of a threshold to limit unnecessary use.

Right now Thailand does not have a big taxpayer base.. mainly stuff from vat and the middle class pays income tax.. the real rich seem to avoid it. So if income tax is put up the middle class is screwed and they already pay a lot (relative to the rich and poor). Put VAT up and you screw the poor more.. so land taxes would be a way to go (with a threshold) but as the rich control the system I dont see that happening anytime soon.

[samran]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

Of course universal healthcare is a good thing, but if i read this then Thailand is already close to 8-9% of the GDP and it still is not enough. It should of course not be unlimited because then Dr's and medicine companies can get rich. Question is should you let this percentage up up unlimited or should there be limitations.

Its a hard and complicated thing, back where i come from now they show how much it cost by having a payment go straight out of the salary (income related) and an other part you pay to an insurance (non income related). I am not sure its the best thing but people should see its not free so they use it wisely. Also there are some things you have to pay yourself to put up a bit of a threshold to limit unnecessary use.

Right now Thailand does not have a big taxpayer base.. mainly stuff from vat and the middle class pays income tax.. the real rich seem to avoid it. So if income tax is put up the middle class is screwed and they already pay a lot (relative to the rich and poor). Put VAT up and you screw the poor more.. so land taxes would be a way to go (with a threshold) but as the rich control the system I dont see that happening anytime soon.

Believe it is 9% of government budget not national income (ie the value of all economic activity in the country).

You make valid points on the issue of the government needing to broaden its revenue base, but as I said, I think cost pressures are better addressed in the delivery mechanisms ( ie get paid x baht per procedure and link payments to doctors and hospitals based on performance). This helps control the otherwise monopoly incentives of doctors and hospitals.

Sent from my iPhone using Thaivisa Connect Thailand

[Thai at Heart]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

The voice of reason.

Of course this would be improved of more people paid into whichever fund they had to to get covered. 2500 per year isn't massive but every little helps.

[Thai at Heart]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

Of course universal healthcare is a good thing, but if i read this then Thailand is already close to 8-9% of the GDP and it still is not enough. It should of course not be unlimited because then Dr's and medicine companies can get rich. Question is should you let this percentage up up unlimited or should there be limitations.

Its a hard and complicated thing, back where i come from now they show how much it cost by having a payment go straight out of the salary (income related) and an other part you pay to an insurance (non income related). I am not sure its the best thing but people should see its not free so they use it wisely. Also there are some things you have to pay yourself to put up a bit of a threshold to limit unnecessary use.

Right now Thailand does not have a big taxpayer base.. mainly stuff from vat and the middle class pays income tax.. the real rich seem to avoid it. So if income tax is put up the middle class is screwed and they already pay a lot (relative to the rich and poor). Put VAT up and you screw the poor more.. so land taxes would be a way to go (with a threshold) but as the rich control the system I dont see that happening anytime soon.

Believe it is 9% of government budget not national income (ie the value of all economic activity in the country).

You make valid points on the issue of the government needing to broaden its revenue base, but as I said, I think cost pressures are better addressed in the delivery mechanisms ( ie get paid x baht per procedure and link payments to doctors and hospitals based on performance). This helps control the otherwise monopoly incentives of doctors and hospitals.

Sent from my iPhone using Thaivisa Connect Thailand

The 9% is what the govt puts in I think. That doesn't count what insurance people pay themselves.

Not to do with you, but debating health care in the EU with Americans is a very difficult thing to. It tends to descend to the words liberal, progressive and finally communist.

[samran]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

Of course universal healthcare is a good thing, but if i read this then Thailand is already close to 8-9% of the GDP and it still is not enough. It should of course not be unlimited because then Dr's and medicine companies can get rich. Question is should you let this percentage up up unlimited or should there be limitations.

Its a hard and complicated thing, back where i come from now they show how much it cost by having a payment go straight out of the salary (income related) and an other part you pay to an insurance (non income related). I am not sure its the best thing but people should see its not free so they use it wisely. Also there are some things you have to pay yourself to put up a bit of a threshold to limit unnecessary use.

Right now Thailand does not have a big taxpayer base.. mainly stuff from vat and the middle class pays income tax.. the real rich seem to avoid it. So if income tax is put up the middle class is screwed and they already pay a lot (relative to the rich and poor). Put VAT up and you screw the poor more.. so land taxes would be a way to go (with a threshold) but as the rich control the system I dont see that happening anytime soon.

Believe it is 9% of government budget not national income (ie the value of all economic activity in the country).

You make valid points on the issue of the government needing to broaden its revenue base, but as I said, I think cost pressures are better addressed in the delivery mechanisms ( ie get paid x baht per procedure and link payments to doctors and hospitals based on performance). This helps control the otherwise monopoly incentives of doctors and hospitals.

Sent from my iPhone using Thaivisa Connect Thailand

The 9% is what the govt puts in I think. That doesn't count what insurance people pay themselves.

Not to do with you, but debating health care in the EU with Americans is a very difficult thing to. It tends to descend to the words liberal, progressive and finally communist.

I think for most non-Americans it is non-issue, though we might complain around the edges about wait lists etc.

Always need to be careful of bringing on overseas models as you point out. What I explain though is basic economics however (well maybe not basic, I've done health economics to the masters level). At the end of the day, it is cheaper and more cost effective to have everyone in the one system. It broadens the risk pool to the greatest extent and lowers the overall average risk profile. Top down control of costs by the government is also another factor in keeping costs down. More broadly, a healthy society is a productive economy.

I think thailand can and should amalgamate its various systems into one. It would be alot more effective that way.

[cmsally]

I think if more people could self insure through the social security system they would. But as I understand it they have to enter through an employer first for at least 13 months before they can self insure and keep up their payments.

Is that correct, or have I been told wrong. It can be the case that some people just don't have the right info.

[belg]

farang , even working legally / paying taxes, gets nothing free or 30 baht

i dont work but 15% of my intrest for savings goes to the governement

and that is much, much more than many thai people that contribute / pay 0%

[robblok]

farang , even working legally / paying taxes, gets nothing free or 30 baht

i dont work but 15% of my intrest for savings goes to the governement

and that is much, much more than many thai people that contribute / pay 0%

If you work legally you can get the free healthcare. You are in the system as a foreigner.. no distinction is made then.

[robblok]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

Of course universal healthcare is a good thing, but if i read this then Thailand is already close to 8-9% of the GDP and it still is not enough. It should of course not be unlimited because then Dr's and medicine companies can get rich. Question is should you let this percentage up up unlimited or should there be limitations.

Its a hard and complicated thing, back where i come from now they show how much it cost by having a payment go straight out of the salary (income related) and an other part you pay to an insurance (non income related). I am not sure its the best thing but people should see its not free so they use it wisely. Also there are some things you have to pay yourself to put up a bit of a threshold to limit unnecessary use.

Right now Thailand does not have a big taxpayer base.. mainly stuff from vat and the middle class pays income tax.. the real rich seem to avoid it. So if income tax is put up the middle class is screwed and they already pay a lot (relative to the rich and poor). Put VAT up and you screw the poor more.. so land taxes would be a way to go (with a threshold) but as the rich control the system I dont see that happening anytime soon.

Believe it is 9% of government budget not national income (ie the value of all economic activity in the country).

You make valid points on the issue of the government needing to broaden its revenue base, but as I said, I think cost pressures are better addressed in the delivery mechanisms ( ie get paid x baht per procedure and link payments to doctors and hospitals based on performance). This helps control the otherwise monopoly incentives of doctors and hospitals.

Sent from my iPhone using Thaivisa Connect Thailand

Ok Samran I misread about the 9%, then the budget should be higher as I think GDP is a lot higher as the tax budget. But If they want to increase the budget they either need a bigger tax-base (more taxes) or need to shift priorities. How I read it now is that they are not willing to up the budget but want people to pay. So it looks like this scheme is not funded properly. But i doubt that they will get extra taxes easy or that other sectors will take a budget cut to increase the healthcare budget.

The delivery that you are talking about is the same as in Holland hospitals get an x amount per procedure. They now have hospitals specializing at certain procedures ect. Still the Dutch healthcare is not perfect its still expensive and it might be better to kick the insurers out and make it 100% government. They put in private parties to keep it cheaper.. but now the cost are lower the insurers are building up reserves instead of lowering premiums. (sorry to go off topic)

[chotthee]

farang , even working legally / paying taxes, gets nothing free or 30 baht

i dont work but 15% of my intrest for savings goes to the governement

and that is much, much more than many thai people that contribute / pay 0%

Tax on interest can be claim back. All farang do that.

[aussieinthailand]

Here's a Question or 2.

1. There's money for submarine station, that don't have any sub's, but not for public health.

2. there money for free world cup for all Thailand but not for public health.

3. There's money for a free move, zoo visit's, and free food, but not for the public health.

4. There money for salary's to pay for inactive post's but no money for public health.

and this is a befit to the country how?

While i agree with you its all budgeted and I don't see why all should go to healthcare. Also the more healthcare you give the more expensive it gets (people get older and it will cost more and more). So in the end it will be too much to pay. I think in the end if the poor want better service they will have to pay into it too. You cant expect everything to be grade A for free.

As for the inactive posts.. i think its stupid too but i hear its just too expensive and hard to fire them.

Hard question do you think everyone should get the best healthcare at all cost or less if your an alcoholic and your liver is gone or if your old and not long to live anyway ? Remember its not nice talking money.. but there are limits to this and there is only so much tax to go around.

Yes I do think everyone should get the best health care that can be provided, and yes I think there should be limits on those that came be recipients, and this is already in practice, as doctor said she (my wife) is young so no problem for approving transplant,

ie , just to old, hardened criminal, drug addict,

I'd like to see any politician try to justify a new submarine, or a politicians world travel expenses, politicians wage rise, vat tax and income tax increase costing billions, and at the same time saying no money for public health in an election year, what are the chances of that???

[robblok]

Here's a Question or 2.

1. There's money for submarine station, that don't have any sub's, but not for public health.

2. there money for free world cup for all Thailand but not for public health.

3. There's money for a free move, zoo visit's, and free food, but not for the public health.

4. There money for salary's to pay for inactive post's but no money for public health.

and this is a befit to the country how?

While i agree with you its all budgeted and I don't see why all should go to healthcare. Also the more healthcare you give the more expensive it gets (people get older and it will cost more and more). So in the end it will be too much to pay. I think in the end if the poor want better service they will have to pay into it too. You cant expect everything to be grade A for free.

As for the inactive posts.. i think its stupid too but i hear its just too expensive and hard to fire them.

Hard question do you think everyone should get the best healthcare at all cost or less if your an alcoholic and your liver is gone or if your old and not long to live anyway ? Remember its not nice talking money.. but there are limits to this and there is only so much tax to go around.

Yes I do think everyone should get the best health care that can be provided, and yes I think there should be limits on those that came be recipients, and this is already in practice, as doctor said she (my wife) is young so no problem for approving transplant,

ie , just to old, hardened criminal, drug addict,

I'd like to see any politician try to justify a new submarine, or a politicians world travel expenses, politicians wage rise, vat tax and income tax increase costing billions, and at the same time saying no money for public health in an election year, what are the chances of that???

Thing is there are limits to what should be paid for healthcare. It gets more expensive all the time with an aging population and better medicine and never treatments (both always more expensive). If you as a country are not careful then healthcare will become too expensive. So yes I do think there should be restrictions to healthcare.

Just like pension schemes are wrong.. now there are too many old people and not enough young paying into it. I know that I would protest as a young person because the chances of me ever getting a dime while paying my whole life for older guys is low. Pensions where I came from were given to people who did not pay in all the time. It should be changed to getting what you paid into it not paying for others. The old people where I come from made the laws and screwed the young ones over. Its totally unfair.

[harrry]

Some people seem to think that a heavy charge should be made to keep people from visiting the hospital for "minor" cases like colds, infections and stomach problems. What they fail to consider is that there is a strong attempt to steer people to doctor based care which is snow aviailable in the hospital rather than the local massage person or more lately non qualified pharmacist. People are starting to use the hospital for this and the illnesses are being treated properly not by handing them a mixed handful of antibiotics with a take three times advice.

Thailand has a good health service for the majority part of the population even though it does not suit those who want to make money through the Private Hospital system.

[Thai at Heart]

Some people seem to think that a heavy charge should be made to keep people from visiting the hospital for "minor" cases like colds, infections and stomach problems. What they fail to consider is that there is a strong attempt to steer people to doctor based care which is snow aviailable in the hospital rather than the local massage person or more lately non qualified pharmacist. People are starting to use the hospital for this and the illnesses are being treated properly not by handing them a mixed handful of antibiotics with a take three times advice.

Thailand has a good health service for the majority part of the population even though it does not suit those who want to make money through the Private Hospital system.

Well it doesn't make.much differencr if someone goes to the doctor for 30 baht, but they get prescribed 300 baht worth of unnecessary antibiotics or the such. In a way, they should cut the type of medication issued by pharmacists and insist on more scripts and more 30 baht visits.

Then the money would stay in the system instead of being pocketed by pharmacists.

[Thai at Heart]

Some people seem to think that a heavy charge should be made to keep people from visiting the hospital for "minor" cases like colds, infections and stomach problems. What they fail to consider is that there is a strong attempt to steer people to doctor based care which is snow aviailable in the hospital rather than the local massage person or more lately non qualified pharmacist. People are starting to use the hospital for this and the illnesses are being treated properly not by handing them a mixed handful of antibiotics with a take three times advice.

Thailand has a good health service for the majority part of the population even though it does not suit those who want to make money through the Private Hospital system.

Well it doesn't make.much differencr if someone goes to the doctor for 30 baht, but they get prescribed 300 baht worth of unnecessary antibiotics or the such. In a way, they should cut the type of medication issued by pharmacists and insist on more scripts and more 30 baht visits.

Then the money would stay in the system instead of being pocketed by pharmacists.

[harrry]

Some people seem to think that a heavy charge should be made to keep people from visiting the hospital for "minor" cases like colds, infections and stomach problems. What they fail to consider is that there is a strong attempt to steer people to doctor based care which is snow aviailable in the hospital rather than the local massage person or more lately non qualified pharmacist. People are starting to use the hospital for this and the illnesses are being treated properly not by handing them a mixed handful of antibiotics with a take three times advice.

Thailand has a good health service for the majority part of the population even though it does not suit those who want to make money through the Private Hospital system.

Well it doesn't make.much differencr if someone goes to the doctor for 30 baht, but they get prescribed 300 baht worth of unnecessary antibiotics or the such. In a way, they should cut the type of medication issued by pharmacists and insist on more scripts and more 30 baht visits.

Then the money would stay in the system instead of being pocketed by pharmacists.

Yes if they go to the hospital they get what they need and there is no profit incentive to giving extra medicines as they are provided in the 30 baht fee.

[Thai at Heart]

Some people seem to think that a heavy charge should be made to keep people from visiting the hospital for "minor" cases like colds, infections and stomach problems. What they fail to consider is that there is a strong attempt to steer people to doctor based care which is snow aviailable in the hospital rather than the local massage person or more lately non qualified pharmacist. People are starting to use the hospital for this and the illnesses are being treated properly not by handing them a mixed handful of antibiotics with a take three times advice.

Thailand has a good health service for the majority part of the population even though it does not suit those who want to make money through the Private Hospital system.

Well it doesn't make.much differencr if someone goes to the doctor for 30 baht, but they get prescribed 300 baht worth of unnecessary antibiotics or the such. In a way, they should cut the type of medication issued by pharmacists and insist on more scripts and more 30 baht visits.

Then the money would stay in the system instead of being pocketed by pharmacists.

Yes if they go to the hospital they get what they need and there is no profit incentive to giving extra medicines as they are provided in the 30 baht fee.

All the medication is rolled into the 30 baht also? I am no expert on the system, but that that seems incredibly unworkable.

[Balance]

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.

The Gold Health Care Plan offered to most civil servants could be extended to all Thais. I believe that the cost to the Government was on the order of 50,000 ThB per person, which is not expensive.

The revenue department has reported that there are millions of very well off Thais that do not pay taxes. The Junta needs to drop the hammer on this outrage. This is one of the main reasons Greece went bankrupt; the wealthy decided that they should not have to pay taxes.

Before "poor" people can be expected to take better care of their health, they need to know something about their health. There is no public health education in Thailand that produces results.

[aussieinthailand]

farang , even working legally / paying taxes, gets nothing free or 30 baht

i dont work but 15% of my intrest for savings goes to the governement

and that is much, much more than many thai people that contribute / pay 0%

Tax on interest can be claim back. All farang do that.

How exactly do I do that? fill in a form in the bank?

I've never done it as I usually keep money in a no tax account that pays higher interest rate but locked for X months.

[citizen33]

Health economics is a thing most people don't understand. They view it in terms of accounting costs (eg the 30 baht doesn't cover admin costs) and this blinds them to the wider issues.

But first things first. Medical care isn't a market. Even if it was a market, it isn't a competitive market.

On the demand side - unlike most other products we consume in life, we don't get a choice to 'choose' what illness we are going to get, for how long, what medicine you might need and how much it might cost.

On the supply side - unlike most things in life where if we don't like one shop or price, we go up the road, with medicine for the most part, you are stuck with doctors and they aren't too many of them, so if you 'let them loose' they'd charge whatever they want.

Universal health care is the way to go. Sure it is populist, but it is also common sense economically. In the US - where universal care doesn't exist, 19% of GDP (ie all national income) is spent on medical care. In the rest of the developed world where universal care exists in one form or another, that number is held to 8 or 9% of GDP....for the same level of outcome.

In otherwords, you get more medical care bang for your buck under a universal system.

None of this means that it is 'free' to run. It just means that it should be free or heavily subsidised at the point of delivery.

The question remains, which Thailand faces, how do you balance the equity vs efficency aspect.

A raised visit fee to see the doctor might be fine - it makes people think twice about pointless visits to the doctor and perhaps makes them concentrate on their health a bit more. But you don't want it so high that it becomes a disincentive for people to visit the doctor when they need to.

This is the debate Thailand needs to have. My personal view is that as much as possible it should be free at the point of deivery, with other budgetary and efficiency measures put into place in the delivery system. The case-mix system pioneered in Australia is a case in point.

Samran makes some good points here. I'm not sure though whether he is recommending changes in the financing system to improve incentives as a general point, or implicitly saying that this something Thailand fails to do and should consider. Actually there has been a lot of thought given to this already in terms of the capitation funding system, DRGs, some special funding arrangements for priority services, and some performance based (P4P) payments for prevention and promotion work. The so-called 'closed-end' (read prospectively-capped) funding through capitation and DRGs has attracted a lot of interest from other aspiring UHC countries, and Rockefeller and the Thai government presently fund a scheme called 'Cap-UC' to help build capacity in eligible countries. Thailand provides the secretariat for the ASEAN+3 UHC network, which aims to have all member countries move towards UHC in the coming years..

Just as a footnote for a couple of other posters, the 30 baht co-payment was never very significant in funding terms, though some believed it would help prevent capricious use. The main funding comes via the so-called capitation (per head per year paid whether the member is sick or not) allocation, which currently is set at 2755 baht per member. This is top-sliced at various levels, and the main hospital in-patient (IP) budget is separated out and paid according to an average cost per case (diagnosis related group) to hospitals. The rest goes down to the contracting units for primary care (CUPs) to fund the local provider networks (community hospitals and tambon health promotion hospitals - the new name for the health centres). So the technical funding discussions are usually about how this 2755 baht per member will be distributed and used rather than about the 30 baht co-payments, which are anyway not automatically collected by all hospitals.

The original plan in 2001/02 had been to merge the new UCS with the existing public schemes for formal workers (SSS) and civil servants (CSMBS), or at least to have a single purchasing body operating for all three (the NHSO). The latter is in the 2002 National Health Security Act, but, because members of the other schemes think they will lose out and some technical factors, it has not been possible to make much progress towards 'harmonisation' of the schemes.

It is hard to know why Aussie's relative had to pay for care. The obvious possibilities are ( a ) she was not referred to the charging hospital by the primary care network as is required to get free care ( b ) she fell foul of informal practice in some local hospitals which try to charge when they should not (call the 1330 hotline if this happens), or (c ) this was one of a small number of treatments where an extra payment is required - for example, patients wanting haemodialysis rather than peritoneal dialysis have to pay a supplemental charge. There are some excluded treatments, which you can find on the NHSO webpage,but nothing startling.

It is a real pity after so much progress in what in 2002 was still a lower-middle income country, then told by World Bank consultants that universal coverage was unaffordable, that the Thai UHC model is being cast into doubt by the conservative faction in the MoPH. However, there are still plenty of people in the Ministry and the NHSO who will fight to maintain the gains they have made. Many are on the yellow side, but I suspect they are now wondering where all this is going.

Edited July 27, 2014 by citizen33

[meatboy]

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.

I wonder what percentage goes on corruption,cut half of that out and then they might be able to double the 7%.

[trogers]

How much does the average 'poor' Thai spend on the 2-3 digits lottery in a year? If this money is being spent on premiums for a healthcare insurance policy, the country would be better off.

[ableguy]

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.

Remove The money stolen from the National budget and this health program would be funded by the scheme as was originally envisaged. Even if I was a populist policy by Thaksin .

..