Thai politics: Same standard of healthcare should be available to all

[webfact]

BURNING ISSUE
Same standard of healthcare should be available to all
Chularat Saengpassa

BANGKOK: -- Thailand currently has three major healthcare schemes, each of which differs significantly in terms of the benefits offered.

Hence, in a move to reduce gaps in the healthcare sector, the People's Health Systems Movement has been pushing hard for these schemes to be merged.

However, the issue now is not whether the merger will take place, but whether policy-makers will be able to ensure that all citizens enjoy the same medical welfare.

Thailand has the universal healthcare scheme, the health-benefit part of the social-security scheme, and the healthcare programme for civil servants and their family members.

The first programme covers about 48 million people, with per-head cost averaging Bt2,755.60. In 2011, the scheme spent Bt101.057 billion on its members.

The second programme covers 9.4 million subscribers, with per-head expenditure of Bt2,504, and it spent Bt24.476 billion in 2011.

The third scheme takes care of some 5 million civil servants and their families, with per-head expenditure at Bt14,123.01 per month. It spent Bt61.8 billion on its members in 2011.

According to Dueanden Nikhomborirak, director of economic system management at the Thailand Development Research Institute (TDRI), members of the social-security scheme seem to get the least medical benefits even though they make monthly contributions to the programme.

Many health activists and consumer-protection advocates have echoed this point.

In fact some activists have suggested that members of the social-security programme should stop making monthly contributions on grounds that the benefits are less than even what is offered by the completely free universal healthcare system.

The People's Health Systems Movement also pointed out that when social-security members need expensive treatments, they have to undergo complicated procedures. Such treatments are only granted for free on a case-by-case basis.

Hence, Dueanden said, members of the social-security scheme should not object to the merging of the funds, though she expects stiff opposition from civil servants, if they find their medical-benefit programme getting merged with those that offer fewer benefits.

"The medical-benefit scheme for civil servants has all along been regarded as civil servants' welfare - not health insurance - hence the merging of the schemes could be regarded as cutting civil servants' benefits," Dueanden said.

So she suggested that a "fadeout" method be used, in which changes are introduced gradually as existing members enjoy old benefits and newcomers are taught to accept new rules.

Policy-makers can also consult previously conducted studies showing that many countries have successfully merged their healthcare schemes, and not much resistance is seen in nations where the government steps in to shoulder the cost of the merger and waives health-insurance fees for its citizens.

The United Kingdom, for instance, has successfully merged several health funds and made the national healthcare system free for all citizens.

Actually, the government is not losing out as it uses income tax to fund the programme.

"If you have no income or are very poor, you don't pay. For instance, I [like other earners] pay, not to the Social Security Office, but to the government, and in return I get health insurance," Dueanden explained.

The TDRI report adds that the French government doesn't just rely on income tax to fund healthcare, but also gets funding from asset taxes.

However, in Thailand, influential groups like hospitals and doctors - who benefit from dispensing expensive medicines to civil servants - may oppose the merging of the health schemes.

South Korea was able to tackle just such a challenge successfully, though it took decades for it to merge all of its programmes.

According to the TDRI report, the Korean government agreed to give a 40-per-cent pay rise to doctors if they agreed to join the single healthcare scheme.

Though it is still unclear which direction the authorities will go, let's hope that Thailand is able to offer quality medical services for all Thais in the near future.

Since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all?

Source: http://www.nationmultimedia.com/national/Same-standard-of-healthcare-should-be-available-to-30249418.html


-- The Nation 2014-12-09

[David48]

Humm ... the 'People's Health Systems Movement' made this statement.

Lofty ideal, though seems a little naïve.

[alant]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

[tonbridgebrit]

Good article from the Nation newspaper. This is the type of stuff that Thailand needs the Nation to print. Yes, a newspaper that is calling for the same standards for EVERYBODY. Same standard of healthcare available to all. It might not happen, because Thais who have got money might start saying "I pay more into the system, why should I subsidise people who are poor".

And good to see that the Nation has thrown in politics into the situation. The Nation actually wrote "since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all ?"

If the junta was to actually carry this out, then yes, they will win the next general election. Let's all urge the junta to actually carry this out. Massive credit for the Nation for bringing this up.

[jaltsc]

"Thailand currently has three major healthcare schemes, each of which differs significantly in terms of the benefits offered."

Benefits mean squat if there aren't enough qualified doctors and other medical professionals to perform the necessary services. A few years ago I fractured a bone in my arm. I went to the local (rural) hospital. An x-ray was taken and I was told there was no fracture. I had to point out the break imaged on the x-ray to the doctor. She set my arm and the next day I had to return because the plaster softened and needed to have my arm reset. The same thing happened again. When I told the doctor that she needed to use more padding to absorb the moisture that was affecting the cast, she told me that I needed a special type of plaster because farang arms are different than Thai arms. I found another doctor and mentioned the extra padding. He understood, wrapped my arm with 3 times the amount padding I originally received and set the cast. I had no problems after that.

No matter how many benefits are offered, it will do no good as long as unqualified medical professionals are allowed to practice and believe saving face is more important than providing adequate care. Obviously, the Hippocratic oath is not part of the medical profession in Thailand.

Edited December 9, 2014 by jaltsc

[Robby nz]

There are actually other what may be called schemes, for the police have their own hospitals and the military have their own hospitals paid for out of their respective budgets.

I have no experience of police hospitals but from time to time over the last 8 years have been a patient at a military hospital.

Military hospitals around the country treat all comers and see millions of patients a year and must save the health budget billions.

Whether the police come under the definition of civil servants (some may suggest uncivil self servants) and are part of that scheme I don't know but I doubt the military do or are.

[chainarong]

There needs to be a way to avoid high cost like the US, keep away from that world, there should be some sort of incentive to buy private health , with the seniors and infirmed being offered free health, all the rest are on an income incentive that taxes you extra (If you pay tax) if you are earning ex amount and look for free health instead of private, the medical profession should be discouraged also for promoting any brands, ethical values dictate the patent first, not income and when you look at the structure of the Thai medical industry you have done remarkably well for a country that has been hamstrung in trying to emerge from a third world status for at least 2 decades.

[jpeg]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

Stupid post. Read the article again. It tells you the UK has free and universal healthcare, for one. I know, I'm English.

And 'slippery slope' to where, exactly. Oh my, you're not suggesting, gasp, communism

[jpeg]

Obviously, the Hippocratic oath is not part of the medical profession in Thailand.

I keep seeing this on here. Don't know if you're aware, but this is the East, they've never heard of nor subscribe to Western philosophy including, Hippocrates

[Bigfarang1948]

Won't make any difference to the hundreds of thousands of expats here, will it? I will just go on paying 4X what Thais pay for dr visits and meds and pray I do not have a serious health problem. Neither My US military retiree insurance nor my US Medicare insurance is good in Thailand and I surely cannot afford the $500 a month one international insurance bandit quoted me. No matter though because I still do not grasp the intricacies of Thai healthcare for eve my wife;s poor family, who seem to have to first see the local doctor and then get a written referral before they can go to the next larger hospital. The only service I know my wife and her family get for free is teeth extraction

Good article from the Nation newspaper. This is the type of stuff that Thailand needs the Nation to print. Yes, a newspaper that is calling for the same standards for EVERYBODY. Same standard of healthcare available to all. It might not happen, because Thais who have got money might start saying "I pay more into the system, why should I subsidise people who are poor".

And good to see that the Nation has thrown in politics into the situation. The Nation actually wrote "since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all ?"

If the junta was to actually carry this out, then yes, they will win the next general election. Let's all urge the junta to actually carry this out. Massive credit for the Nation for bringing this up.

[Rumble]

Does that go for the Ferang too?

[GarryP]

I assume that the tax payer is helping to foot the bill for all three schemes as I doubt the monthly charge for the social security scheme covers the actual running costs. It makes me wonder how in the hell the per head cost for civil servants is so bleedin' high. How much are civil servants paying in each month? Are they abusing the system such that the costs are disproportionate?

[MaxYakov]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

Stupid post. Read the article again. It tells you the UK has free and universal healthcare, for one. I know, I'm English.

And 'slippery slope' to where, exactly. Oh my, you're not suggesting, gasp, communism

OK, then. Let's start with this "free" word. Do the resources for the English healthcare system come from heaven in golden chariots?

[jaltsc]

Obviously, the Hippocratic oath is not part of the medical profession in Thailand.

I keep seeing this on here. Don't know if you're aware, but this is the East, they've never heard of nor subscribe to Western philosophy including, Hippocrates

However..."Do No Harm" is also a Buddhist concept. So East v. West does not apply with this concept. , no loophole here to justify being hypocritical on Hippocratical.

Edited December 9, 2014 by jaltsc

[MaxYakov]

Article: "Though it is still unclear which direction the authorities will go, let's hope that Thailand is able to offer quality medical services for all Thais in the near future."

Will hope raise Thailand's per capita GDP comes up from only 27% of world average? Will hope train skilled medical professionals? Will hope bring more farang welfare contributors to pay for the desired level of quality?

[David48]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

Stupid post. Read the article again. It tells you the UK has free and universal healthcare, for one. I know, I'm English.

And 'slippery slope' to where, exactly. Oh my, you're not suggesting, gasp, communism

Maybe the USA system of HealthCare as opposed to the UK's System of HealthCare?

I've experienced both ... plus the Australian system which seems to be a blend of both of them.

[assayer]

Won't make any difference to the hundreds of thousands of expats here, will it? I will just go on paying 4X what Thais pay for dr visits and meds and pray I do not have a serious health problem. Neither My US military retiree insurance nor my US Medicare insurance is good in Thailand and I surely cannot afford the $500 a month one international insurance bandit quoted me. No matter though because I still do not grasp the intricacies of Thai healthcare for eve my wife;s poor family, who seem to have to first see the local doctor and then get a written referral before they can go to the next larger hospital. The only service I know my wife and her family get for free is teeth extraction

Good article from the Nation newspaper. This is the type of stuff that Thailand needs the Nation to print. Yes, a newspaper that is calling for the same standards for EVERYBODY. Same standard of healthcare available to all. It might not happen, because Thais who have got money might start saying "I pay more into the system, why should I subsidise people who are poor".

And good to see that the Nation has thrown in politics into the situation. The Nation actually wrote "since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all ?"

If the junta was to actually carry this out, then yes, they will win the next general election. Let's all urge the junta to actually carry this out. Massive credit for the Nation for bringing this up.

Actually Bigfarang, Tricare will reimburse here if you do the proper paperwork beforehand.

[jpeg]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

Stupid post. Read the article again. It tells you the UK has free and universal healthcare, for one. I know, I'm English.

And 'slippery slope' to where, exactly. Oh my, you're not suggesting, gasp, communism

OK, then. Let's start with this "free" word. Do the resources for the English healthcare system come from heaven in golden chariots?

Ah ha! An attempt (poor one) at sarcasm. Read it again and again and again. The National Health Service (with me so far?) is free for anyone (even you) at point of entry. We are not discussing how it is funded, certainly not by the likes of foreigners like you tripping up to take advantage of that which the indigenous race, the British, have already paid. Gottit?

[jpeg]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

Stupid post. Read the article again. It tells you the UK has free and universal healthcare, for one. I know, I'm English.

And 'slippery slope' to where, exactly. Oh my, you're not suggesting, gasp, communism

Maybe the USA system of HealthCare as opposed to the UK's System of HealthCare?

I've experienced both ... plus the Australian system which seems to be a blend of both of them.

Being British, I am not aware of how the USA funds/provides it's health care system other than reports of people having to choose between whether to eat that day or have their ailment treated and the elderly being dumped on the streets, whereas in the more civilised UK, this is not the case.

[umbanda]

Does that go for the Ferang too?

Are you dreaming or allucinating? Government Healthcare for foreigners? In any country I know......

Comparing with most 3rd world countries Thai Government healthcare is very good......Gettig better coverage paying just 2400THB/year for social security makes it even more convenient to Thais because includes retirement at 60 years old, paying minimum salary for life after that age, and that apply even for foreigners under 60 working legally in the country.

That's better than many developed countries like the US, before Obamacare, when poor people was getting free healthcare help only by filantropic organizations, before qualifying for Medicare at 62.

I praise the new Thai Government in having these new social programs in mind...that never was proposed under "democratic rule"..

[marcusd]

There needs to be a way to avoid high cost like the US, keep away from that world, there should be some sort of incentive to buy private health , with the seniors and infirmed being offered free health, all the rest are on an income incentive that taxes you extra (If you pay tax) if you are earning ex amount and look for free health instead of private, the medical profession should be discouraged also for promoting any brands, ethical values dictate the patent first, not income and when you look at the structure of the Thai medical industry you have done remarkably well for a country that has been hamstrung in trying to emerge from a third world status for at least 2 decades.

The way to avoid the US style is to avoid PRIVATE HEALTH funds who want PROFITS before care as they do in the USA.

Ask Bill Clinton who wanted to WIPE the mongrelks out and follow the Australian System where EVERYONE gets GREAT FREE CARE.

Now our stupid government wnats to follow the slippery slope of the US system and make all pay to private health and up our taxes to support PRIVATE HEALTH FUNDS profits.

Thailand needs to avoid this

[Balance]

Good article from the Nation newspaper. This is the type of stuff that Thailand needs the Nation to print. Yes, a newspaper that is calling for the same standards for EVERYBODY. Same standard of healthcare available to all. It might not happen, because Thais who have got money might start saying "I pay more into the system, why should I subsidise people who are poor".

And good to see that the Nation has thrown in politics into the situation. The Nation actually wrote "since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all ?"

If the junta was to actually carry this out, then yes, they will win the next general election. Let's all urge the junta to actually carry this out. Massive credit for the Nation for bringing this up.

Yes, great but the article did not address the absurdity in the numbers that were quoted. The first two plans quote annual per person costs that are so low as to question their credibility. But the civil servant numbers are quoted as monthly costs and if you multiply by 12 you get TB 169,0476 per person per year. Compare this to the annual per person costs a little over TB 2,500 for the other two schemes.

So, (1)something is wrong with the numbers; (2) Very few people in the first two plans get sick or do not go to the doctor, or (3) Civil Servants are chronically ill or the government is getting ripped off along to way.

Nowhere does it provide any information about what the benefits are for each of the plans.

Talking about what other countries have done does not have any relevance to Thailand when it comes to healthcare financing as health status of the people is different, knowledge of the people is different, and the quality of care is different. It has to be a Thai solution beginning with what is wanted as an outcome and then figuring out how to finance it.

[MaxYakov]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

Stupid post. Read the article again. It tells you the UK has free and universal healthcare, for one. I know, I'm English.

And 'slippery slope' to where, exactly. Oh my, you're not suggesting, gasp, communism

OK, then. Let's start with this "free" word. Do the resources for the English healthcare system come from heaven in golden chariots?

Ah ha! An attempt (poor one) at sarcasm. Read it again and again and again. The National Health Service (with me so far?) is free for anyone (even you) at point of entry. We are not discussing how it is funded, certainly not by the likes of foreigners like you tripping up to take advantage of that which the indigenous race, the British, have already paid. Gottit?

No. An attempt to drive to more descriptive terminology. It's publicly funded out of general tax revenues. I do personally disdain the word "free", however. It may seem like a fine point, but I prefer something like "no [immediate/out of pocket/direct] cost to the user" or even the dubious "free of charge".

How do you know I'm a foreigner? Where did you come up with "indigenous race, the British"? In any event, I wonder how all the post-1707 immigrants to England (that would be non-British races, I suppose) would take your implying that they are not paying in to NHS. Hey, maybe they're not paying!

Gratuitous BBC Article on the "British Race"

I don't have any plans to "trip up" to take advantage of services for which other people have paid.

Apparently, some NHS Services are not "free" to foreigners now and will they will Face More Charges in the future - BBC Article

Other than that, I guess I "Gottit" (waaaay off-topic).

Edited December 9, 2014 by MaxYakov

[GinBoy2]

Won't make any difference to the hundreds of thousands of expats here, will it? I will just go on paying 4X what Thais pay for dr visits and meds and pray I do not have a serious health problem. Neither My US military retiree insurance nor my US Medicare insurance is good in Thailand and I surely cannot afford the $500 a month one international insurance bandit quoted me. No matter though because I still do not grasp the intricacies of Thai healthcare for eve my wife;s poor family, who seem to have to first see the local doctor and then get a written referral before they can go to the next larger hospital. The only service I know my wife and her family get for free is teeth extraction

Good article from the Nation newspaper. This is the type of stuff that Thailand needs the Nation to print. Yes, a newspaper that is calling for the same standards for EVERYBODY. Same standard of healthcare available to all. It might not happen, because Thais who have got money might start saying "I pay more into the system, why should I subsidise people who are poor".

And good to see that the Nation has thrown in politics into the situation. The Nation actually wrote "since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all ?"

If the junta was to actually carry this out, then yes, they will win the next general election. Let's all urge the junta to actually carry this out. Massive credit for the Nation for bringing this up.

I'm just curious who quoted you $500/month for health insurance. I'm American and the health insurance I subscribe to here is a fraction of what I would pay for similar private coverage back home. Now if you're comparing it to a Veterans or Federal policy in the US (biggest socialized medical plans on the planet) well maybe not

[h90]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

free is always a big problem.

Make it a minimum of 500 Baht for small cases and 2000 Baht for big cases.

So you get rid of the retired bored people who go every day to the doctor, but someone who got a big accident or cancer has a chance to get a good treatment.

[Soutpeel]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

free is always a big problem.

Make it a minimum of 500 Baht for small cases and 2000 Baht for big cases.

So you get rid of the retired bored people who go every day to the doctor, but someone who got a big accident or cancer has a chance to get a good treatment.

And what exactly does THB 2k buy you in say the case of a heart attack and you end up in ICU ? "Free" or nominal cost medical care is a recipe for disaster, no problem on the concept of subsided medical treatment but the costs charged should be means tested, eg a foreigner in Thailand with 800k or a 65k p/m pension should be charged far more than uncle Somchai making 10k/m

In the case of foreigner's living long term in Thailand for what ever purpose mandatory medical insurance should be required as part of the visa or extension renewal

Edited December 9, 2014 by Soutpeel

[h90]

free, universal, the slippery slope.

Very difficult, I think impossible to achieve. As other countries have proved.

free is always a big problem.

Make it a minimum of 500 Baht for small cases and 2000 Baht for big cases.

So you get rid of the retired bored people who go every day to the doctor, but someone who got a big accident or cancer has a chance to get a good treatment.

And what exactly does THB 2k buy you in say the case of a heart attack and you end up in ICU ? "Free" or nominal cost medical care is a recipe for disaster, no problem on the concept of subsided medical treatment but the costs charged should be means tested, eg a foreigner in Thailand with 800k or a 65k p/m pension should be charged far more than uncle Somchai making 10k/m

In the case of foreigner's living long term in Thailand for what ever purpose mandatory medical insurance should be required as part of the visa or extension renewal

That fees are not meant to buy anything, that is just a fee you have to pay, no matter if it is a broken arm or heart attack. I know from my country where the lonely middle age women go twice a week to the doctor because they are bored and it is free. Just to prevent that. And exclude dentist, glasses hearing adds.

I agree with your idea on making it depending on the salary. Just I don't have an idea how to make it practical without much bureaucracy. The insurance is already depending on the salary.

Visa: Of course, Business Visa, charge the double insurance fee than for Thai people. Other long term Visa: Let the Visa cost 5000 Baht per month, which includes insurance for emergency treatment (accidents, OK also the heart attack but no cancer or replacement knee which you have to pay yourself or go home).

My idea is to tailor it that way, that unfortunate people get help, but these who have plenty of money not with as little of possible abuse as possible. And with little bureaucracy.

Maybe to add: Make it free to study medicine or learn nurse. That also helps to keep the costs down.

[ABCer]

"Same standard of healthcare should be available to all."

Not only Thailand would be the Hub,

It would be the First in the World,

And the only one!

Edited December 9, 2014 by ABCer

[tonbridgebrit]

Good article from the Nation newspaper. This is the type of stuff that Thailand needs the Nation to print. Yes, a newspaper that is calling for the same standards for EVERYBODY. Same standard of healthcare available to all. It might not happen, because Thais who have got money might start saying "I pay more into the system, why should I subsidise people who are poor".

And good to see that the Nation has thrown in politics into the situation. The Nation actually wrote "since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all ?"

If the junta was to actually carry this out, then yes, they will win the next general election. Let's all urge the junta to actually carry this out. Massive credit for the Nation for bringing this up.

Yes, great but the article did not address the absurdity in the numbers that were quoted. The first two plans quote annual per person costs that are so low as to question their credibility. But the civil servant numbers are quoted as monthly costs and if you multiply by 12 you get TB 169,0476 per person per year. Compare this to the annual per person costs a little over TB 2,500 for the other two schemes.

So, (1)something is wrong with the numbers; (2) Very few people in the first two plans get sick or do not go to the doctor, or (3) Civil Servants are chronically ill or the government is getting ripped off along to way.

Nowhere does it provide any information about what the benefits are for each of the plans.

Talking about what other countries have done does not have any relevance to Thailand when it comes to healthcare financing as health status of the people is different, knowledge of the people is different, and the quality of care is different. It has to be a Thai solution beginning with what is wanted as an outcome and then figuring out how to finance it.

I'm trying to say that this is a great article because, the Nation is trying to get 'the same standard of health-care for everybody'. This is basically trying to say, that Thais who are poor and rich should both have the same decent health service.

Yes, it will be a system where everybody pays into it, unless they're very poor or maybe retired. And off-course, people on higher incomes will pay more. It will cost billions, and Thais who drive around in a three million baht car will certainly pay more than a Thai who earns ten or twelve thousand baht per month.

I don't think it's wrong to have decent health-care for everybody, and higher income people will pay more than others. However, I accept there's some rich people in any society who will say 'why should I subsidise health-care for people who are poorer than myself ?'. These people, hopefully, are a minority group.

As for there not being enough trained doctors and nurses to provide a decent service for everybody. Well, how about raise taxes, go and train a vast number of new staff, (hey, maybe draft in a stack of doctors and nurses from the Phillipines and other ASEAN countries if they work for lower wages, bear in mind ASEAN 2015 and all that talk). And who is going to pay for all this ? Easy, target the Thais who drive around in three million baht cars. These people are a minority, what percentage of the voters do they make up ? Is the junta (or anybody) going to lose the general election because it upsets such a small minority ? Off-course NOT.

Yes, the Nation newspaper, a newspaper for the nation of Thailand ! Up the NATION NEWSPAPER !

[manarak]

best possible healthcare for everybody makes no sense at all.

decent minimum level of healthcare for all, yes.