Co-payment for Thai medical service looms amid cost crisis

[webfact]

Co-payment for medical service looms amid cost crisis
POUNGCHOMPOO PRASERT
THE NATION

BANGKOK: -- A CO-PAYMENT system looks set to be introduced under a healthcare reform, which would require people to shoulder some of their medical expenses.

This became clear yesterday at a seminar on health-system reform, held through the National Legislative Assembly (NLA) committee on public health and the National Reform Council (NRC) committee health system reform.

"If the government cannot provide an adequate health budget, co-payment is definitely needed," Dr Jate Sirataranon said in his capacity as the chair of the NLA committee.

He believed that a co-payment system would ensure that people get access to proper and quality medical services.

Assoc Prof Dr Pornpan Boonyarat-tanapan, who heads the NRC committee, revealed that her committee was studying various forms of co-payment. "We are looking into whether it should be direct or indirect co-payment," she said.

The co-payment system is just one of the issues coming up as the Prayut government looks at ways to improve the healthcare sector.

There are three main healthcare schemes in the country: one for civil servants and their family; another is for people joining the social security scheme, and the third is the universal healthcare scheme.

The last scheme is the biggest, covering about 48 million Thais and offering free services for most types of treatments.

The universal healthcare scheme, however, has caused a massive workload and budget constraint on state hospitals to the point that the Public Health Ministry has clashed seriously with the National Health Security Office (NHSO) over how the scheme is run.

The NHSO has run the scheme mainly through services of state hospitals, paying them via per-head subsidy of just Bt2,895.90 per year.

Jate said it might be necessary to separate the budget for medical workers' salary from the per-head subsidy to ease budget constraints.

Meanwhile, an informed source said the Cabinet would be asked to approve a rise in the per-head subsidy.

"In 2016 year, the per-head subsidy will rise to Bt3,160.94 if the Cabinet gives the green light," the source said.

Source: http://www.nationmultimedia.com/national/Co-payment-for-medical-service-looms-amid-cost-cri-30253814.html


-- The Nation 2015-02-11

[NeverSure]

Why don't they just get consultants from the UK's NHS to tell them how to properly run a socialist health care system?

[zaphod reborn]

Finally, an admission that another of Thaksin's so-called populist successes was ultimately unsustainable.

[siampolee]

NeverSure post # 2

Why don't they just get consultants from the UK's N.H.S. to tell them how to properly run a socialist health care system?

Perhaps if you were resident in the U.K or even up to date with the N.H.S. system in the U.K you would be well aware that all is not well.

It was a fine system and is still to a lesser degree,however it has suffered years of abuse and now the politicians and business mafia are chipping away at the N.H.S. structure for their own ends.

Now what about your own country asking the experts in the U.K for advice as how to run a ''socialist'' i.e. caring health system paid for by salary deduction and taxes as opposed to letting patients enter bankruptcy in order to survive. Or of course legalised state sponsored euthanasia by letting them die by not providing treatment due to patients lack of funds.,

[craigt3365]

A small charge of even 100B would keep many from going to the hospital every time they have a minor cough.

[smedly]

Finally, an admission that another of Thaksin's so-called populist successes was ultimately unsustainable.

not when you throw 700billion baht down the swampy

Although it is a perception that the UK NHS is free - it is not free, everyone contributes whether sick or not

[tbthailand]

A small charge of even 100B would keep many from going to the hospital every time they have a minor cough.

That used to be 30B, is 100B just inflation?

[tbthailand]

this will go over like a lead dirigible.

sell the blimp, cut the military budget, invest in hospitals and staff in the countryside and get on with the job of taking care of the Thai people - literally.

[colinneil]

Its crazy people pay 30 baht get thousants worth of hospital treatment.

It cannot be compared to NHS in UK.

People pay towards NHS with national insurance payments.

When i was in hospital in Khonkaen a Thai man had treatment cost 40.000 baht. Staff asked his wife for small donation to help hospital she refused.

When i left hospital my wife was asked the same, she donated 20.000 baht.

Most of my costs approx 90% were covered with my wifes health insurance (government official)

Remember i was in hospital for 7 months so cost of my treatment was a rather large amount.

[madmitch]

NeverSure post # 2

Why don't they just get consultants from the UK's N.H.S. to tell them how to properly run a socialist health care system?

Perhaps if you were resident in the U.K or even up to date with the N.H.S. system in the U.K you would be well aware that all is not well.

It was a fine system and is still to a lesser degree,however it has suffered years of abuse and now the politicians and business mafia are chipping away at the N.H.S. structure for their own ends.

Now what about your own country asking the experts in the U.K for advice as how to run a ''socialist'' i.e. caring health system paid for by salary deduction and taxes as opposed to letting patients enter bankruptcy in order to survive. Or of course legalised state sponsored euthanasia by letting them die by not providing treatment due to patients lack of funds.,

I think the smiley indicates irony!

[smedly]

NeverSure post # 2

Why don't they just get consultants from the UK's N.H.S. to tell them how to properly run a socialist health care system?

Perhaps if you were resident in the U.K or even up to date with the N.H.S. system in the U.K you would be well aware that all is not well.

It was a fine system and is still to a lesser degree,however it has suffered years of abuse and now the politicians and business mafia are chipping away at the N.H.S. structure for their own ends.

Now what about your own country asking the experts in the U.K for advice as how to run a ''socialist'' i.e. caring health system paid for by salary deduction and taxes as opposed to letting patients enter bankruptcy in order to survive. Or of course legalised state sponsored euthanasia by letting them die by not providing treatment due to patients lack of funds.,

absolutely 100% correct

They hire nurses from "private" agencies - the nurses get about 20% of what the agency is actually paid from the government, I don't know what the rate is now but it was about 4x the actual rate paid to NHS nurses at the time, the owners of these agencies should have been investigated to see how they were linked to politicians or Hospital/NHS administration

[Toknarok]

If they cut the Defense Budget by getting rid of 90% of the generals, stopped buying expensive aeroplanes and submarines etc.maybe they could afford it. They might get away with a small co-payment but anything substantial will cause massive resentment amongst the poor. Like it or not Thaksin's popularist policy of affordable health care was one of the main things that got the reds into power and helped them remain there.

Edited February 11, 2015 by Toknarok

[seajae]

taxes should pay for it bit how many actually pay taxes, A lot of those getting the treatment pay no tax and never have so of course it is not working and these same people will jump up and down if they are expected to put in anything towards their own health. This scheme can only work when there is money/taxes going to it from the people it helps, when there is nothing from those people it starts to fall in on itself and general taxes can no longer help it. Thaksins idea worked for a short time while the money was there but it never allowed for long term and now that i starting to show, they do need a service for the poor but it does need to be sustainable. They cannot expect just one part of the thai community to pay all the taxes that support the country, there simply isnt enough of them and they are out numbered by those that dont pay taxes but want all the same services. This is going to be a very drawn out problem till it is solved and will cause many conflicts of interest

[robblok]

Small payments might be a good idea.. but nothing major.

Problem is that in Thailand there is such a taxpayer base its hard to finance stuff like this.

[Strangebrew]

Do like your doing now charge farang double to help pay for lazy Thai's.

[robblok]

If they cut the Defense Budget by getting rid of 90% of the generals, stopped buying expensive aeroplanes and submarines etc.maybe they could afford it. They might get away with a small co-payment but anything substantial will cause massive resentment amongst the poor. Like it or not Thaksin's popularist policy of affordable health care was one of the main things that got the reds into power and helped them remain there.

Maybe.. I would not want to be without a powerful army in this neck of the woods. Too many conflicts looming. But scaling down a bit is never a bad thing.

[Toknarok]

taxes should pay for it bit how many actually pay taxes, A lot of those getting the treatment pay no tax and never have so of course it is not working and these same people will jump up and down if they are expected to put in anything towards their own health. This scheme can only work when there is money/taxes going to it from the people it helps, when there is nothing from those people it starts to fall in on itself and general taxes can no longer help it. Thaksins idea worked for a short time while the money was there but it never allowed for long term and now that i starting to show, they do need a service for the poor but it does need to be sustainable. They cannot expect just one part of the thai community to pay all the taxes that support the country, there simply isnt enough of them and they are out numbered by those that dont pay taxes but want all the same services. This is going to be a very drawn out problem till it is solved and will cause many conflicts of interest

Everybody pays tax Seajae. Every time you buy a bag of fertilizer for your frangipanis you pay 7% tax. It's called VAT.

[seajae]

taxes should pay for it bit how many actually pay taxes, A lot of those getting the treatment pay no tax and never have so of course it is not working and these same people will jump up and down if they are expected to put in anything towards their own health. This scheme can only work when there is money/taxes going to it from the people it helps, when there is nothing from those people it starts to fall in on itself and general taxes can no longer help it. Thaksins idea worked for a short time while the money was there but it never allowed for long term and now that i starting to show, they do need a service for the poor but it does need to be sustainable. They cannot expect just one part of the thai community to pay all the taxes that support the country, there simply isnt enough of them and they are out numbered by those that dont pay taxes but want all the same services. This is going to be a very drawn out problem till it is solved and will cause many conflicts of interest

Everybody pays tax Seajae. Every time you buy a bag of fertilizer for your frangipanis you pay 7% tax. It's called VAT.

thats true but not on earnings, how many actually pay tax on what they earn, only those that work for a business/company/govt that takes it automatically, all the others simply pocket the lot.

[robblok]

taxes should pay for it bit how many actually pay taxes, A lot of those getting the treatment pay no tax and never have so of course it is not working and these same people will jump up and down if they are expected to put in anything towards their own health. This scheme can only work when there is money/taxes going to it from the people it helps, when there is nothing from those people it starts to fall in on itself and general taxes can no longer help it. Thaksins idea worked for a short time while the money was there but it never allowed for long term and now that i starting to show, they do need a service for the poor but it does need to be sustainable. They cannot expect just one part of the thai community to pay all the taxes that support the country, there simply isnt enough of them and they are out numbered by those that dont pay taxes but want all the same services. This is going to be a very drawn out problem till it is solved and will cause many conflicts of interest

Everybody pays tax Seajae. Every time you buy a bag of fertilizer for your frangipanis you pay 7% tax. It's called VAT.

Not exactly true many smaller businesses are free of VAT so there is no VAT paid on many items. Problem is that the taxbase in Thailand is small and with limited money you can do limited things.

[Freed1948]

They could get advice from Abbot and Hockey in OZ, in how to implement it!!!.

[Farang99]

Why don't they just get consultants from the UK's NHS to tell them how to properly run a socialist health care system?

Surely you jest! The UK NHS is a fine example of how to lose vast amounts of money while providing a largely inadequate and inefficient service.

[Toknarok]

I've no doubt that vast amounts of money are not being paid in taxes in this Country by tax evaders and avoiders just as there are in most Countries. The average Thai earning 300 baht a day (if he's lucky, or lucky enough to have a job) has no access to tax havens or trust funds like the rich. I dont know what the threshold is before you start paying tax (in Australia it's $18,500) in Thailand but I would think that a majority of Thais would fall under it. By all means go after the rich who are evading taxes but don't penalise the poor when it comes to their health.

Tony Abbot has just tried that in Oz with his Medicare co-payment, and look where that got him. His days are numbered. However with a junta in control in this Country I suppose they can do what they want. They really don't care about the poor, only themselves and keeping control.

Edited February 11, 2015 by Toknarok

[Godders]

In a country with millions of people in virtual wage slavery and struggling to survive, a health service free at the point of delivery should be a top priority. There is plenty of money in Thailand. It just isn't distributed as fairly as it should be. Time for the wealthy to honour their Buddhist principals and make a fairer tax contribution to help the poor members of society.

[billd766]

A small charge of even 100B would keep many from going to the hospital every time they have a minor cough.

My mother in law and my father in law are state pensioners in Thailand are receive from the generous Thai government (whichever one is in power) the magnificent sum of 600 baht per month, each mind you. This is for ALL their living costs and gives them about 20 baht per day to live on.

My FIL also has a small works pension, has a small business and lives in Bangkok but looks after his youngest son who is a casualty of too much sniffing, sticking and eating yaa baa.

My MIL lives out in rural Thailand with us in a small 1 bedroom house about 20 metres from our house and my wife looks after her.

So to quote craigt3365 "A small charge of even 100B would keep many from going to the hospital every time they have a minor cough." Most poor poeple out here DON'T go to the hospital for a minor cough or cold, they go to the local doctor or pharmacy and buy the medicine there.

Of course you could always go hungry for 5 days and pay 100 baht at the hospital.

Craig have you EVER been to a rural hospital in Thailand? The nearest one to me and my MIL is 15km away. The doctors come on duty around 8 am after doing the ward rounds and if you want an early appointment you need to be at the hospital before 6 am. Try it yourself sometime though I can assure you that it won't be fun and there is NO airconditioning, no luxuries, no frills, just an overworked and underpaid but very good staff.

The idea behind it was actually a democrat one though Thaksin did bring it to fruition and I congratulate him for that. He also didn't bother to provide extra funds and charged 30 per visit which cost more to collect and administrate then the 30 baht fee. In 2010 when the Democrats came to power the scrapped the 30 baht fee but under the caring, sharing for the people PTP they put the 30 baht fee back again.

[billd766]

If they cut the Defense Budget by getting rid of 90% of the generals, stopped buying expensive aeroplanes and submarines etc.maybe they could afford it. They might get away with a small co-payment but anything substantial will cause massive resentment amongst the poor. Like it or not Thaksin's popularist policy of affordable health care was one of the main things that got the reds into power and helped them remain there.

If they stopped the corruption the whole country would be 30% or more better off and could afford a decent heath budget.

[Suradit69]

Why don't they just get consultants from the UK's NHS to tell them how to properly run a socialist health care system?

As you say, "properly run." That emoticon has it's tongue firmly planted in cheek, right?

There are grave doubts over the NHS’ capacity to cope with ever-growing demand this winter after emergency departments recorded their worst week in a decade, and more than a dozen hospitals were forced to implement “major incident” emergency plans.

Despite mild weather and without a serious outbreak of seasonal illness, this week at least 15 hospitals in England have had to cancel operations, call in extra staff or limit A&E services to only severely ill or injured patients.*

Latest NHS England figures showed that 92.6 per cent of patients were seen in four hours at England’s A&Es and minor injury units from October to December 2014 – below the 95 per cent target and the worst performance in a decade.

But hey it's free and worth every penny of it.

Edited February 11, 2015 by Suradit69

[Time Traveller]

Finally, an admission that another of Thaksin's so-called populist successes was ultimately unsustainable.

Thaksin's idea was introduced over a decade ago - at a time when incomes were much lower. He himself has not be leader since 2006 and there never was any suggestion that it should stay like that forever.

Regardless, the real issue is if the state wants healthy tax paying workers, then they should at least susidize some of the health costs.

Edited February 11, 2015 by Time Traveller

[craigt3365]

A small charge of even 100B would keep many from going to the hospital every time they have a minor cough.

My mother in law and my father in law are state pensioners in Thailand are receive from the generous Thai government (whichever one is in power) the magnificent sum of 600 baht per month, each mind you. This is for ALL their living costs and gives them about 20 baht per day to live on.

My FIL also has a small works pension, has a small business and lives in Bangkok but looks after his youngest son who is a casualty of too much sniffing, sticking and eating yaa baa.

My MIL lives out in rural Thailand with us in a small 1 bedroom house about 20 metres from our house and my wife looks after her.

So to quote craigt3365 "A small charge of even 100B would keep many from going to the hospital every time they have a minor cough." Most poor poeple out here DON'T go to the hospital for a minor cough or cold, they go to the local doctor or pharmacy and buy the medicine there.

Of course you could always go hungry for 5 days and pay 100 baht at the hospital.

Craig have you EVER been to a rural hospital in Thailand? The nearest one to me and my MIL is 15km away. The doctors come on duty around 8 am after doing the ward rounds and if you want an early appointment you need to be at the hospital before 6 am. Try it yourself sometime though I can assure you that it won't be fun and there is NO airconditioning, no luxuries, no frills, just an overworked and underpaid but very good staff.

The idea behind it was actually a democrat one though Thaksin did bring it to fruition and I congratulate him for that. He also didn't bother to provide extra funds and charged 30 per visit which cost more to collect and administrate then the 30 baht fee. In 2010 when the Democrats came to power the scrapped the 30 baht fee but under the caring, sharing for the people PTP they put the 30 baht fee back again.

My wife's mother, who lives in a very small, poor village, goes to the doctor for every small thing. Even for a minor cough or sore throat. It's so cheap, or free, she just goes. Without hesitation. But for something critical, she goes to a private hospital because many times, the doctor never shows up and you end up leaving the village at 5am, waiting till noon, only to find this out. Very poor service.

And yes, I've been to many rural hospitals. Both as a patient and as a visitor. I know the issues with them fairly well, having lived here for almost 12 years. And as you pointed out, it's a failed scheme in some places. In others, it seems to be OK. But it's definitely not a nationwide success.

As mentioned in another post, few pay taxes here. Which makes services like this hard to support.

http://www.thaivisa.com/forum/topic/578851-bt30-healthcare-scheme-is-back-but-not-everybody-is-happy-thailand/

[billd766]

A small charge of even 100B would keep many from going to the hospital every time they have a minor cough.

My mother in law and my father in law are state pensioners in Thailand are receive from the generous Thai government (whichever one is in power) the magnificent sum of 600 baht per month, each mind you. This is for ALL their living costs and gives them about 20 baht per day to live on.

My FIL also has a small works pension, has a small business and lives in Bangkok but looks after his youngest son who is a casualty of too much sniffing, sticking and eating yaa baa.

My MIL lives out in rural Thailand with us in a small 1 bedroom house about 20 metres from our house and my wife looks after her.

So to quote craigt3365 "A small charge of even 100B would keep many from going to the hospital every time they have a minor cough." Most poor poeple out here DON'T go to the hospital for a minor cough or cold, they go to the local doctor or pharmacy and buy the medicine there.

Of course you could always go hungry for 5 days and pay 100 baht at the hospital.

Craig have you EVER been to a rural hospital in Thailand? The nearest one to me and my MIL is 15km away. The doctors come on duty around 8 am after doing the ward rounds and if you want an early appointment you need to be at the hospital before 6 am. Try it yourself sometime though I can assure you that it won't be fun and there is NO airconditioning, no luxuries, no frills, just an overworked and underpaid but very good staff.

The idea behind it was actually a democrat one though Thaksin did bring it to fruition and I congratulate him for that. He also didn't bother to provide extra funds and charged 30 per visit which cost more to collect and administrate then the 30 baht fee. In 2010 when the Democrats came to power the scrapped the 30 baht fee but under the caring, sharing for the people PTP they put the 30 baht fee back again.

My wife's mother, who lives in a very small, poor village, goes to the doctor for every small thing. Even for a minor cough or sore throat. It's so cheap, or free, she just goes. Without hesitation. But for something critical, she goes to a private hospital because many times, the doctor never shows up and you end up leaving the village at 5am, waiting till noon, only to find this out. Very poor service.

And yes, I've been to many rural hospitals. Both as a patient and as a visitor. I know the issues with them fairly well, having lived here for almost 12 years. And as you pointed out, it's a failed scheme in some places. In others, it seems to be OK. But it's definitely not a nationwide success.

As mentioned in another post, few pay taxes here. Which makes services like this hard to support.

http://www.thaivisa.com/forum/topic/578851-bt30-healthcare-scheme-is-back-but-not-everybody-is-happy-thailand/

My apologies for asking you about rural hospitals.

Fortunately none of my family or neighbours goes to the hospital for anything trivial which helps.

My MIL has type 2 (I think) diabetes and I take her up once a month at about 6 am and my wife collects her later but if she doesn't get there until after 7 am she won't get seen until the afternoon. She has been taken in several times and the last time they stuck her in an ambulance and took her to the regional hospital as she may have had a small stroke but though my wife's English in general her medical and engineering English is very poor.

She can't even build a rocketship would you believe. She is a good cook though which is more valuable to me.

Last year I went for an ingrowing toenail problem that my local doctor wouldn't do anything about. The hospital doctor who spoke good English and has a good sense of humour convinced me that it should be removed. )The ingrowing toenail problem dated back to 1993 and a doctor in the UK). At the hospital i was injected and the toenail removed all for about 550 baht which I happily paid. After that I went to the local clinic for daily dressings for a while which was free and back to the hospital doctor 3 times for a check and now apart from looking ugly I have no problems with my toe. The visit to the hospital doctor cost me 70 baht a time rather than 30 baht but it is worth it.

[maidee]

and why would they not ?

healthcare in 1st world countries, you get because most people pay taxes

here it is a minority that pays nothing and gets everything for free

when i go to a private hospital in the middle price range, i get to pay high bills, while thais sign off a paper & pay nothing

did i mention i pay more in tax than average yo smo thai

15% tax on every single baht of savings and that amounts to a nice yearly salary of a middleclass thai