Co-payment for Thai medical service looms amid cost crisis

[rubl]

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/

'even' here in Bangkok those who only depend on the 30-Baht Medical Scheme are poorly off. Long waiting times, limited attention. In some state hospitals both doctors and nurses are so overworked as to be reduced to 'talk a tablet and come back in some days if it doesn't help'.

The scheme was never really properly financed and with an aging population, choices need to be made. Broaden the tax base is one. To introduce an "own risk" portion of the costs as done in other countries would be untenable in Thailand as some don't have the finances for that.

[Balance]

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

Yes, health care economics and construction of a sustainable, partially self funding (means tested) insurance system is complicated stuff. The biggest problem is that Thais do not buy insurance much, health or anything else. They pay cash, and so they do not go to the doctor. According to my Thai wife, people do not want to pay the B30 even. So, they are sick, just how sick and with what is not known entirely and centralization of health data is most likely not happening.

The other problem is that a big percentage of the upper middle class and above do not report their income, therefore there is no withholding system. This makes "employer" based healthcare impossible.

To reduce the overalll costs and keep premiums as low as possible everyone has to be included in the pool, including young, healthy people who are not earning very much.

So bring on the consultants, but having been one for a number of years, care should be exercised as very often there is a conflict of interest between what is best for the client and what is best for the consulting firm.

[rickirs]

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

How can they when Thailand hasn't invented a socialist healthcare system yet?

[baboon]

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

Maybe they should. I am happy with the treatment I receive from the NHS, as are those I get chatting to in hospital. There are plenty of folk from other countries clamouring to avail themselves of its services too, but that is another story...

[Ricardo]

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.

While I agree 100% about the waste which would be involved, in buying some submarines for the RTN, they haven't actually done that, as yet.

But a certain former-PM did buy an Airbus for a Billion Baht, to ferry senior politicians to important meetings, about a decade ago !

http://www.thaivisa.com/forum/topic/16373-an-airbus-for-thaksin/

Perhaps he should have used the money to better-fund his 'affordable health care' plans, but he didn't.

[bangon04]

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.

Like buy aircraft carriers, submarines, blimps, and maintain a loss-making national airline? just for example?

Not that a large taxbase prevents waste - I have probably paid for 2 cruise missiles in my working life. I am so proud of that achievement (not).

At least Thailand does not feel any need to spend significant money on overseas aid projects to corrupt government regimes.

Edited February 11, 2015 by bangon04

[kareona]

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

Only around 16 percent of government revenue comes from personal income tax. The rest is from VAT, corporate taxes, and so on, which everybody pays, even the poorest Thais.

Edited February 11, 2015 by kareona

[pogal]

JFYI, Camellian Hospital in Tong-Lor is opting out of the Government insurance scheme because they are owed 60M Baht by the government who pay late every year costing the hospital millions every year. They apparently have had enough and from 2016 will not participate in the government insurance scheme.