Thai doctors push for healthcare co-payment

[webfact]

UNIVERSAL SCHEME
Doctors push for healthcare co-payment
CHULARAT SAENGPASSA
THE NATION

A GROUP of doctors has continued to press for the introduction of a co-payment system in the medical sector.

BANGKOK: -- The doctors insist that if such a system is not launched promptly the country will succumb to the growing weight of a free healthcare system that has devoured an increasing amount of state budget in recent years.

"A co-payment system will be the saving grace. It is going to create a win-win situation. We can do it simply through voluntary health insurance. This initiative is not going to hurt the poor either. Only those who can afford it would be required to go to co-payment," said Arnond Sakwo-rawich, of the National Institute of Development Administration's Business Analytics and Research Programme, School of Applied Statistics.

Arnond, Dr Apiwat Muti-rangura of Chulalongkorn University and Dr Churdchoo Ariyasriwatana, who heads the Federation of Healthcare Workforce of Thailand, came to Nation Multimedia Group to explain their idea.

These doctors have, in essence, opposed the universal healthcare scheme that covers nearly 50 million Thais. People who have exercised their rights under this scheme can get almost all kinds of treatments for free.

"The scheme is good for the poor. We definitely don't want to see people die on the street simply because they don't have money to pay for their treatment," said Arnond. "But still, I must say that the universal healthcare scheme is not reasonable. Such free medical services should be made available only to those who can't afford it".

He said people should be made to pay, and not allowed to enjoy free medical services.

"Go for the middle path. The universal healthcare scheme is extreme," he said.

Arnond said when a co-payment system is launched, poor patients would enjoy even better medical treatment and the society would see narrow gaps.

"Some rich patients used their connections to queue-jump and get free treatment under the scheme," he said. He also noted research by the Thailand Development Research Institute (TDRI) that suggests that patients with chronic diseases have a higher mortality rate if they get treatment under the universal healthcare scheme, as opposed to the medical-benefit scheme for civil servants and their family members.

"When focusing on cancer patients alone, the mortality rate is 70 per cent higher," Arnond said.

He reckoned that patients' knowledge about how to take care of their health and initial health conditions at the time of getting treatment were different and also factors. Arnond believed efforts to improve treatment standards for the poor could immediately save many lives.

"Of course, we will have to act on other factors too. But clearly the treatment factor ranks among the very first thing we can do," Arnond said. He and many doctors, thus, back co-payment, which is something that would ease the state finances from the promise to provide free medical treatment for all and focus the resources on those who really needed it.

Arnond pointed out that Nakornping Hospital had already joined a health-insurance system with insurance firms and the results were impressive.

"Insurance firms can get treatment for customers at a reasonable cost while patients get services from capable state doctors."

He said the extra money earned by state hospitals could improve other parts of hospital operations.

Churdchoo said several state hospitals had also made it an option for affordable patients to get services from them.

"Look at the premium clinic of the Ramathibodi Hospital and Siriraj Piyama-harajkarun Hospital," she pointed out, "Their patients are happy to pay. They don't have to wait too long".

She said money paid by those who can afford it would mean more cash for medical facilities.

"Since the launch of the universal healthcare scheme, which was initially known as the Bt30 per medical visit scheme, state hospitals in general have received a lower budget. Their facilities worsen," she said.

Arnond said voluntary insurance would cost people about Bt8,000 a year per head if they bought it as a group. "Individually, they might have to pay between Bt12,000 and Bt13,000," he said.

Apiwat believed people should learn to be responsible for their own health too. "If you smoke, you should pay a higher insurance cost," he said.

He also did not agree with the universal health scheme's prescribed guideline for treatment, saying it limited doctors' choices on delivering the best medical treatments.

The Public Health Ministry disclosed recently that the number of state hospitals with budget problems from the universal health scheme has dropped - from 158 in the third quarter of last year to 48 in the second quarter of this year. This figure has been used to counter the claim that the universal scheme "ruins" state hospitals.

Source: http://www.nationmultimedia.com/national/Doctors-push-for-healthcare-co-payment-30263822.html


-- The Nation 2015-07-06

[dieter1]

to translate it:

the big and influential lobby of the insurance companies wants a much bigger part of the whole Cake (BIP)

to hide this interest a bit more , they send the "doctors" first, to promote this- And- also the lobby of the "Doctors" (private hospitals etc.) does expect to expand their cash inflow.

Health care for free? Hey, we live in a capitalistic world! Making profit comes first and not the health of the people.

The arguments of the"doctors" ( " group of doctors" ! Who are they ? Whom are they representing ?) are contradictory!

""Some rich patients used their connections to queue-jump and get free treatment under the scheme" Prove of it? or is it just a rumour ?

and on the other hand:

"patients with chronic diseases have a higher mortality rate if they get treatment under the universal healthcare scheme"

To finance fundamental health care with tax revenue is the best way. It is mostly efficient and everyone does contribute to this system in relation to his income. In fact, poor people pay more, because they pay a bigger part of their income for tax by VAT.

Thailand is not a poor country anymore and it would be no problem to pay more for the free healthcare year by year, according to the growing of the GDP.

That s typical: On the other hand, there is a very influential lobby demanding extremly costly new toys (submarines) ! The costs of these toys would be enough money to finance the realy needed demand of the free healthcare system for the next years.

Edited July 6, 2015 by dieter1

[Bannum opinions]

This is scary.

The medical establishment has a white-heat-hatred on for Thaksin for his 30-baht hospital program....For purely self-serving reasons.

For these anti-democratic, Bangkok-centric elite to be negotiating with their own kind about Thaksin-care (a play on Obama care) with no nation wide representation that a legitimate electoral process would provide, is alarming, to say the least.

Of the many Post-Thaksin policies that resulted in his subsequent electoral successes, none ranks higher than the 30-baht hospital thing. To have these Bangkok-centric elite cozily meddling with this program amongst themselves is frightening indeed.

Some critics link this to misplaced motives regarding health-care vs. Submarine-care.....There is some truth to that, but it is primarily the medical establishment yet again trying to recover their golden goose. This is a selfish Medical establishment effort to avoid re-distribution of national wealth......As their Elitist brethren, they are OK with the Nations's wealth percolating upward, but resist mightily having any of it trickling back to the Plebs. They want to trap it in their own gilded world.

Edited July 6, 2015 by Bannum opinions

[tbthailand]

The first step in dismantling a universal health care system is to make in not-universal. Then it can be taken down, a piece at a time.

The co-payment system is not the answer - unless you are a MOPH doctor who also moonlights with his/her own private clinic. Then a co-payment system will drive more people to your clinic so that you can pay for your Mercedes.

This issue surfaced early on under this regime as a trial balloon and that was shot down pretty quickly.

It looks like the morons are taking another stab at it and this time with a coordinated series of policy statements and fabricated propaganda.

Happiness for the Thai people...

[tbthailand]

This is scary.

The medical establishment has a white-heat-hatred on for Thaksin for his 30-baht hospital program....For purely self-serving reasons.

For these anti-democratic, Bangkok-centric elite to be negotiating with their own kind about Thaksin-care (a play on Obama care) with no nation wide representation that a legitimate electoral process would provide, is alarming, to say the least.

Of the many Post-Thaksin policies that resulted in his subsequent electoral successes, none ranks higher than the 30-baht hospital thing. To have these Bangkok-centric elite cozily meddling with this program amongst themselves is frightening indeed.

as a report stated which I posted just the other day, the 30 bhat healthcare system brought a dramatic (13%) reduction in infant mortality in one year - a result averaged across the nation - the most dramatic changes were obviously for the rural poor.

The system saves lives. Who cares who put it in place - it is a good idea and it should be expanded, not diminished.

The hand-wringing over financials is fake concern for the country coming from people who hate the idea of universal care.

[Toknarok]

Any attempt to dismantle the 30 baht scheme would be received with enormous resentment by the populace especially in Isaan. It could well lead to civil unrest completely destroying the Junta's plans for 'happiness' and 'reconciliation' Why don't these doctors lobby against the purchase of useless submarines with the monies being put into health care. But this of course would not be of a financial advantage to the doctors.

[oneday]

This so-called "free" medical system is not as free as advertised, but I'm not complaining about the current system as it has saved many poor people's lives and allowed for almost free medical care in a lot of circumstances, but not all circumstances.

My girl's mother is fighting cancer, which everyone knows, is often a long battle and unless it is fought vigorously by doctors and a system that really cares, the patients more often than not end of dying when they might have survived through quick and aggressive action.

Her medical bills at these so-called "free" medical facilities are 10,000+ a month mostly for the diagnostics and tests they have to do, such as x-rays. She must pay these costs above the 30B supposedly charged. I don't understand the system so I can't explain why these extra costs are levied on the patients and when and why it falls under the "30B" only; I just know what money is being paid.

So now doctors want to throw in a co-payment. I guess more people will just have to die, because many people can't afford the system as it is, especially when it's cancer they are fighting.

Edited July 6, 2015 by oneday

[slapout]

the assignment of a patient with a specific complaint (having trouble breathing/getting breath) maywill be put in que and next doctor avaliable will see him/her. not to worry that doctora he is in the broken bone practice, thus he prescribs a inhalent a litt salve for chest, pats their arse and its next. time consumed about 5-8 minutes.

many hospitals operate like a line of cash registers at a supper market and with the same humanity toward patients.

hosp[tals losing money is due to theft in many cases. i know of a hospital in CM whose bank banklance is more than enough to offer a 30 milliom us loan to build a new school for another group. doctors operate clinics where assistants perscribe and dispense, have rights at several hospitals, make rounds between 0900 and 1800 and complain about conditions they and hospitals have to endure.

now there are some/many great doctors out there but not so many hospitals and certainly not the administors of said hospitals look for this wakness as the priorty to go after, ineffeciency/corruption as is exhibited thoughtout the thai system

Edited July 6, 2015 by slapout

[sammygood]

i know something where they could cut costs seriously

it is called PREVENTION & EDUCATION

anyway, why it has to be free ? it is never free, always someone will be paying for it, aka tax payers

[NickJ]

The 30b program of free health care.....Is a band aid program. If a patient has anything serious and they dont have money they are as good as dead.

[aussieinthailand]

"The rich using connections to jump the queues and get treatment for free", WHAT A LOAD, the rich have top end insurance, even many middle income people have it and a few minimum wage have top to intermediate insurance either for themselves or parents.

Any one who has walked inside a public (state) hospital will see the overcrowded front desk all waiting 1-2 hours sometimes more just to get their medical file.

Then it's off to see the doctor, there's another several hours wait, now if you need to see a specialist then that doctor will give you a referral, that may take a week or more, then if you need a x-ray or ultrasound your now up for a 6 week wait so you can come back too the hospital and wait for 1-2 hours for your med file again, wait to get your procedure done then wait for results and any other appointments and procedures.

Now if you the misfortune to have to be admitted, well for warned the experience is just going to get worse.

If your lucky you'll get to share a ward with 30-40 other unfortunates in an overcrowded sweat box with a revolving ceiling fan.

or not so lucky stuck out in the hallway.

Now three times a day an orderly will push a meals trolley into the overcrowded hallway hall way lined with both patients and family of the unfortunates and call out your meal is here, so a mad rush in made by families and a few mobile patient's for the bounty, but if your family is not with you at the time and you can't move, then you have to hope a kind hearted person will get you a plate of that Mmmm just like mum used to make fair.

Nurses are not taking care of basics health care that is left to the family of the patient.

The whole public health system is broken due to a number of factors and corruption is playing a very big part of it.

The next is that half the people in the hospital could be treated as an out patient but their is more money to be made by an in-patient, result mass overcrowding.

Case in point, My wife asked about 2 separate minor medical procedures in a (state) hospital, one of which was a simple single injection, head nurse answer was Admit into the hospital on both occasions and all the costs submitted for government for inflated payment, she choose to go too a privet hospital and was in and out of the hospital in 15 min's and the coast was 200 Baht each procedure.

Also it's not uncommon for hospital staff (usually a nurse) to ask the patients of government employees of the health scheme or their family's to sign a document that has massive inflated prices of treatments to be submitted for government payments.

Result, The public health scheme is being hijacked by the corrupt, and transparency is just lip service.

[h90]

to translate it:

the big and influential lobby of the insurance companies wants a much bigger part of the whole Cake (BIP)

to hide this interest a bit more , they send the "doctors" first, to promote this- And- also the lobby of the "Doctors" (private hospitals etc.) does expect to expand their cash inflow.

Health care for free? Hey, we live in a capitalistic world! Making profit comes first and not the health of the people.

The arguments of the"doctors" ( " group of doctors" ! Who are they ? Whom are they representing ?) are contradictory!

""Some rich patients used their connections to queue-jump and get free treatment under the scheme" Prove of it? or is it just a rumour ?

and on the other hand:

"patients with chronic diseases have a higher mortality rate if they get treatment under the universal healthcare scheme"

To finance fundamental health care with tax revenue is the best way. It is mostly efficient and everyone does contribute to this system in relation to his income. In fact, poor people pay more, because they pay a bigger part of their income for tax by VAT.

Thailand is not a poor country anymore and it would be no problem to pay more for the free healthcare year by year, according to the growing of the GDP.

That s typical: On the other hand, there is a very influential lobby demanding extremly costly new toys (submarines) ! The costs of these toys would be enough money to finance the realy needed demand of the free healthcare system for the next years.

Obamacare is a nice example how to make big money from it........

At some rich patients use the free healthcare: if they have the right to use the free healthcare than they have the right...no matter how rich they are.

And I am sure patients with chronic diseases have a lower mortality rate if they get treatment under the universal healthcare scheme than if they don't get any treatment.

So I complete agree with you, it is just for the profit.

For the subs...it is always the problem with defense. It is lost money until you need it.

[rubl]

Since the start in 2001 people have been complaining about the underfunding of the scheme, the 30-Baht copayment was dropped because is cost more than double to administer (the Yingluck Admin ended up only reinstating the name "30-Baht" scheme). People at fist were happy with the service as going from none to some is a big step. Now people have grown used to the scheme and have started to realise that it doesn't really amount to much (apart from wait, wait, wait) and started demanding more. Government workers have been abusing the system for many years.

Still the good news is that according to smutcakes only 4% of GDP is spent and that there is room for improvements.

The remarks about expensive toys I'll ignore in this thread just like I'll not go into details (or costs) of how all farmers got rich and no longer require a national Heath Care scheme.

[sawadee1947]

that's a perfect idea. We know that from our Health Systems (NHS). Also it will reduce the amount of people attending the doctor's with minor problems !!

[VINCENT2012]

thats incredible:The doctors insist that if such a system is not launched promptly the country will succumb to the growing weight of a free healthcare system that has devoured an increasing amount of state budget in recent years.

the doctors insist ???????????? what the good ones or the ones who only wear the stethoscope to show the galery they have the rank of doctor...but what about knowledges?????.wwwwwwhoua..anyway..thats so bad ... ......but how much cost the military thai systeme every year ?isnt it worse?

come on man.....education and anykind of heathcare and medecine are 3 things that should always be free for everybody every where on this planet.

are we human or not????

Edited July 6, 2015 by VINCENT2012

[dageurreotype]

to translate it:

the big and influential lobby of the insurance companies wants a much bigger part of the whole Cake (BIP)

to hide this interest a bit more , they send the "doctors" first, to promote this- And- also the lobby of the "Doctors" (private hospitals etc.) does expect to expand their cash inflow.

Health care for free? Hey, we live in a capitalistic world! Making profit comes first and not the health of the people.

The arguments of the"doctors" ( " group of doctors" ! Who are they ? Whom are they representing ?) are contradictory!

""Some rich patients used their connections to queue-jump and get free treatment under the scheme" Prove of it? or is it just a rumour ?

and on the other hand:

"patients with chronic diseases have a higher mortality rate if they get treatment under the universal healthcare scheme"

To finance fundamental health care with tax revenue is the best way. It is mostly efficient and everyone does contribute to this system in relation to his income. In fact, poor people pay more, because they pay a bigger part of their income for tax by VAT.

Thailand is not a poor country anymore and it would be no problem to pay more for the free healthcare year by year, according to the growing of the GDP.

That s typical: On the other hand, there is a very influential lobby demanding extremly costly new toys (submarines) ! The costs of these toys would be enough money to finance the realy needed demand of the free healthcare system for the next years.

Indeed. Rumours of cutting back on healthcare in order to procure these ridiculous subs are spreading so fast Prayut's deemed it necessary to come out on today's BP and quash these 'ridiculous rumours'. Not a 'rumour' then ..

[Nobb]

Update to me because every time i go to the hospital even though i have health care insurance i always have to pay a co-payment. Why do Thais not have to pay

this?

[Thaidream]

Of course doctors want co payments. They are greedy and the Insurance companies are even worse Health care is a basic human right. It is incomprehensible to me why anyone should be making a profit from the suffering of others. Obamacare in the United States is an abomination- no pun intended. It only helps the insurance industry get richer and does nothing to lower health care costs in America- the costliest in the World. The Japanese system is one of the best. The government controls everything and it works. Yes- it is Socialist- who cares. In japan, those who are employed pay per a sliding scale a percentage of their income to the government , those making the most, pay the highest percentage. The unemployed, elderly or children pay nothing. Every person in the country has healthcare. No one worries about access. Doctors and Nurses do not make exorbitant salaries but are compensated well. Healthcare is not a business nor should it be. The 30 Baht scheme is not perfect but it is a start- however, the corruption involved is horrid. The General might want to look at reforming the current system and lay down the law to the hospital staff-if you are corrupt- you won't be sent to that inactive post- you'll be sent to prison. I have no tolerance for those stealing money off the ill or elderly.

[Bernard Flint]

The Junta rules ok. I cannot even call him PM .

[Bluespunk]

"He also noted research by the Thailand Development Research Institute (TDRI) that suggests that patients with chronic diseases have a higher mortality rate if they get treatment under the universal healthcare scheme, as opposed to the medical-benefit scheme for civil servants and their family members"

Wasn't there a story on TV saying this was not true earlier today?

Edit:

Thought so

http://www.thaivisa.com/forum/topic/838260-little-difference-in-death-rates-of-thai-health-scheme-users-nhso/

Edited July 6, 2015 by Bluespunk

[slapout]

doctors, lawyers, preachers/monks,and poltians all seem to have the same total disreguard for the well being of the general population and country they have sworn to god, buda, king, legal and medicals council to help,support in living and having a good ;life.

while at the same time these out and out thieves are holding themselves up as examples to be followed, they are so full of themselves that they make good gater bait. it best when putruid and they are certaintly rotten at least. they refuse to acknowledge the number of deaths they are responsible for the malnutrition, disablity etc the elete of thailand has brought new meaninhg to usless as teats on a boar pig

[MaeJoMTB]

This is actually a cunning plan by the doctors to cause a revolution and bring Thaksin back.

If I were PM (Prayut), I would see through their scheme and put them all in jail for planning to overthrow the government.

[aussieinthailand]

Of course doctors want co payments. They are greedy and the Insurance companies are even worse Health care is a basic human right. It is incomprehensible to me why anyone should be making a profit from the suffering of others. Obamacare in the United States is an abomination- no pun intended. It only helps the insurance industry get richer and does nothing to lower health care costs in America- the costliest in the World. The Japanese system is one of the best. The government controls everything and it works. Yes- it is Socialist- who cares. In japan, those who are employed pay per a sliding scale a percentage of their income to the government , those making the most, pay the highest percentage. The unemployed, elderly or children pay nothing. Every person in the country has healthcare. No one worries about access. Doctors and Nurses do not make exorbitant salaries but are compensated well. Healthcare is not a business nor should it be. The 30 Baht scheme is not perfect but it is a start- however, the corruption involved is horrid. The General might want to look at reforming the current system and lay down the law to the hospital staff-if you are corrupt- you won't be sent to that inactive post- you'll be sent to prison. I have no tolerance for those stealing money off the ill or elderly.

Unfortunately the corruption levels in this country is at such a point that most everyone knows and see's it but not prepared to do anything about it and when it has gone to such an extent that someone makes noises then the threats start coming then the beatings and then the shootings and if your lucky some token head will be transferred instead of being dragged to court and gaoled...............WHY?????????? MONEY for the higher up's.

Thailand's national anthem has the words we are not cowards and will fight but we like peace, what a load of BULL.

There is a way to fix the problem and it's not that difficult, have 2 independent auditors sent in UNBEKNOWN to each other reporting back to different people, then real action taken for those caught in corrupt practices.............

[tbthailand]

This so-called "free" medical system is not as free as advertised, but I'm not complaining about the current system as it has saved many poor people's lives and allowed for almost free medical care in a lot of circumstances, but not all circumstances.

My girl's mother is fighting cancer, which everyone knows, is often a long battle and unless it is fought vigorously by doctors and a system that really cares, the patients more often than not end of dying when they might have survived through quick and aggressive action.

Her medical bills at these so-called "free" medical facilities are 10,000+ a month mostly for the diagnostics and tests they have to do, such as x-rays. She must pay these costs above the 30B supposedly charged. I don't understand the system so I can't explain why these extra costs are levied on the patients and when and why it falls under the "30B" only; I just know what money is being paid.

So now doctors want to throw in a co-payment. I guess more people will just have to die, because many people can't afford the system as it is, especially when it's cancer they are fighting.

you are absolutely right. The government/state needs to pony up to the table and take responsibility for the welfare of all Thai citizens. On that point, I don't care if the "government" is one elected by the people or self-imposed.