Is universal healthcare a basic right for Thai people?

webfact · July 6, 2015

BURNING ISSUE
Is universal healthcare a basic right for Thai people?
CHULARAT SAENGPASSA
THE NATION

BANGKOK: -- A BIG conflict is erupting in the country's healthcare sector over whether the universal healthcare scheme should go ahead.

So, will the scheme survive this boiling conflict? Or will it end up being scrapped once and for all?

Covering about 49 million Thais, this universal scheme promised to provide almost all kinds of medical treatment for free. Since its launch - initially known as the Bt30-per-medical-visit scheme, in the 2000s - patients showing up at hospitals no longer have had to worry about medical bills. Gone are the days when poor people were so reluctant to see a doctor, fearing they would fall into big debt and illness would swallow all the little savings their family had.

Since the universal healthcare scheme started, people exercising their rights under the scheme feel assured that seeking treatment for their health condition was not going to ruin their family or their children's chances of further education. As a result they are not forced to wait until their condition turns to serious.

Their human dignity also remains intact when they show up with cards entitling them to treatment under the scheme.

Before the launch of the universal healthcare scheme, patients who needed free medical treatment were described as "anatha" or destitute patients. They needed to ask for help. Free medical treatment was not their right. It was something that needed to be asked or something to be begged for.

But while the universal healthcare scheme works well for millions of Thais, several state hospitals and medical workers lament that the scheme is going to bring about the collapse of Thailand's health.

The budget for the scheme has been climbing up, with the latest annual figure at about Bt120 billion.

A group of doctors has warned that if the government does not abandon the project and opts for a co-payment system soon, the country will succumb.

They claim a co-payment system would not hurt the poor. Destitute patients could continue to receive free treatment. It was just those who could afford to do so, should be required to pay. They pointed out that if state-provided resources were reserved for the poor, destitute patients could enjoy even better medical services.

They quoted recent research by the Thailand Development Research Institute that showed the mortality rate was higher among patients exercising their rights under the scheme, than those using the medical benefits programme for civil servants and their family members. According to them, someone needed to put an end to the "populist and extreme" universal healthcare scheme.

While the universal healthcare scheme had an annual budget of Bt120 billion for 49 million people, the programme spent Bt60 billion on taking care of just 5 million civil servants and their family members.

Although the pro-co-payment system group's argument does not sound unreasonable, many others beg to disagree.

Dr Somsak Tiamkao of the Khon Kaen University's Faculty of Medicine said via Facebook that he had seen changes for the better among rural people following the launch of the universal healthcare scheme.

"I don't base my opinion on any research. I simply speak from my direct experience as a doctor who has treated patients since 1990. Before the launch of the universal healthcare scheme, I saw many families go bankrupt because of medical costs. I saw how some patients refused to move to better-equipped hospitals for sophisticated treatment that could have saved their lives, just because they were worried about the medical bill," Somsak said.

This doctor, therefore, supports the implementation of a universal healthcare scheme.

He does not worry about the financial losses that some state hospitals |say they have sustained.

"They are not complete losses. They are gains for people who need the treatment," Somsak said, "State hospitals are not designed to seek profits".

Of course, the government should not aim to seek profits from patients. But I do believe that running state hospitals needs a budget, which the government may not be able to fully shoulder. This is a reason why many countries around the world have already introduced the co-payment system.

But at the same time, I do support the creation of a programme that would allow cash-strapped people to enter hospital without fear or concerns of medical bills, to enjoy free treatment, and are seen as service users - not someone who has come to beg for help.

Thailand needs to find an answer for this.

Source: http://www.nationmultimedia.com/politics/Is-universal-healthcare-a-basic-right-for-Thai-peo-30263904.html

-- The Nation 2015-07-07

trogers · July 6, 2015

We have the right to the best free universal health care as Thais. Our own money is best spent on the Lottery.

halloween · July 6, 2015

Who pays for it comes under the Universal I Don't Care (as Long as it's not Me) Scheme.

jonclark · July 7, 2015

The problem here is not the health care scheme, which is an excellent scheme that allows all people access to basic and lifesaving health care. But the complete lack of efficiency in the health care scheme means it loses money handover foot. How many times do you see patients being given vast amounts of medicines, antibiotics, paracetamol, anti cough, anti sore throat etc. for very minor ailments, perhaps it has happened to you? I perish to think how many needless x-rays, CT-scans etc have been provided over the years.

Clearly the scheme works but how the funds are administered needs to be changed as i am sure savings of about 40% could easily be made.

I will leave kick backs and corruption aside.

worgeordie · July 7, 2015

Its better to provide health service,than buy Subs or other

war toys.

regards Worgeordie

andre47 · July 7, 2015

The problem here is not the health care scheme, which is an excellent scheme that allows all people access to basic and lifesaving health care. But the complete lack of efficiency in the health care scheme means it loses money handover foot. How many times do you see patients being given vast amounts of medicines, antibiotics, paracetamol, anti cough, anti sore throat etc. for very minor ailments, perhaps it has happened to you? I perish to think how many needless x-rays, CT-scans etc have been provided over the years.

Clearly the scheme works but how the funds are administered needs to be changed as i am sure savings of about 40% could easily be made.

I will leave kick backs and corruption aside.

Sure there are too many descriptions of useless paracetamol and too many x-rays. There are savings passible, but not 40%, maybe 10-20%. These savings should be invested into better medical staff. Many of the doctors aren't good. The best medical staff decide to work in private hospitals. The treatment in the goverment hospitals in Thailand is very basic.

On the other hand it is not fair if a Thai who has a good job and earns quite good money gets free medical health care. He should pay into an insurance. Free health care should be for the poorest, Normal Thai people should be forced to pay into an insurance. We have such a system in Germany. Everybody must have an insurance and the goverment pays for the poorest.

Manbing · July 7, 2015

Universal health care should be a basic right.
However its a huge cost burden on the public purse, demanding high taxation to fund it.

Its a mark of development and maybe an ideal Thailand could speak to and work towards in the ASEAN era of anticipated prosperity.

However taxation and income levels will need to change to service this ambition.

trogers · July 7, 2015

Universal health care should be a basic right.

However its a huge cost burden on the public purse, demanding high taxation to fund it.

Its a mark of development and maybe an ideal Thailand could speak to and work towards in the ASEAN era of anticipated prosperity.

However taxation and income levels will need to change to service this ambition.

Or the Greek formula can be used. Less, taxes, more pensions, and just borrow to finance all these spending.

Eric Loh · July 7, 2015

I like to think that health insurance underwriting is a better method than direct taxation or co-payment to fund the cost. Bit like the Singapore healthcare system where a small premium sum is paid to secure medical attention. The government subsidies the premium for the poor while the employed and civil servants paid via their social security or civil servant funds so their take home wage will not be affected.

Ricardo · July 7, 2015

Good to see this now being debated ! It was needed when the 30-Baht scheme was first introduced, IMO.

On the one hand, free public health-care has the proven potential to absorb vast sums of money, as seen in many other countries with some form of social medicine. And there will always be some treatments/medicines which are too expensive to be provided. So there will always be a place for private-medicine, for those who can afford it.

On the other hand the public have to be willing to pay for what they get, whether by increased VAT or income-tax, or some sort of medical-insurance contributions. I suspect this may be difficult to introduce. But TANSTAAFL !

Whatever the future, the money raised needs to be spent efficiently,& effectively so that it generates the greatest possible benefit to the greatest number of people.

Seastallion · July 7, 2015

Universal health care should be a basic right.

However its a huge cost burden on the public purse, demanding high taxation to fund it.

Its a mark of development and maybe an ideal Thailand could speak to and work towards in the ASEAN era of anticipated prosperity.

However taxation and income levels will need to change to service this ambition.

Or the Greek formula can be used. Less, taxes, more pensions, and just borrow to finance all these spending.

Greek? That sounds suspiciously Thai in it's logic.

Seastallion · July 7, 2015

A few months ago, wifey takes a phone call, then announces that we should go to the hospital because dad has just undergone eye surgery (cataracts).

I duly load my pockets with thousand baht notes, and off we go.

What a pleasant surprise: Dad can see again, and it cost nothing.

Wifey's folks are dirt poor. This scheme is good. The problem is the civil servants who abuse it because they extend it to their wider family.

LannaGuy · July 7, 2015

a basic human right along with freedom of speech

Pib · July 7, 2015

A few months ago, wifey takes a phone call, then announces that we should go to the hospital because dad has just undergone eye surgery (cataracts).

I duly load my pockets with thousand baht notes, and off we go.

What a pleasant surprise: Dad can see again, and it cost nothing.

Wifey's folks are dirt poor. This scheme is good. The problem is the civil servants who abuse it because they extend it to their wider family.

You would have needed about Bt60-70K to pay for cataract surgery of both eyes (approx Bt35K/around 1,050 USD per eye) at a govt hospital as I priced it out at two govt hospitals for the MIL.

Initially the Thai wife and I took the MIL to a couple of govt hospitals highly recommended by other Thais for eye problems but the MIL was not assigned to these hospitals for her 30 baht coverage. These two govt hospitals would indeed to the cataracts surgery but she would have to pay since she was assigned to another govt hospital under the 30 baht program. That's when we asked what the cost would be. But at the govt hospital she is assigned to they would do it for free under the 30 baht program...and the MIL and family found out her assigned govt hospital did indeed have good cataract surgery capability...could get it done for free there and went for several evaluations/visits over several weeks to have her vision fully checked. Turned out she didn't really need/get cataract surgery as the vision problem was predominately being caused by a retina problem and not so much by the minor cataracts she has.

Yeap, Bt60-70K total price for both eyes at a govt hospital...I bet a Thai private hospital would charge much, much more.

Edited July 7, 2015 by Pib

sawadee1947 · July 7, 2015

as we are not included in any scheme I don't care. It will not have any impact on my life

samuibeachcomber · July 7, 2015

Is there a free health care scheme? I was under the impression the maximum payment of 30 baht only covered prescription drugs,and then only from a govt. hospital in the area where their identity card was issued.I have never heard of free medical treatment,say for example surgery,thais still have to pay for this,albeit a lot less than a private hospital,but they still have to pay,its not free.There is no free health care yet!

samuibeachcomber · July 7, 2015

And whose going to pay for this free health care? wages are too low to collect any taxes to pay for it.

jackanapes · July 7, 2015

I am a firm believer that people who can afford to pay should pay towards medical costs by a reduction in their wages every week all workers should pay a certain amount every week .