Thai politics: Our healthcare, despite being a leader, needs an overhaul

[webfact]

BURNING ISSUE
Our healthcare, despite being a leader, needs an overhaul
Chularat Saengpassa

BANGKOK: -- THE GOVERNMENT'S universal healthcare scheme has won considerable praise from the international community.

Yet it has drawn much criticism within the country particularly from medical workers. Healthcare reform, therefore, will be needed.

Before reform starts, let's take a look around Thailand. What have other countries been doing? And what factors have affected people's access to healthcare services?

The World Health Organisation (WHO) has recommended that governments spend a budget equivalent to 5 per cent of their country's gross domestic product on healthcare.

The 2013 Asean Declaration on Strengthening Social Protection, meanwhile, has called for collective progress towards universal health coverage.

This requires examination through three dimensions: (a) the breadth or extension of population coverage by insurance schemes; ( the depth or the types of services that need to be provided, such as outpatient and inpatient services; and © the financial risk protection, such as co-payments.

While Thailand spends less than 5 per cent of GDP on health, its universal healthcare scheme has managed to cover about 49 million people who are entitled to almost all types of medical services for free. To outsiders, the programme is a remarkable success.

However, as the scheme is now threatening to jeopardise the state budget and government-sponsored healthcare sector, several groups are pushing for its overhaul.

Co-payments and more have emerged as possible alternatives.

In the Philippines, the government-owned health insurer was providing coverage to about 81 per cent of the population in 2013. Vietnam, meanwhile, has subsidised health-insurance premiums for vulnerable groups.

Health insurance is a must-consider option given that surveys have shown that people, particularly from lower-income families, cannot access healthcare services because of the money factor.

In Laos' rural areas, households in the highest-income quintile (population sample) are three times as likely to seek hospital care as households in the lowest-income quintiles.

To help its people access necessary medical services, Thailand will need to plan well. According to the Mahidol University's Institute for Population and Social Research, Thailand has the highest proportion of elderly people in Southeast Asia. By 2012, the proportion of people older than 65 years stood at 12.59 per cent in Thailand, as opposed to 12.25 per cent in Singapore and 7.5 per cent in Vietnam.

In 2012, Thailand spent Bt430 billion via its healthcare systems, which included the universal scheme. Of that amount, Bt1.4 billion was spent on the elderly.

Even the National Health Security Office has reckoned that it will have to improve its efficiency, particularly in regards to care of the elderly. It is estimated that the number of elderly persons in Thailand will reach 14.5 million by 2025.

As one's healthcare costs will rise in response to age, Thailand will need to be prepared to deal with the elderly. Despite the importance of the money factor, it is not the only thing that restricts people's access to healthcare services.

Indeed, there are several instances whereby people refrain from using healthcare services even though they are available and affordable. In some cases, this may be because of the perceived lack of good-quality care, such that those who can afford to do so visit health facilities in other countries. In other cases, the services may not be considered socially or culturally appropriate, which is particularly the case when it comes to sexual and reproductive health services.

Studies have shown that among patriarchal-oriented societies, husbands or in-laws often decide whether women in the household should make use of healthcare services.

For example, studies on Bangladesh contain reports of numerous examples where women were denied pre- and antenatal healthcare services because male family members considered the use of such services inappropriate.

However, studies have also shown that the use of sexual and reproductive health services as well as healthcare services for children increases with the educational level of both. Use of healthcare services is more prevalent among the older generations and groups with lower education.

Studies in Vietnam have also found that minority ethnic groups tend to use healthcare services to a lower extent than majority groups. For example, indigenous communities in that country often do not make use of health services, even if their households are in close proximity to a healthcare facility. Yet across income quintiles, public health facilities are relatively equitably utilised.

As Thailand is preparing to implement its healthcare reform, it should take into account all relevant factors. Cultural, ethnical and financial and education factors must be studied so as to plan the best reform ever.

People should have access to basic medical services, regardless of their financial status or cultural/ethnic background. The government needs to plan well. The health of people is in many ways the health of the nation.

Source: http://www.nationmultimedia.com/politics/Our-healthcare-despite-being-a-leader-needs-an-ove-30265850.html


-- The Nation 2015-08-04

[dieter1]

sorry but,

as many of these "Nation" articles, this one is of poor quality !

Why?

f.e.

there is no real argument to be find, WHY the the universal healthcare scheme has to be changed!

" the scheme is now threatening to jeopardise the state budget and government-sponsored healthcare sector,"

Where is the proof of that? In the article, who can only find

"In 2012, Thailand spent Bt430 billion via its healthcare systems, which included the universal scheme"

so no number for the univeral scheme alone! So nothing to proof,that there is something to "jeopardise the state budget"

So, if there is a statement without proof,I guess it is pure propaganda!

Right, there is a growing number of old people in the society. And it means, you need more money to pay for their medical needs. More money! That is clear! How to get this money? Most of these older people have no private insurence and have not the money to pay the medical bills out of their own pockets, cause they are still poor. That`s it. To give these old people medical care, there is not other way, as to pay the health care with tax money. There are no other possibilities !

So what is this article all about? I smell the rat! It is the attempt from a lobby, I guess the medical lobby and insurence lobby, to get a bigger piece of the cake ! They want more milk from the cow! More private insurence, a bigger part of the wages from everyone.

As far as I see, the best for a kind of basic healthcare for everyone, especialy for poor people is a free (for free) system , funded by tax money. It cant be that luxury, but it can provide the most urgent needed medical help. So far I see, does the universal scheme provide this. I think, this system needs more money, and is now underfunded.Especialy with the growing number of old people. If they would use all tax for alcohol beverages and for tobacco for this purpose, there would be enough money to fund it ! If not enough, use the money you could save , if not buying (useless) submarines ! I think just the tax money, which goes into corruption or just illegally in to the pockets of the politician, would be more then enough for financing the universal healthcare.

Edited August 3, 2015 by dieter1

[Bluespunk]

"Health insurance is a must-consider option given that surveys have shown that people, particularly from lower-income families, cannot access healthcare services because of the money factor."

No. The "must consider" (and then do) option is increase funding for the health services and ensure all have access.

Edited August 3, 2015 by Bluespunk

[BigBadGeordie]

Time to take a good hard look at the relative expenditure of the universal system and that offered to government/police/civil service staff and families, the difference in cost is astounding.

But then again why am I surprised?

[worgeordie]

It is a much better idea to spend money on health care,

than to buy 3 Submarines,they seem to have been put

on hold,but will be put back on the agenda again,no doubt.

regards Worgeordie

[bamnutsak]

While Thailand spends less than 5 per cent of GDP on health, its universal healthcare scheme has managed to cover about 49 million people who are entitled to almost all types of medical services for free. To outsiders, the programme is a remarkable success.

However, as the scheme is now threatening to jeopardise the state budget and government-sponsored healthcare sector, several groups are pushing for its overhaul.

Yes, let's take something that works and benefits a huge number of people, mess it up, and then buy some submarines.

Meanwhile a (slightly) higher percentage of GDP is spent on an Education system that nearly everyone admits is a failure.

[Bob12345]

As Thailand is preparing to implement its healthcare reform, it should take into account all relevant factors. Cultural, ethnical and financial and education factors must be studied so as to plan the best reform ever.

Wow, this is quite a shock.

I always thought that you should try to disregard as many relevant factors as possible and should plan the worst reform, but luckily these smart people at the Nation set me straight with this highly intelligent and analytical article.

[teacherpaul]

Sorry, who gave them the right to say that Thai healthcare is a leader?

[tbthailand]

hmmm,

Thailand's healthcare system is hardly a leader.

But the one thing that was done, the 30 Bhat system, did dramatically expand access and had / has many benefits - one example being a dramatic and rapid decrease in infant mortality.

So it seems an over-exagerated statement to need an 'overhaul'.

It does need more funding, more trained personnel, and a continued expansion of access, services, and capacity.

But that is not an "overhaul", that is just the nuts and bolts work needed to do a good implementation of healthcare system.

[wabothai]

Which are we talking about?

Private or general hospitals?

[Oil Baron]

Who needs healthcare? It'd be better to spend billions of baht on a few submarines!

In all seriousness, to advance as a nation they need to invest in healthcare and education. Better trained Doctors would also be a good stating point. I digress....

[Shawn0001]

Sorry, who gave them the right to say that Thai healthcare is a leader?

While hardly a leader it is one of the better systems in ASEAN.

[Shawn0001]

hmmm,

Thailand's healthcare system is hardly a leader.

But the one thing that was done, the 30 Bhat system, did dramatically expand access and had / has many benefits - one example being a dramatic and rapid decrease in infant mortality.

So it seems an over-exagerated statement to need an 'overhaul'.

It does need more funding, more trained personnel, and a continued expansion of access, services, and capacity.

But that is not an "overhaul", that is just the nuts and bolts work needed to do a good implementation of healthcare system.

"However, as the scheme is now threatening to jeopardise the state budget and government-sponsored healthcare sector, several groups are pushing for its overhaul."

Unfortunately there is no hope in hell that the overhaul would not bring 'more' of anything. Have no doubt that those pushing for the overhaul only want it stopped as it threatens their ideal of a tiered society which produced endless amounts of cheap labor.

[Jimlove]

Sorry, who gave them the right to say that Thai healthcare is a leader?

Couldnt agree more - Thailand is def not a leader in Healthcare unless they compare them self with Places like Iraq, Afghanistan and other Hell-holes and maybe not even in that comparison Thailand would be leader ...

Only think Thailand lead is Deaths on roads + Number of Military Coups and thats not something to be proud of but what do they know about anything ...

[Down the rabbit hole]

Sorry, who gave them the right to say that Thai healthcare is a leader?

Couldnt agree more - Thailand is def not a leader in Healthcare unless they compare them self with Places like Iraq, Afghanistan and other Hell-holes and maybe not even in that comparison Thailand would be leader ...

Only think Thailand lead is Deaths on roads + Number of Military Coups and thats not something to be proud of but what do they know about anything ...

Hmmm. In their minds, Thais think they are always leaders. They drink quite a lot of Kool-Aid. They do lead in road-kill (as you note) and they are high on the suicide rate but hey, a lead is a lead right?

IMHO though, they ought to means-test healthcare. If you're worth a billion baht, you can afford to pay for doctors and hospitals. Yet when time comes for the government of, by, and for rich Thais, to 'economise' it's always the relatively un-wealthy who get to pay more.

To each according to their needs, from each according to their ability to pay. Hard to find a reason why that's unreasonable.

[emilymat]

I am not quite sure of the message here.

Quote "In 2012 Thailand spent Bt430 billion on healthcare. Of this Bt1.4 billion was spent on the elderly"

Even in my head I can work out the this represents roughly 0.25%. That can't be true surely, when they say 12.59% of the country was over 65 at that time.

If it is, it's a scandal.

[elgordo38]

It is a much better idea to spend money on health care,

than to buy 3 Submarines,they seem to have been put

on hold,but will be put back on the agenda again,no doubt.

regards Worgeordie

Wow what a package of trial balloons. This is usually the calm before the storm. The PM said nothing would be changed well I would not be to sure of that. A military government does not have to be elected its a good period in time to change things.