Winai warns healthcare will be ‘distorted’ by changes

[webfact]

Winai warns healthcare will be ‘distorted’ by changes

By CHULARAT SAENGPASSA
THE NATION

 

Dr Winai Sawasdivorn

 

Former NHSO chief says govt needs to understand that a healthy population is good for the country as a whole

 

BANGKOK: -- ONGOING efforts to amend the National Health Security Act will distort the universal healthcare scheme, but should not bring about its abrupt end, according to the man who oversaw the scheme for nearly eight years. 

 

“The essence of the scheme will be affected,” Dr Winai Sawasdivorn said in a recent interview. “Probably it’s a result of my failure in not being able to convince the government that it’s worth investing in people’s health.” 

 

His comments came as the National Health Security Bill, which looks set to significantly affect the scheme, has reached the stage of public hearings.

 

The bill has raised concern about the future of the scheme, which was launched 15 years ago initially under the banner of the Bt30-per-medical-visit programme. 

 

Winai had to leave the helm of the National Health Security Office (NHSO) under a junta order in 2015, after he clashed with several high-level health officials and prominent doctors over the scheme’s management. 

 

Several doctors and officials affiliated with the Public Health Ministry did not agree with NHSO management. While the NHSO is in charge of managing the universal health scheme, its operations are mainly handled by state hospitals under the ministry’s supervision. 

 

“You may criticise the NHSO, as critical comments can be used to improve the scheme,” Winai said. “But you should not try to undermine the NHSO and the scheme it has tried to defend. Without the NHSO, the scheme might have collapsed a long time ago.” 

 

The universal scheme now offers most kinds of medical services to about 48 million Thais for free. 

 

Winai said if the scheme was distorted, things might go back to the old days when only people described as “destitute” could receive free treatment. But several groups of academics and medical workers have campaigned for the National Health Security Act to be amended, warning that without change, the country will suffer because of the huge financial cost of the scheme. 

 

Several doctors have also complained that the scheme has hit the quality of medical service in Thailand. In their eyes, the NHSO set up criteria and rules that were not practical.

 

“There are many medicines that doctors cannot prescribe to patients because they are not on the drug list authorised by the NHSO,” Dr Yong Poovarawan, from Chulalongkorn University’s Faculty of Medicine, wrote on Facebook. 

 

He said patients also had to undergo a complicated and sometimes impossible referral process. 

 

“I also need to emphasise that today Cambodia now offers more free vaccinations for children than Thailand,” he said. Supporters of the National Health Security Bill and changes to the universal healthcare scheme believe co-payments should be introduced. 

 

Yong, for example, said overall medical service quality would improve if people agreed to pay for services they could afford. 

 

Winai, however, said it was hard to determine who exactly should be entitled to free treatment. 

 

“The people who are rich today may become poor tomorrow,” he said. 

 

Winai and advocates say the current scheme was good in that it gives people the right to medical treatment, which meant that people were not forced to beg for treatment. 

 

In Winai’s opinions, state hospitals should not complain about financial losses from universal healthcare. 

 

“State hospitals are established to take care of people’s health,” Winai said. “Human resource are important. The government should understand that having a healthy population is good. 

 

It’s well worth spending money to maintain people’s health”. 

 

Aids Access Foundation head Nimit Tien-udom said he was worried about the National Health Security Bill’s stipulation that would boost the number of medical-service provider representatives on the National Health Security Commission. 

 

This raised fears that the commission could in the future side with hospitals rather than patients. 

 

Dr Thira Woratanarat, a lecturer at Chulalongkorn University’s Faculty of Medicine, recommended that the scope of free medical services be made clear via public participation to ensure the public’s acceptance. 

 

Source: http://www.nationmultimedia.com/news/national/30317794

 

-- © Copyright The Nation 2017-06-12

[SOUTHERNSTAR]

Dig your own graves.

[Bob12345]

Let me look in my crystal ball and tell the future:

the scheme will start charging people a tiny amount for medical treatments. 

Slowly but surely the amount people have to co-pay will increase, but because it is going with tiny increments people just accept it.

Whenever there is a protest a small increase is reversed, only to be added back again a few weeks later when nobody is watching.

 

In a couple of years the country will be back a lot closer to the pre-30-baht-scheme era with the poor getting into debt to pay for their medical bills.

 

Next a populist politician will stand up for the poor and re-introduce the 30-baht scheme.

That person will win with a landslide victory only to be ousted by the military who are afraid their privileged position gets into danger.

 

And then we are back at where we started.

 

Unfortunately for Thailand the world around it moved along during that time period, and the country is now hopelessly behind its neighbors losing out on every front (cheap labor, tourism, safety, national health, etc).

[robblok]

12 minutes ago, Bob12345 said:

Let me look in my crystal ball and tell the future:

the scheme will start charging people a tiny amount for medical treatments. 

Slowly but surely the amount people have to co-pay will increase, but because it is going with tiny increments people just accept it.

Whenever there is a protest a small increase is reversed, only to be added back again a few weeks later when nobody is watching.

 

In a couple of years the country will be back a lot closer to the pre-30-baht-scheme era with the poor getting into debt to pay for their medical bills.

 

Next a populist politician will stand up for the poor and re-introduce the 30-baht scheme.

That person will win with a landslide victory only to be ousted by the military who are afraid their privileged position gets into danger.

 

And then we are back at where we started.

 

Unfortunately for Thailand the world around it moved along during that time period, and the country is now hopelessly behind its neighbors losing out on every front (cheap labor, tourism, safety, national health, etc).

The health scheme should have been better financed (now and in the past) unfortunately the tax payer base is too small. Nobody wants to pay extra tax and the poor can't pay much more.. the middle class is already paying a lot.. and the rich are surely not going to pay. So where is the money going to come from ? I doubt they will spend less on the military. I also doubt that other popular policies get less money as that will make people unpopular. Hard choices for those in charge. They should have left it to real politicians.. then they would be come unpopular.  Because.. it can't go on like this and with an aging population the cost will only rise.

 

Now we got expats that want for a minimum fee to be included in this already overburdened scheme because its so unfair to them they have to get health insurance.. I don't see it happening.. Maybe if they pay 50k or more a year (still peanuts)

[Srikcir]

10 hours ago, webfact said:

" ....convince the government that it’s worth investing in people’s health.” 

Ill and dead people don't vote nor protest regime changes.

That might have a lot of appeal to the Prayut government.

[JAG]

3 hours ago, Srikcir said:

Ill and dead people don't vote nor protest regime changes.

That might have a lot of appeal to the Prayut government.

True, but their families, who see themselves saddled with horrendous debt which will inevitably cost them the family assets, might get a tad upset don't you think.

 

It's a real conundrum for the "good people".

 

They don't need a universal healthcare scheme, after all they are either insured or covered by one of the other state schemes which exist for the states employees. There are so many ways in which money could be spent on projects and  procurements which would greatly benefit them, and improve their standing, yet the money supply is not sufficient and much is being wasted on health care for people who don't even live anywhere Bangkok.

 

"Tis a right booger"

 

[Smarter Than You]

5 hours ago, robblok said:

The health scheme should have been better financed (now and in the past) unfortunately the tax payer base is too small. Nobody wants to pay extra tax and the poor can't pay much more.. the middle class is already paying a lot.. and the rich are surely not going to pay. So where is the money going to come from ? I doubt they will spend less on the military. I also doubt that other popular policies get less money as that will make people unpopular. Hard choices for those in charge. They should have left it to real politicians.. then they would be come unpopular.  Because.. it can't go on like this and with an aging population the cost will only rise.

 

Now we got expats that want for a minimum fee to be included in this already overburdened scheme because its so unfair to them they have to get health insurance.. I don't see it happening.. Maybe if they pay 50k or more a year (still peanuts)

Why aren't the rich going to pay?

Why do they get to decide?

 

[jaltsc]

"Former NHSO chief says govt needs to understand that a healthy population is good for the country as a whole..."

 

Basically what he is saying is: "In order to make the population healthier, you need to give up the sources of income that enable you to live your lavish lifestyle."

 

That should be easy to convince them to do, considering that the government has its fingers in the selling of tobacco, alcohol, sugar and every other unhealthy and arguably addicting products.

Edited June 12, 2017 by jaltsc

[YetAnother]

15 hours ago, webfact said:

Former NHSO chief says govt needs to understand that a healthy population is good for the country as a whole

really ?!

[janclaes47]

How about reorganizing the government hospital administrations?

 

In every government hospital at least 60% of the staff should be fired and the administration modernized.

 

Next, weed out the corruption in the hospital pharmacies. When I go get medicine for my son he gets only 2 week supply because he is on a restricted medicine, which is understandable.

 

But each time I see several people leaving from that window with 2 shopping bags, the size of a Tesco shopping bag, completely full of medicine.

 

A Thai business man once told me it are private pharmacies who have a deal with someone behind the counter, and sell this free medicine in their pharmacy.

[the guest]

A better health scheme can only be achieved by all those that earn an income put into the pot, and VAT to be increased to 10% (currently 7%) to allow adequate funding of the service.

[Reigntax]

6 minutes ago, the guest said:

A better health scheme can only be achieved by all those that earn an income put into the pot, and VAT to be increased to 10% (currently 7%) to allow adequate funding of the service.

 

Unfortunately the junta will prefer use of any increase for more military toys rather than improve the health of those peasants who continue to vote incorrectly.

[Eric Loh]

The irony is that the UHC covers 76% of the population while the civil service medical scheme covers 7% but the expenditures are more than the UHC. Seem a serious look into the use of funds urgently needed for all 3 healthcare systems including the workmen and social security medical coverage. 

[JAG]

Why aren't the rich going to pay?
Why do they get to decide?
 

Because the government answers to them.

[robblok]

2 hours ago, Smarter Than You said:

Why aren't the rich going to pay?

Why do they get to decide?

 

When do the real rich ever pay in any country. 

[robblok]

1 hour ago, the guest said:

A better health scheme can only be achieved by all those that earn an income put into the pot, and VAT to be increased to 10% (currently 7%) to allow adequate funding of the service.

If they increase the vat to 10% everyone will moan.. but I do think it would be a fair way to finance this. There is no way to finance it without either cutting somewhere else (not going to happen) or extra taxes. 

[tomta]

18 hours ago, robblok said:

When do the real rich ever pay in any country. 

In Scandinavia they do. There was a case in Finland a few years back where a billionaire speeding driver got a ticket for  a huge amount, hundreds of thousands of dollars because fines are linked to income as they should be.