Thai universal healthcare: Should it be a right with responsibility?

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OPINION

Thai universal healthcare: Should it be a right with responsibility?

By Titipol Phakdeewanich
Special to The Nation 

 

BANGKOK: -- In 2002, universal healthcare coverage was initiated by the Thai Rak Thai government. Nicknamed the Bt30 healthcare programme in reference to the cost of each medical visit, the scheme gave 49 million people living both above and below the poverty line almost free access to healthcare services.

 

Universal healthcare was overwhelmingly welcomed by the rural poor, especially in the North and Northeast (Isaan) – the political base of the Pheu Thai Party and its predecessor Thai Rak Thai. The policy remains a cornerstone of Pheu Thai’s platform, allowing it to maintain support and popularity by portraying itself as representing the rural poor. 

 

Since 2002, however, discussion on revising universal healthcare has been politicised and become politically sensitive. Increasing numbers of people have begun to perceive healthcare as an absolute right, with little consideration of it as a personal responsibility.

This has triggered concerns over public expenditure on the programme.

 

It is undeniable that a universal healthcare scheme is necessary, and it was originally introduced in compliance with Section 52 of the 1997 Constitution. Indeed, at that time the public was not fully aware that universal healthcare was a constitutional right that the state must provide. 

 

Most supporters of Thai Rak Thai perceived universal healthcare as a gift from the party, failing to realise it was a duty and responsibility of their representatives to pursue such a policy. This allowed the party to establish a personal bond with them – which in fact is typical of Thai political culture regardless of who is in government. 

 

Since 2014, the National Council for Peace and Order (NCPO) has pushed for reform of the universal healthcare bill in order to introduce a co-payment scheme. This is partly because so many hospitals and doctors are complaining about the financial burden on the system, and claim that the people have been “spoiled” by the system and are now making too many unnecessary hospital visits. 

 

However, it is too simplistic to view the rising number of hospital visits and conclude that the universal healthcare scheme has spoiled the people, since the costs of healthcare are not just a medical bill for the rural poor. 

 

Patients, especially the rural poor, incur expenses every time they access medical treatment, including for travel and lost income from not working. Such expenses are a serious financial burden for a large number of patients and mean that rural people often can’t access hospital treatment even when they need it. However, this fact is generally missing from the healthcare debate among doctors and the middle class.

 

“I have to get up at 1am to get here early for the hospital queue,” reports a villager who travelled from a district of Khemarat to the hospital in the city of Ubon Ratchathani recently. “Travelling from a rural part of the province to the hospital is not that easy. Sometimes we have to contribute Bt100 each to rent a truck to take us to the hospital. There are many things that we have to pay for to get here [hospital]. Paying the small amount of Bt30, or not paying at all, really helps us.” 

 

Healthcare should be free and considered a right for the rural poor, particularly for the 10.5 per cent of population that lives below the national poverty line – but not for all. For those who can afford it, healthcare should be considered a responsibility, for which a co-payment scheme should be applied.

 

In addition, Thailand is now considered to be an ageing society, with about 7.5 million people or 11 per cent of the population over the age of 65. The World Bank estimates this figure will rise to 17 million by 2040. Public expenditure on healthcare will almost certainly rise as a result, presenting a big challenge for which the government must be prepared.

 

The introduction of a co-payment scheme by the NCPO makes clear financial sense for the government. However, the validity of the move has been undermined by the priorities set for public expenditure under this administration. The NCPO has demonstrated that its spending often does not synchronise with the needs of millions of Thais. Recent examples include the US$393 million spent on submarines from China, and the agreement to purchase four Black Hawk helicopters from the United States. The NCPO claims these purchases are important for national security, despite the country not being at war.     

 

In his 2016 speech at the UN general assembly, Prime Minister Prayut Chan-o-cha highlighted the importance of healthcare: “We also have a continued policy of providing quality healthcare services for all.” 

 

So where does the government’s priority lie now – with national security or with human security? This is an important question that must be answered by the military leadership. Can a country be secure without a healthy population? Can the economy prosper with a populace that is left prey to illness? 

 

Another important question is how much the junta can successfully reduce the public financial burden of healthcare through the introduction of a co-payment scheme. This is not entirely a question of spending priorities, however, but also a matter of political games, in which politicians will play an important role. Providing social welfare is always rewarding for politicians and those in power, because such policies help ensure they maintain public popularity. 

 

Exactly how much individuals will need to contribute to the co-payment scheme has not yet been finalised. However, this scheme must not become a barrier to accessing healthcare for those who live in poverty. 

 

Titipol Phakdeewanich is dean of the Faculty of Political Science at Ubon Ratchathani University, and a visiting fellow at the Centre for the Study of Globalisation and Regionalisation at the University of Warwick in England. 

 

Source: http://www.nationmultimedia.com/news/opinion/30320395

 

-- © Copyright The Nation 2017-07-11

[connda]

The local hospital in our Amphun in Lamphun routinely processes 100 people in four hours, then up to another 30 or so stragglers in the afternoon.  They are incredibly efficient.  Significantly better than a private hospital such as Sripat.  

Thai Universal Healthcare works.  But there are always forces at work to privatize the nationalized healthcare system so the private sector can harvest the wealth of the most vulnerable in society or otherwise dump the financial burden of the system of those who simply cannot afford it.  This program is in place to take the financial pressure off the poorest segment of Thai society.  

You'll never hear the success stories of this program from Thai mainstream media.  There are many success stories.  

Edited July 11, 2017 by connda

[lordblackader]

1 hour ago, connda said:

The local hospital in our Amphun in Lamphun routinely processes 100 people in four hours, then up to another 30 or so stragglers in the afternoon.  They are incredibly efficient.  Significantly better than a private hospital such as Sripat.  
 

I visit one of the small private hospitals (well small in comparison to the massive better well known ones) in Chiang Mai that caters for public and private patients and I've never, ever in my entire life seen a more efficient hospital anywhere in the world. By separating each part of the process out (ie the GP doesn't do everything) you can be in and out in under 30 minutes, a couple of hours max if things like bloods test and shots are required. Western countries could learn a thing or two by coming an observing how to properly run an efficient hospital. 

[perthperson]

The provision of "free" (or almost free) universal healthcare does result in allegations of abuse. 

 

For proof look up the ongoing debate in the UK where the NHS provide "free at the point of delivery" healthcare to all comers. 

 

I am a supporter of universal healthcare but do not have any answers about how it can be made more affordable unless the service is severely restricted in terms of what is treated "free" 

[robblok]

Universal healthcare is good.. but it should be better funded. However the Thai tax base is quite small so I understand that they are searching for co payment. IMHO the increased spending on the military should have been diverted to the health budget (not that that is going to happen). But one has to accept that healthcare will never be perfect and there will always be a shortage of funds. Now Thailand has an aging population the strain on the budget will only get worse. Choices have to be made and people will have to be taxed more else its not possible to go on like this.

 

Its nice to say its a right.. but who is going to pay for this right ? Maybe the vat should be raised by 1% and that 1% should be directed at the health budget (and put in law that it stays that way). 

[robblok]

2 minutes ago, perthperson said:

The provision of "free" (or almost free) universal healthcare does result in allegations of abuse. 

 

For proof look up the ongoing debate in the UK where the NHS provide "free at the point of delivery" healthcare to all comers. 

 

I am a supporter of universal healthcare but do not have any answers about how it can be made more affordable unless the service is severely restricted in terms of what is treated "free" 

Same here.. healthcare is never free.. someone has to pay.. and that someone is the taxpayer. The more people and services are included the more the taxpayer has to pay. Here in Thailand the taxbase is real small.. so I can see people against this as it is probably going to be the middle class again who needs to pay. 

 

Though a 1% added to the VAT and directly spend on the health budget might be an option. 

Edited July 11, 2017 by robblok

[Samui Bodoh]

I really dislike the debate labeling health care either a 'right' or a 'commodity'. It is simply a fact that everyone, at some point in their lives, will use the health care system. The logical outcome of the previous sentence is that it should be a shared function among all citizens. It is a question of fairness.

 

Is it free? No, it isn't. It should be payed for by taxpayers, and those that have done well in life should kick in more if they have more. This is not a 'socialist' point of view; rich people, especially in Thailand, tend to come from rich families who were able to provide for education, etc. I would say that being rich depends on luck as much as anything else; the poor work just as many hours as the rich,  but they haven't been rewarded as well. And before anyone says, it, I am okay with rich people; it is the way humanity works.

 

I would compare the two systems that are familiar to me, the US and Canada. In the US, if you are wealthy, you have access to a great health system and things are fine. If you are poor, well, tough luck. In Canada, everyone is covered because everyone contributes a small portion of their income based on its size. You (everyone!) might not get into see a doctor as fast as a rich American, but you get in and get treated. And it is covered.

 

Big picture, the US spends twice as much on their health system as Canada, and achieves worse results. 

 

Unfortunately, I think Thailand will model the US system as all the people in government are rich, unless you believe that the soldiers live on their salaries.

 

Poor people deserve health care, not just the rich. Period.

[Nurseynutcase]

I am all for healthcare free at the point of delivery, but such a system is open to abuse.

 

I worked in healthcare in the UK for 38 years and saw first-hand the growing reliance on the NHS.  It is abused greatly with people not willing to take any responsibility for their own health, instead expecting the NHS to pick up the pieces.  Ultimately the tax-payer.

 

At least once a day I saw someone from 'the worried well' set whose words were, invariably 'I have read on google that I could have this, that or the other'.  Invariably time consuming and frustrating for the medics involved.  Thus consuming time that could be better spent with those who were genuinely unwell.

[BEVUP]

Well now that the government knows how many poor people there are ( like some 14 mil ) & i think this number is under quoted , they should concentrate on them & use a sliding scale depending income ( those who obviously cant prove should be investigated ) to determine how much extra should be paid for various cover like private insurance.

Something Auss should learn instead of making me pay an amount that would cover the world (including America) with triple A Gold + cover

[Samui Bodoh]

3 hours ago, Nurseynutcase said:

I am all for healthcare free at the point of delivery, but such a system is open to abuse.

 

I worked in healthcare in the UK for 38 years and saw first-hand the growing reliance on the NHS.  It is abused greatly with people not willing to take any responsibility for their own health, instead expecting the NHS to pick up the pieces.  Ultimately the tax-payer.

 

At least once a day I saw someone from 'the worried well' set whose words were, invariably 'I have read on google that I could have this, that or the other'.  Invariably time consuming and frustrating for the medics involved.  Thus consuming time that could be better spent with those who were genuinely unwell.

 

I don't have the courage to argue with someone who has 38 years with the NHS, so I won't.

 

That said, I would make two points. First, a country's health care system is designed to provide care to its citizens, and not all citizens are...ahem... terribly bright or all there. In an ideal world, the only people who would use the health care system would be those who took care of themselves and needed it. However, we don't live in an ideal world, so we will have to build in costs for "the worried well" and others. I don't like wastage or inefficiencies either, but any system used by human beings will have them.

 

Secondly, any effective health care system will need to be able to deal with the human factor. I hope any and all nurses and practitioners would be willing to rip the head off of anyone who was wasting their time. In fact, I would argue that it is (unfortunately) part of their job. And having been chewed out by a nurse more than once (non-medical reasons, nuff' said), I would argue that a "worried well" would think twice before they tried it again.

 

As you said, " I am all for health care at the point of delivery". I fully agree and would like to see every country, especially Thailand, have a system that works. It is hard, expensive and worth it. 

[Samui Bodoh]

7 hours ago, perthperson said:

The provision of "free" (or almost free) universal healthcare does result in allegations of abuse. 

 

For proof look up the ongoing debate in the UK where the NHS provide "free at the point of delivery" healthcare to all comers. 

 

I am a supporter of universal healthcare but do not have any answers about how it can be made more affordable unless the service is severely restricted in terms of what is treated "free" 

 

This is an interesting point. And I don't have a great answer either.

 

The link is from a Canadian province where they tried "user fees", but then later decided they needed to be modified or removed. Interesting reading!

 

http://www.cbc.ca/news/canada/montreal/gaetan-barrette-user-fees-abolition-1.3951648

 

Cheers

[perthperson]

3 minutes ago, Samui Bodoh said:

 

This is an interesting point. And I don't have a great answer either.

 

The link is from a Canadian province where they tried "user fees", but then later decided they needed to be modified or removed. Interesting reading!

 

http://www.cbc.ca/news/canada/montreal/gaetan-barrette-user-fees-abolition-1.3951648

 

Cheers

Thats interesting thanks.  I was always under the impression that private medical practice was banned in Canada. ( I am aware that there are "private" providers of tax funded healthcare) 

[Samui Bodoh]

6 minutes ago, perthperson said:

Thats interesting thanks.  I was always under the impression that private medical practice was banned in Canada. ( I am aware that there are "private" providers of tax funded healthcare) 

 

If I may use a "Canadianism"...

 

:"We allow some, limited, private aspects to the health system if necessary, but we don't necessarily allow some, limited, private aspects to the health system."

 

Actually, our provinces run their own health systems; we don't have a national system. But, as the Federal government does contribute funding to the respective systems, they do get some say about standards.

 

'Interpretations' of federal/provincial rules are legendary in Canada. It's just the way we do things.

 

Cheers