Thai health care scheme may be weakened after reform by the junta

Prayuth Chan-Ocha, the head of the junta and Prime Minister, has revealed the eleven policies of his administration, one of which is a plan to improve Thailand’s health system; however, the conservative junta might set Thailand’s health policies back by ten years.
 
Prayuth stated that they would facilitate a health insurance system accessible to all, prioritize preventive medicine to reduce costs, and redistribute health personnel to rural areas in accordance to the fifth policy of his government.
 
This, however, contradicted his words in early August when he called on the rich to leave the universal health insurance system to the poor.
 
“The rich should make a sacrifice to people with lower income without being forced to by the state. If 3-5 million people give up their universal health care rights, we will have a bigger health budget,” said Prayuth on his Friday TV programme on 22 August 2014.
 
This might sound reasonable, but that fact that the junta might try to reduce the budget for the national health care scheme and increase the salary of bureaucrats instead would contradict their promise to provide health care accessible to all. 
 
The junta wants to reduce the cost of the public health care by setting the per capita health care budget next year at 2,895 baht in contrast to the inflation-adjusted figure of 3,060 baht proposed by the National Health Security Office (NHSO). 
 
This reduction will cause a net shortfall of 483 baht per capita, and will take 23,184 million baht out of the national health insurance budget.            
 
According to Sureerat Treemaca of the People's Health Systems Movement, a reduction in the budget for health care will worsen the public health system in Thailand.
 
“The idea that there is not enough budget for health care is a discourse that the Bureau of Budget has always been using. But in fact, out of a national budget of 2-3 trillion baht a year, 140 billion baht is spent annually for public health care, which is not much at all” said Sureerat.
 
She also pointed out that the junta’s health policy, which only prioritizes the poor, is flawed because the essential reason for creating a welfare system is to reduce the income gap. Therefore, the health care system should be created equally for both the poor and rich via a system of taxes that they can afford to pay.    
 
Sureerat said unequal provision of health care will set Thailand back ten years in its public health policies. 
 
“When we talk about welfare and health insurance, we should keep in mind that it should be accessible to everyone equally. However, the conservative paradigm of the junta, which thinks that welfare and health care should be provided only for the poor because a universal system will have additional costs, will set Thailand back ten years in its health system,” said the outspoken member of the People's Health Systems Movement.
 
Thaksin Shinawatra, a controversial ex-prime minister renowned for his so called ‘populist policies’, introduced the universal health coverage scheme in 2001. The scheme was called the ‘30 baht policy’ where people receive a ‘gold card’, allowing them to access medical treatment in their registered district with a co-payment cost of 30 baht per illness. 
 
According to the World Bank, 99.5 percent of Thailand’s population have access to public health care, which is divided into three schemes, one for government officials and their families, a social security system for employees in the formal private sector, and the universal health coverage.
 
When Thaksin’s government was overthrown by the coup in 2006, the next military-appointed government chose to retain the universal health care policy. However, they cancelled the co-payment and relied fully on tax revenue for funding health care. 
 
Although most Thais have access to public health coverage schemes, there are two apparent problems; one is the imbalanced distribution of health personnel, which are scarce in rural areas, and inequality in the medical treatment provided to patients covered by different healthcare schemes.
 
 
According to Sureerat, the contrasts of the number of physicians in cities and in rural areas and among the health budget for government officials and others are striking.
 
“Physicians are more concentrated in cities because they can treat patients with all kinds of diseases, earn more, and can pursue further medical studies as well. Another problem is inequality in health care policy. In Thailand, the budget for government officials’ medical treatment is unlimited, whereas others covered social security and the universal health scheme get limited treatment and cheaper medicines,” said Sureerat.
 
She added that, annually, 5-6 million government officials and family members in Thailand consume six to seven billion baht a year for health care, paid for by the Comptroller General’s Department, whereas ten million people eligible for social security consume only two to three billion annually and the rest, numbering more than 50 million people, get 10-20 billion baht a year.
 
Moreover, the high medical costs of the government officials’ scheme are not transparent and accountable, according to Sureerat.
 
“People who are under the universal health coverage and social security schemes usually get different medicines, which are cheaper than those provided under the government officials’ scheme. The way of allocating medicines is not standardized,” said the welfare campaigner. 
 
Another major problem of public health system in Thailand is the commoditization of health institutions in the country. Hospitals in the private sector operate in a manner similar to for-profit businesses. These private hospitals are more attractive for physicians and nurses since they pay more than public hospitals. These private hospitals have been drawing resources away from the public health sector.
 
“Thailand allows private hospitals to become profitable businesses that can even be listed on the stock exchange. It allows private hospitals to absorb important public health resources. In addition, the promotion of Thailand as a ‘medical hub’, with state support for private medical businesses, will take more resources from the public health sector,” said Sureerat.
 
For her, although Thailand prides itself for being one of the most advanced ‘medical hubs’ that welcome medical tourists from all over the world, it does not mean that all Thailand’s citizens have equal access to medical treatment.