Expert says new fiscal policy on public health jeopardises Thailand’s healthcare

A former member of the National Health Security Office (NHSO) has warned that if the new proposal to restructure the national public health budget is implemented, it would be as if the nation’s healthcare scheme was scrapped.

Nimit Tienudom, former commissioner of the NHSO, on Sunday, 3 January 2016, said that despite reassurances from the military government that the universal healthcare will remain intact, a new resolution by the Office of the Council of State on the national healthcare budget would severely degrade the public health system if it is implemented.

Nimit said that under the current healthcare system, public and private hospitals which treat patients under the universal healthcare scheme could allocate the health budget of about 3,000 baht (83 USD) per patient nationwide for other uses such as hiring extra part time personnel, procuring medicines and equipment, or paying for other operational expenses. Under the new resolution on the health budget from the Council of State, however, hospitals would be barred from doing so.

The former NHSO commissioner called the resolution ‘narrow’ and ‘problematic’, saying that without using part of the per capita health budget for operational expenses, hospitals, especially public ones, would not be able to treat patients properly since their medical resources are already strained.

“Frankly speaking, after the military government came to power, universal healthcare in Thailand has become very problematic and patients have been affected. [They said that] it is a good thing and that they won’t destroy it, but their behaviour is the opposite,” said Nimit.

In addition to the budget restrictions under the new policy, the resolution also prevents hospitals from paying extra for health professionals who work extra hours or to compensate health professionals in the case of accidents occurring during working hours.    

“Besides the effects on public health service providers, private health service providers would also be affected because from now on private hospitals would not want to provide services under the universal public health scheme because of complications in budget allocation,” added Nimit.

He commented that another important implication on the new health budget resolution is the fact that the NHSO would no longer be able to procure medicines and prostheses from the Government Pharmaceutical Organisation (GPO) because the Council of State concluded that the expenses for procurement are not part of the public health budget.

“Most people think that this shouldn’t be a problem because hospitals can just buy medicines themselves, but they forget that by procuring medicines [for hospitals] nationwide at once, [the NHSO] has more bargaining power and can get cheaper medicines and equipment,” said the former NHSO commissioner.

On 30 November 2015, Disatat Hotrakit, Secretary-General of the Office of the Council of State, submitted a new resolution on the public health budget to the Public Health Ministry. It is not yet certain whether the resolution will be implemented or not.   

Although most Thais have access to public health coverage schemes, there are two apparent problems: 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 Treemaca from the People's Health Systems Movement, the contrasts in the number of physicians in cities and in rural areas and between 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 by 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.

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