Problems in healthcare much bigger than one rock star can solve alone: expert

Even more rock stars running charity marathons to seek donations for hospitals would not solve the structural problems of the nation’s healthcare system, which is under threat from the current military government.

Last week, Artiwara Kongmalai, aka Toon Bodyslam, lead singer of rock band Bodyslam, made headlines once again after he set off on a 55-day marathon to raise money for 11 public hospitals.

The marathon has attracted a lot of supporters but also a lot of critics who think that Artiwara is trying to solve the problem by the wrong means – bailing out bankrupt public hospitals rather than leaving it to the military government who purchased weapons with a price tag that surpassed the 2.7 billion baht public health budget.

Prachatai talked with Sureerat Treemanka from the People's Health Systems Movement about the current problems of the public healthcare system, how it is under threat from the current military government, and how it can be improved.

 

-Toon Bodyslam’s run is a typical phenomenon in Thai society. Thai people like to donate. They just want there to be someone do the work for donations. It fits with the behaviour of Thai society but if you ask if money that’s been given can solve the problem, it can’t because the system is larger than that. You get 60-70 million for Bang Saphan Hospital, it may be able to buy medicine and equipment but it can’t buy doctors of find doctors to go there. Bang Saphan has the same problems. The capitation rate of 3,000 baht should be increased a little to 35,000. It may need 25 billion baht more. No matter how far Toon runs, it won’t reach 25 billion.

-[The military government’s attitude towards public healthcare] is conceptually undermining of the provision of health insurance as welfare that the state provides for all. It is the opposite of providing welfare just for certain target groups. Universal welfare is provided for everyone regardless whether they are poor or rich. It is basic welfare for human beings. It is not about poverty, but must be provided to everyone no matter who they are.  

-The constitution should not specify that welfare is only for the poor. This is the mind-set that starts to erode the universal welfare system. Next, it will be most eroded by saying that we can’t provide welfare because we don’t have enough money to provide for everyone. Once you say this, universal welfare provision will not then be real. The money that we have will be spent only on the poor. So the policy of registering poor people came up in order to find out where poor people are and to locate the target group. This is the destruction of the principle of universal healthcare.

-The public health insurance budget per head is still not enough. It should be increased a little more to make it more flexible without the problem of liquidity. If it is increased by just 100-200 baht per head, liquidity would increase because we have to grow to keep up with technology and medicine and costs. In the past, increases did not match costs. This increase does not mean that the rise is unreasonable but the rise is in proportion to the national budget, which also increases. But the big problem of health insurance is that the management of the system has problems.

-The state allocates the budget for healthcare unequally. If the money was pooled (from the government officials’ welfare fund, social security and the National Health Security (gold card) system), welfare management could be better, the administration could be better. At the moment, the burden of infants and people above 60 is covered by the gold card scheme. But social security covers working people aged 25-55 years who are physically still strong. Then government officials use services without constraints. This is mismanagement due by the state which cannot manage with a single system. But their way of communicating is just to say that the hospitals lack funds only because of the gold card system but they don’t talk about the lack of funds in the entire system.

-Uniting the three funds is very difficult. We don’t have enough public support and we are not united. Government officials do not care as long as they are left alone. They have their card and they are happy. Social security has almost no mass support. For people in the gold card system just protecting their system is almost impossible. Combining them together has been discussed for more than a decade. People no longer feel excited about the numbers when we say that the average budget per head for universal healthcare is 3,000 baht, for social security it is 2,700 baht per head, but for civil servants it is more than 10,000 baht. They are indifferent, as if they accept that poor people should receive just that.

-It is not that there is not enough money. If they take all the money and manage it seriously, there is enough. It is not about medical care. It is not about the idea that those with money should pay and those who do not should be get welfare. This way of thinking in Thai society sounds plausible because we believe if someone begs, we should give. But those who can work should have work. Saying that the country does not have enough money, we don’t believe that. It is not true. The money is there but is it concentrated in different places so the state cannot get at it to distribute it. When they cannot do this, they shift the burden and lay it on those who are already struggling the most. It turns into the poor being registered as poor even though Thailand has the financial security and natural resources to enable the country to be administered to have better quality and give its people more dignity than this.

-I do not want to compare spending money to buy weapons, so that health insurance has no money because they have never believed that health insurance is good for people. They have never believed that welfare should be provided for everyone. Therefore, they do not feel anything. They do not know that it is their fault that they do not have this way of thinking, they do not have a way of monetary and financial management for humans, for society. They just manage according to what the government system says.

-According to the intention of the National Health Security Act, public healthcare does not have to be administered by the National Health Security Office (NHSO) only. Any local administrative organisations which are ready to administer the system and have the potential must be allowed to enter and be given a budget to administer themselves. There will be diversity and ownership of the system. But currently, they have closed the way for private organisations to receive money and forbidden them receiving money from the healthcare fund, claiming that money from the fund can only be used for medical treatment. This makes the former system which was transparent have less participation from the people’s sector and local administrative organizations in thinking together, acting together criticising together, and evaluating together.    

-We propose that hospitals should belong the communities. They do not have to be under the Ministry of Public Health. Let people in the area can run for themselves without Toon having to run. Let us take care of our own hospitals. We will find equipment and doctors for our own hospitals. Finance will be managed by hospital management committees with civil society groups, doctors, and related people in local organizations as hospital administrators. The hospitals do not have to be under state control. They should be mass organizations and everybody pays 10 baht if they want to contribute or want to donate. If people donate 10 baht each, we can take care of our hospitals ourselves. We don’t need Toon to run. We will run together, so everything will last and we can take care of equipment over the long term.  It’s not money that we get one year and then finish because that does not help to solve the problem.