Sudarat questions future of 30-baht scheme

Sudarat questions future of 30-baht scheme

Former public health minister Sudarat Keyuraphan has questioned how the draft constitution can improve the 30-baht universal healthcare scheme as claimed by its writers.

She wrote on Facebook a few weeks after constitution writers said the programme would not only remain in place but also be improved.

The former public health minister, who was responsible for supervising the programme during the Thaksin Shinawatra government, started by comparing the clauses endorsing the right to public health care in the previous two charters.

"The 1997 charter says: 'A person has an equal right to standard public health care' while the 2007 constitution says: 'A person has an equal right to suitable and standard public health care'.

"However, the draft charter reads: 'A person has a right to public health care'."

She pointed out the missing words were: "equal" and "standard".

Even though the two charters and the draft to be put to the Aug 7 referendum endorse the right of the poor to public health care free of charge as defined by law, the absence of the two words means the services provided to the poor and to the rich might be different because they are not a "universal" right, she wrote.

"I think the differences reflect the different attitudes toward human rights."

A state is obliged to guarantee that all people have the same right to the same standard of health care, she continued. "And this is the core principle of the universal healthcare scheme."

She also asked the charter writers two questions.

First, she asked what the guarantee was that people in the scheme would receive the same standard of care. "Does this mean the poor will receive the kind of treatments provided under the 'charity card' before the 30-baht programme?" she asked.

Second, she questioned why the writers cut out the two words in their version.

"After carefully reading the draft, I don't see any provision that could improve the gold card as claimed [by the writers]," she wrote.

"I therefore will exercise my right not to endorse the draft charter," she concluded.  

Meechai Ruchuphan, head of the draft constitution writers, said on July 7 the existing 30-baht programme would continue and the draft charter would make it more efficient, cost-effective and of higher quality.

Less than a month before the charter referendum, the 30-baht programme is the deal-breaker for many voters and Mr Meechai claimed there were attempts to distort the charter by saying it would be scrapped, which was not true.

However, rumours about the fate of the universal health care scheme are not without grounds. Since the coup, the junta has made no secret of its intention to change the programme in some way, claiming it was not sustainable and the country could ill-afford it.

It started when Piyasakol Sakolsatayadorn, former public health minister, floated idea of a co-pay system late last year but met with strong resistance.

Defenders of the programme said people already paid for the programme through various taxes and its per-head cost was five times less than the budget spent on government official heath care.

A 2011 study found the government paid 14,000 baht per person to cover medical bills for some 5 million government officials and their family members, or 62 billion baht a year in total.

The 30-baht programme for 48 million people costs 2,700 baht per person, or 101 billion baht in all.

The prime minister also said the programme was a big burden for the country and wanted to cap it by limiting eligibility only to the poor.

The cost of the programme, which covers 48 million people, stands at 1.3% of GDP while the total public healthcare cost was 4%, according to the National Health Security Office (NHSO), the operator of the 30-baht programme.

Since its launch in October 2001, the scheme has caused resentment among public health officials, doctors and state hospitals because it shifted most of their budget to the NHSO, which acts as the buyer of the services on behalf of the members and drives a hard bargain with hospitals and doctors to maintain the standard.

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