Negative remarks time and again by Prime Minister Prayut Chan-o-cha about the Universal Healthcare Coverage (UC) scheme seem to signify its uncertain future. He has complained that the scheme, which provides free health access to more than 48 million Thais, is a huge financial burden for the administration.
Early this month, the Federation of Regional and General Hospital Doctors posted financial data on its Facebook page showing that 18 state-run hospitals were in deficit. Later Public Health Minister Piyasakol Sakolsatayadorn corrected the figures, saying only five hospitals were in a critical financial situation.
The future of UC has long been debated while the parties concerned attempted to find the root cause of problems for the scheme, which was launched in 2002 by the Thaksin Shinawatra government. Operated by the National Health Security Office (NHSO), the scheme was then known as the "30-baht healthcare scheme".
The NHSO receives the scheme's budget from the government and distributes it to hospital operators, based on capitation payments per person.
Under the UC's philosophy, the scheme is operated not as a charity but rather as serving the rights of citizens to access social welfare. Initially, UC recipients were required to pay 30 baht for any medical treatment. Later the Abhisit Vejjajiva government transformed the scheme, renamed it the Universal Healthcare Coverage scheme and removed the 30-baht fee.
The capitation budget has more than doubled from its first year of operation, increasing from 1,202 baht per head per year in 2002 to 3,029 baht in 2016. The NHSO was provided with 163 billion baht to operate the UC in 2016.
However, some doctors often blamed the UC's inadequate budget as the reason for their hospitals' financial trouble, while health personnel have to handle a large number of patients under the scheme. Work overload, they claim, has compromised the health service. Some doctors suggested a co-payment method for the UC, meaning patients are required to partially pay for medical bills. Some go further and say the scheme should be terminated.
Apart from its financial problems, we have to admit that the scheme, which has gained international recognition, has been a great success because it truly benefits the public.
Some believe that critics of the scheme, including politicians, state officials and particularly hospital administrators, have politicised the problem because they have lost the power to manage the budget. Worse, many see the move as an attempt to wipe out the influence of former prime minister Thaksin as some still think the health scheme is one of his populist legacies.
In particular, the negative remarks of Gen Prayut about the financial burden are not a good sign for the scheme. Earlier, Gen Prayut, who in 2015 shared the UC success story at the 70th Regular Session of the United Nations General Assembly in New York, seemed to want to backtrack, saying access to the scheme should be limited to the poor only.
The Public Health Ministry recently set up two committees to revise the National Health Security Act and the NHSO's management. Details are not available but it is believed the revision will seek to reduce the NHSO's role and to adjust the procurement system.
Though it remains unclear how the scheme will be affected, it's necessary that all parties avoid political bias and work for the benefit of the Thai people. The government must listen to all stakeholders before making a decision. More importantly, it must adhere to the principle that the UC is the people's right and that those running state-owned hospitals must place people's welfare ahead of profits.
The NHSO should encourage hospital administrators to improve their management to stay out of financial trouble. It would also be helpful if the government cut its military budget and used the money on welfare.
The UC scheme is a great policy that seeks to promote equality in Thai society -- that everyone, rich or poor, can have good health care. It has won praise from the international community as an innovation and a model that guarantees people's well-being.
It's true the scheme has attracted more patients to state-run hospitals, especially those at regional and provincial levels that possess more personnel and medical equipment than community-level health establishments. This has exhausted the resources of major hospitals in the capital and the provinces.
The government must make step up efforts to better equip community-based health establishments. With appropriate support, these small establishments or hospitals can help to screen patients, reducing the burden on major hospitals.
The state must intensify health promotion and prevention strategies in the community. As they say, prevention is better than cure. If that happens, the burden on hospitals can be largely removed.