A proposal that people earning more than 100,000 baht annually be subject to co-payments of 10-20% for health services covered by the Universal Healthcare Coverage (UC) scheme has come under fire as agencies distance themselves from the idea.
National Health Security Office secretary-general Sakchai Kanjanawatana said Wednesday the co-payment proposal was an unofficial idea floated by the director-general of the Comptroller General's Department to boost the rights of low-income earners.
The co-payment proposal calls for patients who earn more than 100,000 baht per year and are covered under the UC scheme, widely known as the gold card scheme, to co-pay 10-20% to help relieve the government's financial burden.
However, Suttirat Rattanachot, director-general of the Comptroller General's Department, insisted the department had never suggested money be collected from gold-card holders.
The duty to take care of gold-card holders lies with the Public Health Ministry and the department only looks after the healthcare benefits of civil servants.
Finance Minister Apisak Tantivorawong also denied the ministry had anything to do with the idea.
Dr Sakchai said the government realises the issue affects the rights of people and it needs to be discussed thoroughly and the overall benefits must be taken into account.
For the proposal to be turned into a policy, it must be presented to the National Health Security Board for consideration, Dr Sakchai said. Section 5 of the 2002 National Health Security Act also mentions cost-sharing or joint payments but in practice there are many models of cost sharing, he said.
Asked if the proposal would materialise, Dr Sakchai said it stands little chance of becoming a reality because it affects the rights of people in general.
Sakchai: Rights will be affected
Addressing the possible impact of the proposed co-payment scheme, Dr Sakchai said this idea would be the least effective in terms of giving people access to health services. People would not be certain about how much they would have to pay for medical services and treatment costs for each illness vary.
For example, it costs up to a million baht to treat some illnesses. If people have to be subject to co-payments of 10%, this means they must pay 100,000 baht, which in turn would discourage them from seeking treatment even though it is necessary, Dr Sakchai said.
The scheme, formerly known as the 30-baht health scheme, has been hailed internationally as a public health model that has benefited the poor.
The state healthcare benefit aimed at assisting middle- to lower-class Thais with their medical expenses was initiated by Sanguan Nittayarampong, a rural doctor, before the Democrat-led Chuan Leekpai government proposed a bill on national health insurance. The bill failed the parliamentary deliberation.
However, the Thai Rak Thai government under Thaksin Shinawatra succeeded in introducing the scheme as its policy. The National Health Security Office (NHSO) was then established.
Nevertheless, calls for a rejig of the scheme have been growing since the National Council for Peace and Order took power.
Prime Minister Prayut Chan-o-cha once said the scheme burdened the national budget while some critics cite the financial model and spending by the NHSO.
Suwit Wibulpolprasert, a member of the National Health Security Board, said the UC scheme itself has been proved to be a worthy investment.
A study by Chulalongkorn University shows that an investment of 100 baht in the UC scheme will yield a return of 20 baht as well as bringing other economic benefits to the pharmaceutical industry, medical equipment suppliers and logistics, Dr Suwit said.
He said the Word Bank found that those who benefit from Thaland's investment in the UC scheme are low-income earners, 20% of whom have more purchasing power each year.
"However, when it comes to co-investment, the question remains as to how much the people should co-invest," Dr Suwit said adding that it can come in the form of sharing the payments of insurance premiums, or sharing the costs after getting ill.
He said asking the people to co-pay for 10-20% would relieve only a small proportion of the burden but have a big impact on people who have low incomes but do not have welfare cards issued for the poor.