One scheme for all will provide fairer and better care

One scheme for all will provide fairer and better care

Public Health Minister Piyasakol Sakolsatayadorn is one among many officials involved in the dispute over health insurance for government officials. (Photo by Wichan Charoenkiatpakul)
Public Health Minister Piyasakol Sakolsatayadorn is one among many officials involved in the dispute over health insurance for government officials. (Photo by Wichan Charoenkiatpakul)

The government's idea of taking out private healthcare insurance as an alternative to the state-run medical care system for government officials needs a rethink.

The proposal, which will affect some 10 million active and retired civil servants and their family members, was put forward as an attempt to cut healthcare expenditure which is a huge financial burden on the state.

However, such private cover is unlikely to help curb state expenditure. Nor will it guarantee equal or higher healthcare benefits for state officials. Instead, it could widen the inequality gap of healthcare coverage between this group and those who are covered by the Universal Health Coverage (UHC) scheme and the Social Security Fund (SSF).

The government has set an annual budget of 60 billion baht, or 10,000 baht per head for this civil servant scheme that requires its members to seek treatment from state-own hospitals.

However, the actual total cost which has risen to 68 billion baht a year exceeds the limit. The excessive amount has been shouldered by the Comptroller-General's Department, which sees the need for the switch in the hope it can curb or even cut the hike in expenditure.

But the Prayut Chan-o-cha government really needs to take a closer look at this proposal. The subscription to private insurance means the state will have to transfer the hefty annual budget and place it under the management of the private sector. It is doubtful whether state officials and their families will benefit from this change. It is more likely that benefits will mainly go to non-life insurers and private hospitals which will impose additional fund management charges on the state.

Both the civil servant scheme and the UHC are financed by the state, and thus are supposed to be universal and equal in nature. But they are not. The government has subsidised the former more than the latter which the majority of Thais are eligible for. Every year, a sum of 140 billion baht goes to the UHC covering 48 million people. The UHC cost per head is 3,000 baht per year, much lower than the cost for government officials.

If the Prayut government really needs to overhaul the civil servant scheme, now is the right time to integrate it with the UHC and SSF, which operates on a 50 billion baht budget, and introduce a single healthcare package for all. The merger will mean a new annual budget of around 250 billion baht for the government to invest in a true universal and equitable medical package for all Thai citizens.

Taking out private insurance policies will not help the state limit or cut costs. In reality, it is the purchase of insurance premiums that will require the government to spend the same amount of money or higher.

We are all aware that non-life insurers set their own rules and private insurance policies usually carry some exclusions.

The insurers usually dictate what types of disease and health conditions are included and excluded in each package. Even though the government may say that it is in a position to be able to negotiate benefits with insurers, there have been costly lessons learned in many countries that in the end private insurers can get away with keeping such exclusions.

Some may argue that injecting a sum of 60 billion baht a year into the private sector may stimulate economic growth. But it will affect the quality of public health services and widen the inequality gap among Thais.

Besides, private hospitals will tempt more medical people to quit their jobs in state hospitals and that will worsen the current state hospital staff shortage.

Alternatively, if the government opts for the single health budget for all and channel it through to state hospitals, all Thai citizens will get equal benefits and the cost per head for all will be higher than the current maximum rate of 3,000 baht per head under the UHC.

People with high incomes who do not want to use state services can still opt for private hospitals if they are willing to meet the cost.

As a result, state medical personnel will get higher incomes.

The National Health Security Office then can effectively manage the fund and provide appropriate benefits and better services for Thai citizens.

Merging the three healthcare budgets and using it on one state hospital scheme will yield more benefits for the majority and bring about equality and fairness.


Sureerat Trimanka is a health advocate and a coordinator of the People's Health Systems Movement. The article originally appeared in Prachatai news website.

Sureerat Trimanka

Health advocate and a coordinator of the People's Health Systems Movement

Sureerat Trimanka is a health advocate and a coordinator of the People's Health Systems Movement. The article originally appeared in Prachatai news website.

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