Healthcare woes never too big to solve
Anyone who has never had to admit or nurse a loved one at state hospitals in the provinces cannot really understand what it feels like to be in such crowded and cramped state medical facilities.
Patients and their relatives usually find it hard just to get some breathing space, not to mention the doctors, nurses and medical personnel working there day in, day out who also have to endure deteriorating public health facilities.
The charity run of Artiwara "Toon" Kongmalai, the lead singer of the Bodyslam rock bank, has helped bring to light the sad state of our public health system.
Aiming to raise donations from the public to procure medical equipment for 11 state hospitals, Toon set a goal of a 2,191-km run from Betong district in the southernmost province of Yala to the northernmost district of Mae Sai in Chiang Rai. The widespread public support for his plan shows that people want improved medical services in state hospitals across the country.
Some might say the donations raised by Toon's charity run, even if they reach a billion baht, will not be enough to bring about a meaningful improvement to state hospitals. Such an amount is tiny compared to the annual state budget allocated by the government to the Ministry of Public Health, which comes to over 100 billion baht.
It is true that the charity run would generate too small a sum to improve the deteriorating conditions of state hospitals. Public health reform indisputably requires a much bigger budget.
In past years, political parties had proposed public policies that intended to transform the country into a welfare state. Voters overwhelmingly applauded those policies, especially the 30-baht healthcare policy, also known as the Universal Healthcare Coverage (UC) scheme, proposed by the now-dissolved Thai Rak Thai Party.
The policy helped the party win the general election in 2001. It drew huge support from voters in the provinces where they not only had to put up with poor healthcare facilities but also felt financially insecure when it came to personal healthcare spending.
As a result, then Thai Rak Thai leader Thaksin Shinawatra used equal access to public health, an idea initiated by the late doctor Sanguan Nittayaramphong, as a policy during election campaigns. Notwithstanding the implementation of the 30-baht scheme, public healthcare woes still exist. These include a lack of essential medical equipment, deteriorating medical facilities and a shortage of medical personnel.
If the country's economic reforms fail to bring about sustainable growth, we can hardly expect an upgrade in public healthcare standards of state facilities, especially those in the provinces.
At present, the UC, a state subsidy for those not listed under the Social Security or medical welfare for civil servants systems, requires an annual budget of more than 100 billion baht to cover healthcare costs of nearly 50 million people. But the cost per head under the UC is still much lower than that of medical welfare for civil servants which receives an annual budget of more than 60 billion baht but serves just 2 million people.
I am not calling for a downgrade in the quality of the civil servants' healthcare package to the same level as the 30-baht scheme. But I would like to see improved healthcare services at all state hospitals.
In fact, we could have more money left in state coffers to better finance our entire public healthcare system if prudent and efficient management of public spending were adopted. There are ways for the government to do it. For instance, in recent years, prevention of collusion among public procurement project bidders, through the adoption of e-bidding, has helped the government save 30 billion baht a year -- an amount believed to have been previously paid by the state for unusually high prices of services and products offered by businesses due to bidding collusion.
Moreover, the state can save more money by ending unnecessary overseas trips arranged for government officials. Often, those trips are arranged for large entourages, including many who are not required for the mission. It is also common for a large proportion of such trips to be dedicated to leisure activities rather than real business.
The government can also cut other lavish and unnecessary spending such as public relations budgets. If it can slash costs there, then we will have more money left for public health spending -- an amount likely to be much larger than the donations raised by Toon's run.
Moreover, many irresponsible populist policies adopted by several governments in the past years have created a huge financial burden on the state budget. Without those policies, we could have saved hundreds of billions of baht to improve state hospitals in the provinces and developing irrigation systems for the sake of better agriculture and flood control. We could even have money left over to allocate as allowances for the more than 8 million elderly.
However, I still admire Toon's determination to bring about better quality healthcare in those hospitals. Sceptics may say that his efforts will not result in structural changes to the system. But his run at least draws public attention to this problem, and makes people feel that change is possible.
There is a Chinese folk saying that I am reminded of when speaking of making the impossible possible. It is called "Mr Stupid Moves the Mountains".
Mr Stupid was an old man who had to climb mountains to get to the city from his house. He wanted to move the mountains elsewhere. Local people said he was stupid for coming up with that impossible idea. But the old man did not give up. He insisted that if he and his family members for generations kept breaking the rocks on the mountains and moved them to the sea, they would eventually achieve their goal. The size of the mountains could not conquer their will.
I do believe in Toon's determination. He risks his health in proceeding with this long run, for a period of nearly two months, to raise public donations for the procurement of medical equipment for those hospitals.
His efforts may only result in a small change to the system. But the mountain of our public health woes will never become larger as long as there are still people like him.
Senior economics reporter
Wichit Chantanusornsiri is a senior economics reporter, Bangkok Post.