Achieving universal healthcare coverage by 2030 is one of the targets within the United Nations Sustainable Development Goal 3 on health. It is a target that Thailand achieved when it rolled out universal healthcare coverage (UHC), known locally as the 30-baht healthcare scheme, in 2002.
Currently, there are 48.26 million people covered by UHC regardless of their financial status. The scheme benefits those who are not covered by the civil servant welfare fund, the Social Security Fund (SSF) or private health insurance.
The World Health Organisation also praised Thailand's UHC for being a good, successful model that other countries can learn from in terms of national health security. As a result, it is not surprising that Prime Minister Prayut Chan-o-cha chose to highlight it in his speech at the 74th Session of the United Nations General Assembly in New York last week. He later boasted, on a Government House Facebook Live broadcast, that foreign delegations were amazed by Thailand's achievement and gave him a round of applause.
His remarks, however, drew rebuke at home from critics, including Pheu Thai Party politicians, who said Gen Prayut claimed the achievement of the scheme as if it was an initiative of his government.
It is true the UHC was initiated by the Thaksin Shinawatra government. But without significant and sustained commitment by subsequent governments, the country would not have been able to maintain UHC in its current successful form. Of course, the Thaksin government deserves credit even though critics may point out that it was one of its many populist policies designed to woo voters.
For Gen Prayut, it is legitimate for him to partially claim the achievement. In the 2020 budget bill, his government has allocated 173.75 billion baht to finance the UHC, a 4.39% year-on-year increase. That is equal to 3,600 baht per head, a 173-baht increase from the year before. But the premier should have credited the past governments for the scheme's success.
However, it is less his government's actions, and more his mindset towards the scheme, that has drawn criticism. In recent years, Gen Prayut has accused the UHC of being a financial burden to the government. He even mulled the idea of making UHC only available to the poor. During the last election campaign, executives of the Palang Pracharath Party, which nominated him for prime minister, proposed a co-payment model in which patients would share their medical treatment and service costs with the state.
The fact is that the scheme faces challenges brought about by Thailand's increasingly ageing population. Its budget has already tripled over from 56 billion baht in 2003 to 173 billion currently.
Instead of considering co-payment models, the government should proportionally balance the budget allocation for three health schemes -- the UHC, the civil servant welfare fund and the SSF -- to ensure equal spending per head by all of them.
Currently, the state spends over 70 billion baht a year to support around 6 million civil servants, or about 12,000 baht per head, while it subsidises 3,400 baht per head for 48 million people under the UHC and 14 million workers under the SSF.
However, critics rightly point out that defence spending has only increased in recent years so the onus must be on the government to re-prioritise its overall budget allocations to different ministries to ensure the UHC receives sufficient funding to keep it sustainable and also improvement the system.