Health budget cuts rife with prejudice
The government's plan to divert 2.4-billion-baht in funding from the Universal Health Coverage (UHC) scheme to finance the state's Covid-19 relief and recovery programmes has caused a stir.
While it's true the government needs huge sums of money to combat Covid-19, the idea of diverting money from the health sector, which covers almost 50 million people, to fund its anti-virus operations does not seem sensible -- especially when their shortcomings are considered.
The diversion is a part of a bigger plan which was initiated in the wake of the coronavirus crisis. The government initially instructed all state agencies to cut 10% from their 2020 budget which they cannot spend before the end of the fiscal year. They were then instructed to put the savings, equivalent to 100 billion baht, into a central "pool" to fund the fight against Covid-19, as well as relief programmes.
The list of ministries and government agencies, and their approximate contribution, appeared in a cabinet meeting document posted on parliament's website last week. Their contributions, summed up in the Budget Transfer Bill, will go to the Lower House, which is scheduled to scrutinise it next month. The list showed the Public Health Ministry -- which oversees the National Health Security Office (NHSO), an independent agency running the UHC -- will dock the scheme's budget to make its contribution. The decision swept NHSO executives off their feet.
The UHC's budget, which is funded by taxpayers' money, is vital to the healthcare system, because it covers the cost of most medical activities in hospitals. As such, the UHC is also a frontline in the fight against the novel coronavirus, as it doesn't only cover the cost of testing and treating Covid-19 patients, but also the salaries of medical personnel.
After reports of the budget diversion came out, the permanent secretary for health, Sukhum Kanchanapimai, explained the money will be used to upgrade 45,000 contracted health workers at the ministry to permanent staff.
While the upgrade is worth the public's support, doing it by slashing the UHC's budget is wrong.
Government spokeswoman Narumon Pinyosinwat has tried to convince everyone the budget haircut will not affect patients, but it's clear she has little idea how the health budget works.
Experts have estimated the government would need to spend 1.5 billion baht to upgrade the ministry's workers. But there is no explanation why the ministry planned the 2.4-billion-baht diversion.
Health advocacy groups have objected to the plan, insisting the UHC budget must not be trimmed at all as it will affect the salary of existing staff. If the government wants to upgrade the employment status of contracted healthcare workers, they said, it must provide an extra budget.
A key point of this debate lies in the complex budget arrangement of the UHC scheme, which provides free healthcare services to over 49 million people in Thailand, many of whom come from poor families.
Introduced in 2002 by the Thaksin Shinawatra administration, the scheme distributes a capitated budget to hospitals, with fixed amounts for different categories of health services -- such as out- and in-patient treatments, health promotion and disease prevention -- and medical staff salaries.
The amount due to each hospital is determined by the size of the population it serves and the number of medical staff in its area. As such, trimming the UHC's budget means hospitals will lose some of their funding, which will undoubtedly compromise the quality of health services.
But the scheme's complicated budget is simply too hard for the current government to understand. To be more precise, none of the leaders have tried to understand the complex mechanisms driving the UHC -- Thailand's flagship public healthcare and social welfare plan which has gained international recognition.
Right after the 2014 coup, junta leader-turned-prime minister Prayut Chan-o-cha criticised the scheme as "a financial burden for the nation". This isn't true since the government only spends the equivalent of 1% of Gross Domestic Product on the UHC. But of course, conservative policymakers wanted to use the money to fund their trips abroad, procure military weapons, and so on.
This had a lot to do with the mentality of Thailand's leaders, policymakers as well as the public, who have a bad impression of the poor -- that they are lazy, uneducated and unwilling to seek progress. Many believe these attributes contribute to their poverty, and as such the poor do not deserve state assistance. By doing so, they are treating bad health and substandard living conditions as personal failures, rather than a structural issue.
Because of this, when the state decided to roll out relief programmes -- such as the 5,000-baht handout -- it had to put a lot of resources into just identifying those who are most affected by the pandemic.
It is ironic that Thais regard helping each other out as a virtue but find the need to step back when it comes to using tax for social welfare or aid programmes for the poor, obviously out of prejudice.
The UHC has been rattled by such myths. Gen Prayut has, on many occasions, spoken ill of the scheme. On one occasion, he said giving free healthcare discouraged people from looking after their own health, which just isn't true, according to surveys on UHC beneficiaries.
Some doctors and policymakers have mislabelled the UHC as a populist scheme, a tactic to solicit support from the poor to win an election. Again, this isn't true -- the scheme was designed by health advocacy and patient groups which managed to convince Thaksin to incorporate it into his campaign.
Reproducing these myths not only fuels the misunderstanding the scheme is a budget burden, but also undermines the possibility of improving and extending social safety nets to other sections beyond health.
Health advocates' complaints about the budget cuts prompted Public Health Minister Anutin Charnvirakul to promise a U-turn, but it remains unclear if he can do that.
What is clear is that if he fails to do so, financial pressure on the UHC will adversely affect millions and the system as a whole will be shaken.
Paritta Wangkiat is a Bangkok Post columnist.
Paritta Wangkiat is a Bangkok Post columnist.