With a Shinawatra returning to Government House, seeing the lavishing upgrade in the 30-baht universal healthcare coverage (UHC) is unsurprising. Nicknamed "the Gold Card" public healthcare system, it was conceived in 2002 under a Thai Rak Thai-led government with Thaksin Shinawatra as prime minister.
From Tuesday, the public can go to drugstores affiliated with the National Health Security Office (NHSO) to consult with pharmacists and receive free medicines for treating 32 common illnesses, such as headaches, skin disease, insomnia, and gum infections. The latest update is just a minor enhancement to this medical welfare benefit.
Successive governments, including two juntas and a Democrat-led cabinet, have also updated the scheme, allowing cardholders to receive treatment at any state hospital and extending coverage to kidney dialysis, cancer treatment and even sex change operations.
The public and political parties have welcomed better medical welfare, but it does take proper financial backing and acknowledgement that each improvement adds to the workload of the public healthcare system. Indeed, medical doctors in state hospitals have long complained that they are on their last legs as politicians upgrade services covered in the scheme.
Meanwhile, the NHSO received only 200 billion baht -- 3% of the total fiscal budget -- to care for 48 million people who depend on the UHC. The funds given are insufficient. It can only provide a per capita budget of 3,988 baht. It is little wonder that so many state hospitals suffer financial problems.
For example, Khon Kaen University's Srinagarind Hospital said the hospital makes about 100 million baht in losses every year due to a daily overload of patients after the number of patients has increased by 400%, especially after the launch of the scheme's "cancer everywhere" policy.
The stress on public hospitals is so severe that some say the UHC is at risk of collapsing unless there is a major financial overhaul.
In October last year, the National Health System Development Committee was formed, with Paetongtarn Shinawatra as deputy chair, to save the UHC from existential crisis and financial collapse. The question is how far these politicians can push the envelope to reform public health at a fundamental level.
The original concept of the UHC has changed over time. It should have been the only healthcare system providing medical welfare for everyone. Under this model, the financial resources would come from three sources: the fiscal budget and transferred money from the Civil Servants' Welfare System and the Social Security System.
However, the Civil Servants' Welfare System and Social Security System -- the only funds members need to pay monthly contributions -- have not joined the UHC. The challenge is how the policymakers can convince these two funds to join. The Civil Servants' Welfare System provides many more benefits. At the same time, members of the Social Security Fund have complained of inferior service as this fund also has to provide welfare services such as retirement, job loss or maternity leave.
That said policy, policymakers must be creative in tuning the system to entice all recipients. The Pheu Thai-led government needs to fix the UHC's financial situation. Without a better financing system, its medical welfare will be unsustainable and risk falling apart.