One thing has to be made clear about the country’s universal coverage healthcare programme. It is not a populist policy. Access to healthcare services is a basic human right. It is also an essential public welfare system that saves lives and rescues people from bankruptcy after incurring expensive health expenses.
In our society marked by an ocean-wide income gap, universal healthcare is also an important tool to help bridge disparity and prevent political instability from public discontent. It is mind-boggling, therefore, that the bigwigs in the Public Health Ministry don't seem to get this.
The ministry is under heavy fire this week following news reports about its effort to convince the military junta that the co-payments of medical costs by patients is necessary to prevent the universal coverage healthcare scheme from going bankrupt in the near future.
The policy lobbying took place during a meeting on May 31 when public health executives met Admiral Narong Pipatanasai, head of the National Council for Peace and Order’s social and psychological affairs committee, to present their reform plans.
At the meeting, universal healthcare was criticised as encouraging people to seek medical treatment excessively. Politicians’ fear of upsetting voters was cited as the reason why the ministry’s past efforts to introduce co-payments had failed. The proportion of co-payments floated at the meeting was between 30% to 50%.
Permanent secretary for health Narong Sahametapat tried to defuse public anger by insisting the universal healthcare scheme would remain intact.
The meeting minutes reported by Post Today newspaper, however, revealed the proposal received enthusiastic support from Adm Narong. If Dr Narong has failed to douse public suspicion, it is because this is not the first time the public health mandarins have tried to push for a co-payment system.
They did that during the Yingluck administration, but the plan was dropped after facing fierce public opposition. They also tried to change the budget dispensation system of the universal healthcare scheme. From having the National Health Security Office in charge of calculating the per-head budget and directly channel it to each hospital, the ministry wants the budget to go through its regional health offices under its central control.
Now that its new push for co-payments seems to have hit a wall once again, the Public Health Ministry bosses are renewing efforts to take control of how the universal healthcare budget is disbursed, hoping the junta will help make it happen for them. At present, the three main health systems, which provide cover to different segments of the population, are plagued by disparity. Some health activists have led the call to merge the three systems to standardise health benefits and bridge gaps in the system.
Whether it should be done or how the new system should be designed to improve healthcare benefits for all should be the ministry’s priority. Instead of thinking power, the Public Health Ministry should think health and equality for all. At present, the three main health systems are plagued by disparity. Five million government officials get full and free health benefits. The costs are 60 billion baht, or 12,000 baht per person per year.
The costs under universal healthcare are 2,755.60 baht each for 48 million people (140 billion baht). Meanwhile, 12 million workers under the social security system must pay social security fees but receive inferior health benefits to those offered by the free universal healthcare scheme.
Bridging disparity and improving health services is another name for reform. Strengthening central control is not.