SPECIAL REPORT: The government must find a way to balance good health with good economics.
The Universal Healthcare Coverage scheme (UC) has experienced a number of difficulties since it was launched 12 years ago, with financial problems being among its biggest challenges.
The UC, which was introduced in 2001, was originally known as the “30-baht scheme” as each patient was required to pay a flat rate of 30 baht per visit.
The scheme was made completely free in 2006 under then public health minister Mongkol Na Songkhla. It has been funded mainly by the government under a capitation payment system. This means hospitals receive fixed monthly payments from the government for each person enrolled in the scheme.
Twelve years on, the UC has proved its worth by providing Thais with access to disease screening tests and medical treatment.
A recent National Health Security Office survey found that 78% of those who use the UC are satisfied with the scheme.
It has greatly improved people’s access to medical care. Authorities believe that 98% of Thais are able to benefit from some kind of public healthcare scheme.
Expenditure on health for many households has also dropped, according to the Health Insurance Research Office.
While the scheme has benefited many Thais, health experts still see challenges ahead for the UC.
“It is a big challenge for the government to manage a health budget while improving the quality of medical care and people’s health,” Jiruth Sriratanaban, an academic from Chulalongkorn University’s faculty of medicine, said.
The government is now facing significant problems such as rising health costs, complaints about inequalities of care between different healthcare schemes, and resource shortages.
Thailand’s health expenditure has increased by 9.6% in the past eight years, while GDP has grown at a rate of 5.8%.
Of the total 188 billion baht spent on health per year over the three healthcare schemes, around 101 billion baht was spent on the UC, which covers 48 million people.
The rest went to the civil servant scheme and social security scheme for employees of private companies.
The capitation expense per head for the UC increased from 1,202 baht in 2001 to 2,755 baht this fiscal year.
Medical Council president Somsak Lolekha said the UC gives priority to providing treatment rather than preventing disease.
Dr Somsak’s observation is in line with Disease Control Department figures showing the number of people with chronic diseases has not declined despite the rise in health service access.
Free treatment could also mean people take the health scheme for granted and take less care of their own health, which is why state-run hospitals are always crowded with patients, he said.
“The scheme reduces self-responsibility,” Dr Somsak said.
This also increases the workload on health professionals and wear and tear on equipment.
Public Health Minister Pradit Sinthawanarong agrees financial management of the UC needs to be improved.
In September, the Pheu Thai government resumed the 30-baht payment demand to relieve the financial burden on the health sector, despite public protests.
Dr Pradit has been trying to curb financial woes in the health system by eliminating unnecessary use of medicines and improving staff efficiency.
The minister believes the money saved could be allocated to where it is needed, such as disease prevention programmes.
“We want Thais to be healthier over the next 10 years,” he said on taking office in October.
“We shall begin managing our finances and upgrading the benefits of each healthcare scheme to bring equity to the public health system.”
A Thailand Development Research Institute (TDRI) study suggests better financial management could be the answer.
The UC is almost entirely funded by the government based on capitation methods. The civil servant scheme is funded by the Comptroller General’s Department via an open-ended method.
Funding for the social security scheme comes through shared payments by employees, employers and the government.
Deunden Nikomborirak, the TDRI’s research director of its sectoral economics programme, suggests the UC’s capitation payment is the most suitable payment method for Thailand because authorities are less than rigorous in monitoring the way budgets are implemented.
The use of a single payment method would help the UC and the other healthcare schemes survive better and would provide enough funds to improve services and disease-prevention programmes.
“The UC has been successful in taking care of 48 million people over the past 12 years. It could be the main pillar for the development of other healthcare schemes,” Ms Deunden said. “It’s the future for people’s good health. But more work still has to be done.”