Presently, people in Thailand belong to one of the three healthcare systems available in the country. The three systems are universal healthcare system, healthcare system for civil servants and social security system. However, in the past ten years, the universal healthcare system requires further improvement in terms of the quality of services offered, prevention schemes, the overall organizational structure of the schemes which includes funding sources and cooperation amongst various stakeholders.
Thailand Development Research Institute (TDRI) recognizes the importance of furthering the discussion about the universal healthcare in Thailand and thus has organized a public forum “Rethinking Universal Healthcare in Thailand” and invited various policymakers and academics to join the discussion.
Dr. Ammar Siamwalla, TDRI’s distinguished scholar argued that the universal healthcare policy such as the 30-baht universal health coverage scheme is an example of an effective health policy which every government in the past tried to achieve. It is universal in nature and treats everybody equally. However, as populist policies became a political tool in Thailand, the services and offers have deteriorated.
At present, Dr. Ammar asserted that the government uses the 30-baht to promote themselves while the doctors are losing their credits. Despite the significant funding that has been put towards the schemes, the quality of services has declined. Thus, Dr. Ammar stressed that we need to improve the quality of services offered to the public. Doctors need to have more time to spend with their patients, focusing on the primary systems’ effectiveness. The Ministry of Public Health should not monopolise the health service providers to ‘hospitals’ only, which gives the impression that proper medical treatments can only be carried out at the hospital, rather than local health centres which are more accessible.
Dr. Suvinai Sawasdiworn, Secretary-General of the National Health Security Office argued that things that should not be rethought are: 1) fundamental principle that states the access to healthcare system is the basic right of all citizens; and 2) the government should be responsible for the cost of healthcare systems.
Nevertheless, there are many factors which require rethinking – namely, the design of the organizational structure that is accountable to the access and quality of services provided to the public. This is perhaps the most challenging role of the state to ensure that all of its citizens have access to high quality healthcare services. Particularly, the government needs to ensure continuous financing to the programmes, which would need even further inputs when Thailand enters aging society in the future.
The third speaker, Dr. Somsak Chunharat, Secretary-General of the National Health Foundation, also emphasized on the design of an effective primary system, which covers the structure of financial and servicing systems. By designing an effective system, Dr. Somsak believed that one should look at the relationship between the ‘consumer’ and the ‘provider’ of services and try to find the right balance between both parties. Designing an effective system also means that the state has to strengthen its role in the implementation of rules and regulations. It should not leave the responsibilities to the public.
The design of the primary infrastructure system is something that everybody agreed to be necessary, but little has been done about it. Dr. Somsak asserted that we need to ensure that every parties involved see the importance of the basic infrastructure system and work together to achieve this main goal. Dr. Somsak proposed that we need to: 1) encourage innovation through continuous funding and create an environment that fosters innovative breakthroughs; 2) create a network of service providers so that services can be outsourced when needed; and 3) we need to bring doctors into the system, to have a role to oversee the health team which can give advice to the general public for less costs.
“Thailand should aim to increase the spending for healthcare services in the country, but it should not happen through other reductions of state’s budget items. If the government seriously invests in the right areas, it should help to achieve this goal”, argued Dr. Somsak.
Finally, Dr. Phusit Prakrongsai, Director of International Health Policy Programme Foundation, argued that rethinking universal healthcare in Thailand should take in account of the trend in diseases and demand in Thailand. One should take into consideration about the state of public health, changes and direction which will incur in the future. In addition, we will also need to think about the restructuring of resource distribution system and improving the awareness about healthcare issues concerning illegal migrants that are on the rise in Thailand. Currently, we do not have an effective system to look after this group of stakeholder.
As in many areas, the healthcare system of illegal migrants has fallen into the responsibilities of the state. Thus, the National Health Security Office should take further action. In the future, Thailand should aim to use “Health Technology Assessment” and ensure that it would be worth the investment and resource use. Finally, Dr. Phusit proposed that public participation is highly vital to the success of all these proposals to ensure inclusiveness and innovation in all the benefit schemes, and ensuring that the government is focusing the effort in the areas which are needed.