Thailand currently has three major healthcare schemes, each of which differs significantly in terms of the benefits offered.
Hence, in a move to reduce gaps in the healthcare sector, the People’s Health Systems Movement has been pushing hard for these schemes to be merged.
However, the issue now is not whether the merger will take place, but whether policy-makers will be able to ensure that all citizens enjoy the same medical welfare.
Thailand has the universal healthcare scheme, the health-benefit part of the social-security scheme, and the healthcare programme for civil servants and their family members.
The first programme covers about 48 million people, with per-head cost averaging Bt2,755.60. In 2011, the scheme spent Bt101.057 billion on its members.
The second programme covers 9.4 million subscribers, with per-head expenditure of Bt2,504, and it spent Bt24.476 billion in 2011.
The third scheme takes care of some 5 million civil servants and their families, with per-head expenditure at Bt14,123.01 per month. It spent Bt61.8 billion on its members in 2011.
According to Dueanden Nikhomborirak, director of economic system management at the Thailand Development Research Institute (TDRI), members of the social-security scheme seem to get the least medical benefits even though they make monthly contributions to the programme.
Many health activists and consumer-protection advocates have echoed this point.
In fact some activists have suggested that members of the social-security programme should stop making monthly contributions on grounds that the benefits are less than even what is offered by the completely free universal healthcare system.
The People’s Health Systems Movement also pointed out that when social-security members need expensive treatments, they have to undergo complicated procedures. Such treatments are only granted for free on a case-by-case basis.
Hence, Dueanden said, members of the social-security scheme should not object to the merging of the funds, though she expects stiff opposition from civil servants, if they find their medical-benefit programme getting merged with those that offer fewer benefits.
“The medical-benefit scheme for civil servants has all along been regarded as civil servants’ welfare – not health insurance – hence the merging of the schemes could be regarded as cutting civil servants’ benefits,” Dueanden said.
So she suggested that a “fadeout” method be used, in which changes are introduced gradually as existing members enjoy old benefits and newcomers are taught to accept new rules.
Policy-makers can also consult previously conducted studies showing that many countries have successfully merged their healthcare schemes, and not much resistance is seen in nations where the government steps in to shoulder the cost of the merger and waives health-insurance fees for its citizens.
The United Kingdom, for instance, has successfully merged several health funds and made the national healthcare system free for all citizens.
Actually, the government is not losing out as it uses income tax to fund the programme.
“If you have no income or are very poor, you don’t pay. For instance, I [like other earners] pay, not to the Social Security Office, but to the government, and in return I get health insurance,” Dueanden explained.
The TDRI report adds that the French government doesn’t just rely on income tax to fund healthcare, but also gets funding from asset taxes.
However, in Thailand, influential groups like hospitals and doctors – who benefit from dispensing expensive medicines to civil servants – may oppose the merging of the health schemes.
South Korea was able to tackle just such a challenge successfully, though it took decades for it to merge all of its programmes.
According to the TDRI report, the Korean government agreed to give a 40-per-cent pay rise to doctors if they agreed to join the single healthcare scheme.
Though it is still unclear which direction the authorities will go, let’s hope that Thailand is able to offer quality medical services for all Thais in the near future.
Since the junta-led government is promising real reforms, will it be able to set a standard and ensure quality healthcare services for one and all?
First published: The Nation, December 9, 2014