Power struggle traps millions of Thais in scheme hospitals hate

Power struggle traps millions of Thais in scheme hospitals hate

The conflict between the Public Health Ministry and the National Health Security Office (NHSO) continues to intensify, leaving millions of Thais in a hostage-like situation.

The two health agencies have now clashed over management of the universal healthcare scheme, which covers about 48 million people across Thailand.

These subscribers are now holding their breath as they are not sure what will happen next to the scheme, which delivers most types of medical services for free to those covered.

While the NHSO manages the scheme, the Public Health Ministry is the key implementation agency.

At least 75 per cent of the scheme's medical units are hospitals supervised by the ministry.

Will people's access to health services be affected? Will there be any change to the coverage of the scheme?

Lately, many state hospitals have joined forces with the ministry to pressure the NHSO to give not just money but some power to manage the scheme to the ministry.

According to the ministry, the NHSO should no longer transfer the per-head subsidy for the scheme directly to each medical unit.

Rather, it should send the money to the ministry's health service area offices so that resources can be shared among medical facilities within the same area.

This way, larger and better-equipped hospitals would be more willing to help smaller medical facilities.

In addition, the ministry wants to have its say over how to allocate funds for the treatment of specific diseases.

In a bid to force the NHSO to bow to these demands, the Thailand Regional and General Hospital Society (Thaihos) has already stopped sending reports on treatments provided under the scheme to the NHSO.

The Public Health Ministry, meanwhile, has announced its plan to stop its registrar services for the scheme from April 30 onward.

The NHSO initially tried to play down the ministry's move, suggesting it could take over the registrar services when the deadline came.

Given that registrar services involve hundreds of thousands of registration-information changes each month - and the fact people would get the most convenient service if hospitals double as the registrar - NHSO secretary-general Winai Sawasdivorn later insisted it would be best for the hospitals to continue providing that service.

But the NHSO is not all alone in this battle.

Many patient groups and the Rural Doctors Society (RDS) have come forward to condemn the ministry's move.

There are concerns that in its fierce bid to win the clash, the ministry is going to hold people as virtual hostages.

With the clash showing signs of getting worse, Public Health Minister Rajata Rajatanavin has decided to step in and instructed state hospitals under the ministry's supervision to continue with registrar services.

Rajata also set up a panel and tasked it with a mission of setting the record straight about the universal healthcare scheme.

Led by prominent health-system researcher Dr Ammar Siamwalla, the panel will check information from both the NHSO and the ministry to determine which side carries more weight.

Clear-cut information is expected to help identify real problems, paving the way for efficient solutions.

While Rajata's moves have brought hope, it remains unclear whether the conflict will really end.

Two months ago, Rajata also set up a panel to look into why 136 hospitals have plunged into deep financial problems.

But no tangible measure has come up since. In fact, each side has continued to quarrel and stick to its stance.

The Public Health Ministry has insisted that since the scheme has been in place for well over one decade, it should become clear now that the NHSO has never heeded the opinions from implementation agencies.

State hospitals have been struggling badly under the weight of the universal healthcare scheme both in terms of massive workload and expenses involved.

Although a budget of Bt2,895 is provided for each person covered by the scheme, the whole amount does not go to medical units.

Some parts are allocated for health-promotion activities, the remuneration of NHSO board members, and sponsorship of some foundations' sports events.

The ministry has also said the NHSO manages the scheme from a financial perspective, while the ministry believes things would be better seen from a service-oriented viewpoint.

Yet, the NHSO says it also has a duty to promote the prevention of diseases.

It has played the crucial role of buyer of medical services through the scheme that has protected Thais from medical bankruptcy.

"We need to separate the buyer and the provider of medical services for Thai people, so as to have check-and-balance mechanisms in place," Winai said.

Just as both sides insist they are working in the public interest - not for power or money from the universal healthcare scheme, the public will need to closely watch their performances.

Actions speak louder than words. In addition, both sides should realise their work will be more useful if there is cooperation.

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