Thailand mulls end of free medical services for most

There has been talk for a while now that the National Council for Peace and Order (NCPO) is planning to scrap the universal healthcare system - which offers free medical services to most Thais - in favour of a co-payment scheme.

Should this really happen, some 49 million Thais would be affected.

According to Nimit Tien-udom, a member of the National Health Security Commis-sion, it was recently proposed that people should start shouldering some 30 to 50 per cent of their medical costs.

This subject has been raised every now and then over the past several years as so many state hospitals and medical workers regularly complain about how the scheme is a huge financial burden.

Dr Prachumporn Booncharoen, president of the Thai Federation of Medical Centre and General Hospital Doctors, said the free service was being overused, and as a result, some 300 hospitals were collapsing under the weight of the scheme.

Professor Udom Kachintorn, dean of Mahidol University's Faculty of Medicine for Siriraj Hospital, said his hospital, which is part of the scheme, had lost about Bt400 million in providing these free services, adding that it had been surviving on government subsidies and public donations.

Critics say the universal healthcare scheme is populist in nature, which is why people in power seem reluctant to change it.

This scheme, which initially began as a Bt30-per-visit deal, has been in place for about eight years.

Launched during Thaksin Shinawatra's reign, the Bt30 medical programme was warmly welcomed by people who used to dread seeking treatment out of concern that hospital bills would bankrupt their families.

With the programme in place, ill people felt confident enough to see the doctor as they could afford the Bt30 fee.

In reality, the Bt30 fee can be considered a co-payment scheme. However, in practice, the sum is far too small to help with the expense, and some hospitals have complained that issuing receipts for the tiny contribution only added to their work.

Eventually, taking all the costs - including the ink and paper used for the receipts - the Bt30 fee was scrapped by the interim government put in after the 2006 coup and the universal healthcare scheme was born.

Under the current healthcare system, Thais who are not covered by Social Security or the Civil Servants Medical Benefit programme can get free treatment at designated hospitals.

The universal healthcare programme follows Article 40 of the Health Security Act, which stipulates that all Thais have the right to a comprehensive range of healthcare services without any financial obstacles.

National Health Security Office secretary-general Dr Winai Sawasdiworn explained that funds for a public healthcare system like this could either come from taxpayers or from a co-payment system like the Social Security programme.

However, Article 5 of the same act says that a patient shall co-pay medical fees except in the event that he or she is poor or is exempted from these fees.

Hence co-payment should be possible in providing public healthcare.

Dr Tawatchai Kamoltham, who heads the Department for the Development of Thai Traditional and Alternative Medicine, said getting people to contribute would encourage them to take better care of themselves.

"Co-payment is based on the idea that people should be responsible for their own health," he said.

He said that even if the co-payment initiative were implemented, poor patients would not be refus-|ed treatment or be forced to pay what they could not afford - only those |who can afford to pay would be charged.

"This will also help reduce the gaps in society," he claimed.

Prachumporn echoed Tawatchai's words, saying people who can afford to wear gold should not be allowed free treatment. Both of them also agreed that the co-payment system would help improve the services offered, cut down on crowds and ease budget constraints.

Nimit, meanwhile, pointed out that only 7 per cent of the national budget was allocated to the universal healthcare system every year.

"Obviously the scheme will not threaten the country's financial security any time soon," he said.

He said he did not agree with the idea of forcing patients to pay for medical treatment, though he added that he would not oppose efforts to develop a co-payment system because it would encourage people to save for future health costs.