Doctors push for healthcare co-payment

Photo: ST

A group of doctors has continued to press for the introduction of a co-payment system in the medical sector.

The doctors insist that if such a system is not launched promptly the country will succumb to the growing weight of a free healthcare system that has devoured an increasing amount of state budget in recent years.

"A co-payment system will be the saving grace. It is going to create a win-win situation. We can do it simply through voluntary health insurance. This initiative is not going to hurt the poor either. Only those who can afford it would be required to go to co-payment," said Arnond Sakwo-rawich, of the National Institute of Development Administration's Business Analytics and Research Programme, School of Applied Statistics.

Arnond, Dr Apiwat Muti-rangura of Chulalongkorn University and Dr Churdchoo Ariyasriwatana, who heads the Federation of Healthcare Workforce of Thailand, came to Nation Multimedia Group to explain their idea.

These doctors have, in essence, opposed the universal healthcare scheme that covers nearly 50 million Thais. People who have exercised their rights under this scheme can get almost all kinds of treatments for free.

"The scheme is good for the poor. We definitely don't want to see people die on the street simply because they don't have money to pay for their treatment," said Arnond. "But still, I must say that the universal healthcare scheme is not reasonable. Such free medical services should be made available only to those who can't afford it".

He said people should be made to pay, and not allowed to enjoy free medical services.

"Go for the middle path. The universal healthcare scheme is extreme," he said.

Arnond said when a co-payment system is launched, poor patients would enjoy even better medical treatment and the society would see narrow gaps.

"Some rich patients used their connections to queue-jump and get free treatment under the scheme," he said. He also noted research by the Thailand Development Research Institute (TDRI) that suggests that patients with chronic diseases have a higher mortality rate if they get treatment under the universal healthcare scheme, as opposed to the medical-benefit scheme for civil servants and their family members.

"When focusing on cancer patients alone, the mortality rate is 70 per cent higher," Arnond said.

He reckoned that patients' knowledge about how to take care of their health and initial health conditions at the time of getting treatment were different and also factors. Arnond believed efforts to improve treatment standards for the poor could immediately save many lives.

"Of course, we will have to act on other factors too. But clearly the treatment factor ranks among the very first thing we can do," Arnond said. He and many doctors, thus, back co-payment, which is something that would ease the state finances from the promise to provide free medical treatment for all and focus the resources on those who really needed it.

Arnond pointed out that Nakornping Hospital had already joined a health-insurance system with insurance firms and the results were impressive.

"Insurance firms can get treatment for customers at a reasonable cost while patients get services from capable state doctors."

He said the extra money earned by state hospitals could improve other parts of hospital operations.

Churdchoo said several state hospitals had also made it an option for affordable patients to get services from them.

"Look at the premium clinic of the Ramathibodi Hospital and Siriraj Piyama-harajkarun Hospital," she pointed out, "Their patients are happy to pay. They don't have to wait too long".

She said money paid by those who can afford it would mean more cash for medical facilities.

"Since the launch of the universal healthcare scheme, which was initially known as the Bt30 (S$1.20) per medical visit scheme, state hospitals in general have received a lower budget. Their facilities worsen," she said.

Arnond said voluntary insurance would cost people about Bt8,000 a year per head if they bought it as a group. "Individually, they might have to pay between Bt12,000 and Bt13,000," he said.

Apiwat believed people should learn to be responsible for their own health too. "If you smoke, you should pay a higher insurance cost," he said.

He also did not agree with the universal health scheme's prescribed guideline for treatment, saying it limited doctors' choices on delivering the best medical treatments.

The Public Health Ministry disclosed recently that the number of state hospitals with budget problems from the universal health scheme has dropped - from 158 in the third quarter of last year to 48 in the second quarter of this year. This figure has been used to counter the claim that the universal scheme "ruins" state hospitals.