Is universal healthcare a basic right for Thai people?

PHOTO: Reuters

A big conflict is erupting in the country's healthcare sector over whether the universal healthcare scheme should go ahead. So, will the scheme survive this boiling conflict? Or will it end up being scrapped once and for all?

Covering about 49 million Thais, this universal scheme promised to provide almost all kinds of medical treatment for free. Since its launch - initially known as the Bt30-per-medical-visit scheme, in the 2000s - patients showing up at hospitals no longer have had to worry about medical bills. Gone are the days when poor people were so reluctant to see a doctor, fearing they would fall into big debt and illness would swallow all the little savings their family had.

Since the universal healthcare scheme started, people exercising their rights under the scheme feel assured that seeking treatment for their health condition was not going to ruin their family or their children's chances of further education. As a result they are not forced to wait until their condition turns to serious.

Their human dignity also remains intact when they show up with cards entitling them to treatment under the scheme.

Before the launch of the universal healthcare scheme, patients who needed free medical treatment were described as "anatha" or destitute patients. They needed to ask for help. Free medical treatment was not their right. It was something that needed to be asked or something to be begged for.

But while the universal healthcare scheme works well for millions of Thais, several state hospitals and medical workers lament that the scheme is going to bring about the collapse of Thailand's health.

The budget for the scheme has been climbing up, with the latest annual figure at about Bt120 billion (S$4.8 billion).

A group of doctors has warned that if the government does not abandon the project and opts for a co-payment system soon, the country will succumb.

They claim a co-payment system would not hurt the poor. Destitute patients could continue to receive free treatment. It was just those who could afford to do so, should be required to pay. They pointed out that if state-provided resources were reserved for the poor, destitute patients could enjoy even better medical services.

They quoted recent research by the Thailand Development Research Institute that showed the mortality rate was higher among patients exercising their rights under the scheme, than those using the medical benefits programme for civil servants and their family members. According to them, someone needed to put an end to the "populist and extreme" universal healthcare scheme.

While the universal healthcare scheme had an annual budget of Bt120 billion for 49 million people, the programme spent Bt60 billion on taking care of just 5 million civil servants and their family members.

Although the pro-co-payment system group's argument does not sound unreasonable, many others beg to disagree.

Dr Somsak Tiamkao of the Khon Kaen University's Faculty of Medicine said via Facebook that he had seen changes for the better among rural people following the launch of the universal healthcare scheme.

"I don't base my opinion on any research. I simply speak from my direct experience as a doctor who has treated patients since 1990. Before the launch of the universal healthcare scheme, I saw many families go bankrupt because of medical costs. I saw how some patients refused to move to better-equipped hospitals for sophisticated treatment that could have saved their lives, just because they were worried about the medical bill," Somsak said.

This doctor, therefore, supports the implementation of a universal healthcare scheme.

He does not worry about the financial losses that some state hospitals |say they have sustained.

"They are not complete losses. They are gains for people who need the treatment," Somsak said, "State hospitals are not designed to seek profits".

Of course, the government should not aim to seek profits from patients. But I do believe that running state hospitals needs a budget, which the government may not be able to fully shoulder. This is a reason why many countries around the world have already introduced the co-payment system.

But at the same time, I do support the creation of a programme that would allow cash-strapped people to enter hospital without fear or concerns of medical bills, to enjoy free treatment, and are seen as service users - not someone who has come to beg for help.

Thailand needs to find an answer for this.