Doctor Thaksin’s Dilemma

THAI Rak Thai’s universal health insurance policy, a major campaign plank that contributed to the party’s landslide victory, could also trigger a backlash amid high public expectation and concerns about its administration.
While it is unclear whether the policy will result in the merging of the government’s entire health-insurance scheme, some critics have already voiced concern over such a possibility, saying the plan could become a logistical nightmare in terms of financial management.
Health advocates, who for years have been pushing for a universal health insurance scheme, have cautioned against any rush to enact the policy.
A hastily introduced plan, they say, could reduce the quality service or in the worst case, bankrupt the healthcare-service coffers.

A member of the party’s executive, Dr Surapong Suebwonglee, said the draft National Health Insurance law would be submitted before parliament when the government announces its policy. The law would make possible the establishment of the Health Insurance Fund, from which budgets would be allocated to hospitals under the health insurance programme.
A royal decree would then be enacted for the establishment of the National Health Insurance Office, which would be authorised to manage the health-insurance budget, said the doctor.

“By October, a pilot project would be launched at 15 hospitals throughout the country where patients can seek treatment and pay only Bt30 each,” he said.
These hospitals would be managed under the new administration, said Surapong. He did not elaborate.
Under the programme, patients would register with the hospital in their area in order to receive service. The party said it hoped the registration system would encourage hospitals to compete among themselves to develop quality service, since budgets would be allocated according to the number of people registered.
Surapong said that by next October, Thailand’s entire population of 62 million should be covered under this health-insurance programme. Currently, about 18 million Thais were not covered by any health-insurance scheme, he said.

Defending the policy as the “turning point” in history of this country’s healthcare system, Surapong said it was not a give-away policy.
With regard to concerns over service quality, Surapong said an independent organisation would be established to monitor and accredit the hospitals to ensure that patients received good care.
While supporting the policy, some health advocates cautioned against a fast-track introduction, saying that more details were needed. Of greatest concern, they said, was the operating budget for the policy.

“The party said that the current health budget is enough to operate the policy, but we are not so sure,” said Senator Jon Ungpakorn, another advocate for the universal health-insurance scheme.
“It remains to be seen whether the party’s health insurance policy will merge the existing schemes and whether it will include welfare for the civil servants,” said Jon.
Jon disagreed with the Bt30 patient user-fee, saying the payment should take other forms.

Social security officials, meanwhile, said it was unlikely all the health-insurance schemes could be merged, citing the difficulty in management.
Jettana Meepien, adviser to the Social Security Office, said there might be a single body to oversee the health-insurance programme but that the management of each health insurance scheme should be separated.
Chamlong Sriprasart, deputy permanent secretary at the Labour and Social Welfare Ministry, said it was still too early to talk about the possibility of merging. However, for the policy to be effective, the system for each scheme needed to be improved first, he said.
Jon said a coalition of 11 non-governmental organisations had long been pushing for a national health-insurance law. The group was now collecting signatures from the 50,000 eligible voters needed to propose the bill.

Pledging full cooperation with the NGOs, Thai Rak Thai’s Surapong said the government would invest about Bt1,100 per head (this figure is based on the cost-subsidy paid to hospitals under the Social Security Programme). The total budget was estimated at about Bt68.2 billion and would be taken from the present budget which had been allocated to several health insurance schemes.
These included welfare for civil servants, the social security programme and the healthcare card scheme for low-income citizens.
In addition, more money would be raised from the Bt30 user fee by patients when they sought treatment, he said, adding: “Thus, there is no need to collect the Bt100-premium from the insured as initially planned.”

Dr Sa-nguan Nittayarampong of the Office of Healthcare Reform suggested that Thai Rak Thai should consider its policy carefully and not rush it into law.
“This [universal] health-insurance policy should take two to three years for the preparation process, to ensure smooth and effective operation,” he said.
He said the party’s health-insurance policy should conform with the plan to decentralise health administration under the 1999 Decentralisation Act.
Of equal importance, he said, was the mechanism to ensure the quality of service. Any health-insurance policy should guarantee that all patients received equality of essential services.

User fees should not be a major problem, Sa-nguan said. Available research on the government healthcare card scheme found that patients were willing to pay up to Bt1,500 for the healthcare card if they could be guaranteed good service.
“Under any health-insurance system, it’s important that we share the [healthcare] cost,” he said.
It was also important for Thai Rak Thai to look beyond treatment and care to healthcare reform and health promotion, said Dr Ampol Jindawattana, director of the National Health System Reform Office.

Ampol said the government also needed to address inequality among various health insurance schemes. For example, the budget for the social security scheme was estimated to be Bt2,106 per head per year, while the budget under the healthcare card for low-income patients amounted to only Bt250 per head, he said.