Co-payment 'best for health scheme'

EXPERTS from the Thailand Development Research Institute (TDRI) have suggested ways to reform the Universal Coverage Healthcare Scheme (UC) so patients make better use of it.

They recommended co-payment by patients and encouraging the middle class to use the scheme by altering budget management and reducing treatment costs.

Yesterday TDRI hosted a press conference “Universal Coverage Healthcare Scheme reform: what to do and what should not be done”.

The panellists noted that the effort to freeze the UC budget was impossible, as the scheme’s costs increase every year due to demographic changes. They said reorganising how the budget is managed was crucial to keeping it a cheap and quality health system for all Thais.

Prominent health-system researcher Dr Ammar Siamwalla said statistics from the National Health Security Office showed that the scheme’s costs rise every year. In 2014 the figure jumped by as much as Bt150 billion, so demands for a budget cut or a freeze on subsidies were technically impossible.

“We will have more old people in the future, our population is slowly increasing and the medical treatment cost is getting higher too. These factors contribute to the larger UC expense and the simplest solution is to increase the budget, but it is not an option,” Ammar said.

With a financial problem looming, TDRI specialist on social security Worawan Chandoevwit suggested that a co-payment system should be introduced to reduce the burden. “Many countries with a similar health security  such as France, Germany, Japan, Australia and Canada have a co-payment system, but the types of co-payment vary. For example the share of payment on medicine costs, paying monthly as an insurance premium, or co-payment when visiting a doctor,” Worawan explained.

She emphasised that the co-payment system should apply only for outpatients who do not have chronic diseases and expensive treatment costs, in order to ensure that the co-payment system will not add more hardship to patients.

She said the budget for inpatients and outpatients should be rearranged because inpatients’ expenditure is higher than outpatients’ and co-payment from outpatients would result in more funds to subsidise inpatients.

“Lowering the treatment cost is also another option to maintain efficiency of the scheme. This can be done by promoting last stage patients to return home, as TDRI research revealed that costs during the patient’s last year of life are much lower when they pass away at home,” she suggested.

 

Middle-class prefer private hospitals

Ammar said nowadays most well-to-do middle class people do not use the scheme but go to private hospitals instead. They did not want to wait in a long queue and were not sure about the treatment quality.

“This is a problem because when more people pay for expensive medical care in private hospitals, the hospitals will have more money to put into medical staff salaries. This will gradually lift health costs in the entire medical system because medical staff in the public system will also demand raises too,” he said.

“It will result in higher UC expenses and the most affected people will be the poor, who rely on UC benefits. The middle class who choose to receive medical care in private hospitals may also be charged expensive prices without any negotiation power,” he said.

During the discussion, questions were raised about inequality between the three main health security schemes and the advice was the three schemes should be merged into a single fund.

Worawan said problem of inequality between each health security scheme could be fixed through the management of funds. TDRI was aiming to show that beneficiaries in the universal coverage scheme could receive quality medical care at a cheap price by implementing suggestions presented by TRDI.