Health security schemes ‘need more money’ in order to survive
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TDRI health expert says security schemes 'need more money' in order to survive, but a doctor says the govt should bring back Bt30 fee and boost staff and health awareness.
MORE money needs to be raised for the country’s three health security schemes to solve the quality problem and ensure the survival of the system, warned the Thailand Development Research Institute (TDRI).
Suggestions on how to raise more money for the programmes – Universal Health Coverage (UC), Social Security (SS) and the Civil Servant Medical Benefit scheme (CSMB) – have been presented to Public Health Minister Piyasakol Sakolsatayadorn.
Many fund-raising methods have been proposed, but a TDRI expert on the healthcare economy, Viroj Na Ranong, supports raising money through a co-payment system, with the beneficiaries paying before they receive medical care.
“It is a common consensus that there is not enough money to run the country’s health security schemes properly and co-payment is needed,” he said. “However, the debate is not settled as to how we can raise more money for the schemes.
“It would be best not to pay when they [the beneficiaries] see the doctor, as it might cause a burden to the beneficiaries, and the amount of co-payment should be based on the beneficiaries’ ability to pay.
“One of the suggestions of the committee studying sustainable long-term funding mechanisms for the health schemes that I find very interesting is to shift the salary ceiling of SS beneficiaries to seven times in the co-payment system. This can create more money for the healthcare service and also increase the pension benefit after retirement.”
He said there were many contentious issues involving the co-payment proposal and there would be no consensus reached on a specific method.
But he suggested that no matter what method was implemented, it must not increase the burden on the poor and bankrupt households.
He disagrees with the idea of implementing a new tax to support the health security schemes as he believes doing so would be too complicated and a lot of money would need to be spent to collect the tax.
He does not believe the health security system will bankrupt the economy, if it is still linked to the current budget.
But he said it would get harder to ensure the quality of the healthcare service and the survival of the system.
“The healthcare expense per head is slowly increasing every year, so it is impossible for the system to be managed with no new budgets in the long run,” he explained.
He said the UC scheme suffered chronically from a lack of quality, and last year it was controversially revealed that UC beneficiaries had a higher death rate than CSMB beneficiaries, who benefited from a fund that was five times that of the UC.
“We cannot expect equal quality of medical services throughout all three health security schemes with the disparity in budgets,” he said.
