All eyes on possible change to health law

THE NATIONAL Legislative Assembly (NLA) is handling a hot potato – how to amend the country’s key health law. 

Any jiggering with the National Health Security Act could have serious side effects, because the law governs the universal healthcare scheme covering 48.7 million people. 

The NLA’s public health committee has presented an amendment in the hope that a new budget management approach will improve the scheme’s efficiency. 

However, its content has attracted opposition from many groups, particularly those that fear that the scheme will collapse or face drastic changes. 

NLA President Pornpetch Witchitcholchai is now considering whether the bill qualifies as a financial law. If it does, the NLA does not have the right to initiate the legislation and the Public Health Ministry would be asked to take over the issue. 

Many figures have come forward to have their voices heard from professional and consumer groups as well as the National Health Security Office (NHSO), which runs the universal healthcare scheme. 

They hope to make sure the amendments are made the way they want. 

The proposed amendment from the NLA public health committee could drastically shake up the universal healthcare scheme through a fresh approach to budget management. 

It seeks to divide the scheme’s budget into two main parts – for medical workers’ salaries and for the direct delivery of medical services. 

Dr Jetn Sirathranon, chairman of the NLA public health committee, said recently the budget separation would clarify many issues. 

While the government had agreed to increase the scheme’s fiscal 2017 budget by 1.7 per cent to Bt3,109.87 per person, salaries for medical workers rose by 5.4 per cent. 

That means the money allocated for services has in effect shrunken.

The only reason the budgets were not separated at the scheme’s inception was because there were plans to turn state hospitals into public organisations.

 

‘Time for a review of scheme’

“But 14 years after the universal healthcare scheme was launched, the plans have not achieved the intended results. So it’s time to review the approach,” Jetn said. 

The proposal from his committee also recommends co-payments by patients. 

It has called for a bigger budget share for the Public Health Ministry from various funds for financing the universal healthcare scheme, such as the fund for kidney dialysis. 

While the NHSO has managed the scheme, the Public Health Ministry has been its operator. 

The ministry and its staff have had to struggle to provide services within a very tight budget. 

“The NHSO can’t keep taking the praise and pass the blame to the Public Health Ministry,” Jetn said.

It would be better for the NHSO and the Public Health Ministry to share the praise and blame from the universal healthcare scheme, Jetn added. 

“To date, the scheme has caused state hospitals a loss of Bt24.3 billion,” he said. 

State hospitals have tried to stay afloat by sharing budgets with other healthcare schemes such as social security and the scheme for civil servants and their families. 

“But such measures won’t be able to help for long. The universal healthcare scheme will collapse if it doesn’t change,” Jetn said. 

However, Mongkol Na Songkhla, a former minister and permanent secretary for the ministry, has objected to the proposal to divide the budget. 

He said on Facebook that the proposal could reduce efficiency at state hospitals and aggravate staff shortages in rural areas. 

Hospitals might try to boost their staffing to get a bigger budget because the budget would no longer be based on the per-head subsidy or the number of patients at each medical facility, Mongkol said. 

Earlier this month, Saree Ongsomwang, chairman of the NHSO committee on public participation, opened a public hearing for the proposed amendment in which some participants expressed disagreement with dividing the budget. 

Dr Kriengsak Vacharanukulkieti, head of the Rural Doctors Society, said the separation would exacerbate the gap between rural and urban medical-service providers. 

“The current practice makes sure big hospitals in town think twice before hiring more doctors because they have to pay the salaries,” he |said. 

Boonyuen Siritham, a former Samut Songkhram senator, protested against the proposal for medical-profession groups to gain more seats on the NHSO’s board.

“Any law amendment should focus on the public interest, not on the benefits of any particular person,” she said. Dr Vichai Chokwiwat, a former member of the NHSO board, objected to the idea of setting up a committee to monitor the performance of the NHSO and its secretary-general. 

“If such committee is established, the NHSO will lack management independence,” he said.