By Chularat Saengpassa
“For example, if you want medicines that are not on the national drug list, you will be charged,” Dr Seree Tuchinda, who heads the national healthcare reform committee, explained.
Seree said the reform will present three healthcare packages. The first one will offer basic healthcare for all Thais, regardless of what level of healthcare they are currently entitled to. Coverage under this package will be no less than that under the universal healthcare system now available for 48.8 million people. The second package will present the additional medical services that each major state-supported healthcare scheme wishes to provide to its members. The third package will offer medical benefits that people will get only when they pay extra under a co-payment scheme.
“The details of these three packages will become clear and definite within the next year,” Seree said.
However, Kannikar Kijtiwatchakul, who sits on the National Health Security Board, attacked this plan. “It’s a reform planned by a certain group of people for their own group’s interests,” she said.
Kannikar said she suspected the reforms would mean that there would no longer be any free medical services for Thais.
At present, the country’s universal healthcare scheme offers most types of medical treatments for free.
Seree, meanwhile, downplayed concerns that these new packages would hurt the benefits Thais now enjoy, saying that fairness and risks of medical bankruptcy would be taken into consideration.
“In the event of co-payment, we will set the ceiling of what Thais will have to pay each year,” he said. “We will also ensure that local administrative bodies help the poor, at least partially, regarding the cost of treatments.”
Seree said that some people might oppose the concept of national healthcare reform because they thought they would lose some benefits. “But it’s necessary that we go with the concept that will benefit the majority. We need to take into account the fact that the government cannot fully pay for everyone’s medical costs. We need to be realistic,” he said.
Dr Churdchoo Ariyasriwatana, an adviser to the association protecting civil servants’ medical rights, agreed with the concept of making three packages available. “People must realise that there are no free things in this world. They can get basic healthcare for free, but if they want more than that, they have to accept co-payment,” she said. Churdchoo also believed that people would take better care of their health if they were aware they would have to pay a medical bill.
Asst-Professor Dr Thira Woratanarat, who teaches at the Chulalongkorn University’s Department of Preventive and Social Medicine, said medical costs would continue to climb in the face of increasingly advanced medical technologies. He noted that even rich countries could not afford to provide completely free medical services to their people. “The government cannot pay for medical treatments of all its citizens. At one point, sooner or later, it will find that it doesn’t have enough money to do that,” he said.
Thira recommended the government consider using the proceeds of “sin taxes” for public health and to promote healthy behaviour among people.
He said the government should also provide Thai consumers with healthy alternatives. For example, the government may offer tax incentives to entrepreneurs who produce healthier choices such as food with less sodium, fat or sugar.
Thira said the government should also provide counselling services to Thais to raise their awareness of medical costs and their choices so they can seek proper medical coverage. “Without counselling services, many people may fall prey to health-insurance firms. The government should help people assess their health risks and advise them as to which health insurance policy is suitable for them,” he said.
Thira also recommended the use of family medical services, which would ease overcrowding at big hospitals and reduce the use of unnecessary healthcare.
There are now three major healthcare systems in Thailand: the universal healthcare scheme, the social security scheme, and the medical benefit scheme for civil servants and their family members. In the current fiscal year, the annual per-capita budget is Bt2,592.89 for the first scheme, Bt3,354.80 for the second, and Bt12,676.06 for the third.
The upcoming national healthcare reform will set up a new National Health Policy Board to align healthcare policies and goals, and establish a National Health Data Clearing House to facilitate the delivery of medical services.
“We will also go toward decentralisation,” Seree explained.