Our healthcare, despite being a leader, needs an overhaul

Yet it has drawn much criticism within the country particularly from medical workers. Healthcare reform, therefore, will be needed.

Before reform starts, let’s take a look around Thailand. What have other countries been doing? And what factors have affected people’s access to healthcare services?

The World Health Organisation (WHO) has recommended that governments spend a budget equivalent to 5 per cent of their country’s gross domestic product on healthcare. 

The 2013 Asean Declaration on Strengthening Social Protection, meanwhile, has called for collective progress towards universal health coverage.

This requires examination through three dimensions: (a) the breadth or extension of population coverage by insurance schemes; (b) the depth or the types of services that need to be provided, such as outpatient and inpatient services; and (c) the financial risk protection, such as co-payments. 

While Thailand spends less than 5 per cent of GDP on health, its universal healthcare scheme has managed to cover about 49 million people who are entitled to almost all types of medical services for free. To outsiders, the programme is a remarkable success. 

However, as the scheme is now threatening to jeopardise the state budget and government-sponsored healthcare sector, several groups are pushing for its overhaul. 

Co-payments and more have emerged as possible alternatives. 

In the Philippines, the government-owned health insurer was providing coverage to about 81 per cent of the population in 2013. Vietnam, meanwhile, has subsidised health-insurance premiums for vulnerable groups.

Health insurance is a must-consider option given that surveys have shown that people, particularly from lower-income families, cannot access healthcare services because of the money factor.

In Laos’ rural areas, households in the highest-income quintile (population sample) are three times as likely to seek hospital care as households in the lowest-income quintiles.

To help its people access necessary medical services, Thailand will need to plan well. According to the Mahidol University’s Institute for Population and Social Research, Thailand has the highest proportion of elderly people in Southeast Asia. By 2012, the proportion of people older than 65 years stood at 12.59 per cent in Thailand, as opposed to 12.25 per cent in Singapore and 7.5 per cent in Vietnam.

 In 2012, Thailand spent Bt430 billion via its healthcare systems, which included the universal scheme. Of that amount, Bt1.4 billion was spent on the elderly. 

Even the National Health Security Office has reckoned that it will have to improve its efficiency, particularly in regards to care of the elderly. It is estimated that the number of elderly persons in Thailand will reach 14.5 million by 2025.

As one’s healthcare costs will rise in response to age, Thailand will need to be prepared to deal with the elderly. Despite the importance of the money factor, it is not the only thing that restricts people’s access to healthcare services. 

Indeed, there are several instances whereby people refrain from using healthcare services even though they are available and affordable. In some cases, this may be because of the perceived lack of good-quality care, such that those who can afford to do so visit health facilities in other countries. In other cases, the services may not be considered socially or culturally appropriate, which is particularly the case when it comes to sexual and reproductive health services.

Studies have shown that among patriarchal-oriented societies, husbands or in-laws often decide whether women in the household should make use of healthcare services.

For example, studies on Bangladesh contain reports of numerous examples where women were denied pre- and antenatal healthcare services because male family members considered the use of such services inappropriate.

However, studies have also shown that the use of sexual and reproductive health services as well as healthcare services for children increases with the educational level of both. Use of healthcare services is more prevalent among the older generations and groups with lower education.

Studies in Vietnam have also found that minority ethnic groups tend to use healthcare services to a lower extent than majority groups. For example, indigenous communities in that country often do not make use of health services, even if their households are in close proximity to a healthcare facility. Yet across income quintiles, public health facilities are relatively equitably utilised.

As Thailand is preparing to implement its healthcare reform, it should take into account all relevant factors. Cultural, ethnical and financial and education factors must be studied so as to plan the best reform ever. 

People should have access to basic medical services, regardless of their financial status or cultural/ethnic background. The government needs to plan well. The health of people is in many ways the health of the nation.