FRIDAY, March 29, 2024
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Selection of the new NHSO chief embroiled in power game

Selection of the new NHSO chief embroiled in power game

The only qualified candidate for the National Health Security Office (NHSO)’s secretary-general post, who had won the backing of rural doctors, ended up losing at the very last minute early this week.

However, before one gets too preoccupied with the power game between rural doctors and the Public Health Ministry-led camp, it is important to note that the universal healthcare scheme is in the hands of the NHSO. 
In other words, any idea espoused by the NHSO chief can affect the scheme, which now covers most Thais.
Currently the universal healthcare scheme covers 48.7 million people offering most types of medical services for free. 
On Monday, with a 14:13 vote the NHSO board decided not to endorse Dr Prateep Dhanakijcharoen as its new secretary-general. The NHSO has been managing the universal healthcare scheme since it was launched 14 years ago. 
Prateep had won the full backing of rural doctors, who have dominated the NHSO since it was established. This camp believes that if its presence in the agency decreases, doctors loyal to the Public Health Ministry will try to scrap or drastically change the universal healthcare scheme. 
The ministry, which operates state hospitals nationwide, is practically in charge of the scheme’s operation. All along, it has been unhappy with the scheme, saying it overburdened its medical workers, triggered the brain-drain phenomenon and had made several hospitals bankrupt. 
Before Monday’s vote, the rural-doctor camp struggled to thwart the other camp’s candidate Dr Wanchai Sattayawuthipong from winning and finally managed to have him disqualified by the Council of State. 
With Wanchai removed, Prateep became the only candidate for the NHSO board to consider on Monday.
But now that Prateep too has failed, the rural doctors suspect that the other side has been plotting to shake-up the universal healthcare scheme. 
The Public Health Ministry-led camp, after all, has never really stopped calling for drastic changes to the scheme. 
It has cited studies that show co-payment as a more reasonable approach to providing healthcare to people. If the government is forced to shoulder the cost of the entire population’s healthcare, it will stagger under the constantly rising cost, especially since its population is largely greying. 
Supporters of the co-payment system claim the budget allocated by the state for healthcare would benefit the poor even more because the funds would not have to be shared with those who can afford treatment. 
Opponents, however, believe that everybody should be entitled to healthcare services. If the scheme is not universal, then people entitled to welfare will have to step up and ask for it. 
Both sides, however, believe they are right – listing their reasons respectively. They have also been clashing openly and behind closed doors to pursue their causes or defend their ideas. 
However, clashes will not really benefit the country. What will serve public interest are rational discussions and moves to jointly seek solutions. 
Let’s look at how developed nations have handled their healthcare schemes as this could provide useful pointers. Japan, for instance, takes pride in its different healthcare schemes that are specifically designed to cover particular needs of different groups. One of these schemes serves just those between the ages of 65 and 75. Co-payment is also mandatory, with Japanese citizens shouldering between 10 and 30 per cent of their medical expenses. 
Over the past 14 years, Thailand’s universal healthcare scheme has actually offered people free access to medical services, though the scheme is not without problems. 
State hospitals have pointed out that the NHSO came up with these good sounding policies and guidelines from an ivory tower, without really understanding the operation. There are many loopholes about how some hospitals get reimbursements, while some other hospitals reel under excessive workload or costs. 
Reimbursements get especially complicated for hospitals that have to treat patients with complicated conditions who have been transferred from other hospitals. 
Many hospitals have also wondered why the NHSO funds activities that are not directly related to health, but does not allocate more for the direct delivery of medical services. 
This fiscal year, the universal healthcare scheme was allocated Bt147 billion, Bt40 billion of which was earmarked for the remuneration of medical workers and the rest for direct medical cost. 
This budget accounts for about 1.3 or 1.4 per cent of the country’s gross domestic product. While the ratio is reasonable, it is undeniable that better management and improvement is needed or else the universal healthcare scheme may end up affecting the country adversely.  
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