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Co-payments near reality as universal healthcare system reformed: minister

Jan 02. 2018
Public Health Minister Dr Piyasakol Sakolsatayadorn.
Public Health Minister Dr Piyasakol Sakolsatayadorn.
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By Chularat Saengpassa
The Nation

LIKE IT OR NOT, indications are that patients will have to pay a portion of their medical expenses if and when the proposed National Health Security Bill is passed under the junta government.

“After we push through this bill, we will hold serious discussions on co-payments,” Public Health Minister Dr Piyasakol Sakolsatayadorn said during a recent exclusive interview with The Nation. 

He added that there had already been extensive studies on co-payment options. 

The draft National Health Security Bill has long been a subject of debate and controversy, with at least two groups clashing fiercely over its contents. Most critics worry that the bill would change the essence of the very popular universal healthcare scheme that now offers most medical services to about 48 million citizens for free. 

Their concerns are not unwarranted, given that advocates of co-payments have been persistent in pushing their belief over the years. 

Several health economists and experts have argued that without co-payments, the much-praised universal healthcare scheme – and Thailand – will collapse if the public insists on government shouldering the full financial weight of the scheme. 

“Even rich countries have limited healthcare budgets,” Piyasakol said in arguing for co-payments. “You have to understand that not all services can be free.” 

However, Piyasakol is quick to claim that healthcare reform is not intended to reduce people’s rights to healthcare. 

“We will ensure your right to basic healthcare services is not affected. But if you want more than the basic, you will have to pay,” Piyasakol said. 

When he had eye surgery, Piyasakol said, he had to pay out of his own pocket for extra services even after exercising his right under the medical scheme for civil servants and their family members. 

He added that healthcare reform was inevitable for the sake of sustainability and long-term efficiency. 

He said conflicts over the bill had already been reduced as relevant parties worked to reconcile their differences. There was also tangible cooperation from the National Health Security Office (NHSO), which manages the universal healthcare scheme, and the Public Health Ministry, which is mainly in charge of the scheme’s operation, he added. 

Although some topics remained divisive, Piyasakol said he was confident that compromises were possible and the bill would sail through, while still emphasising that co-payments were in the current National Health Security Act.

“I trust that there will be no big conflict,” he said. 

He added that the provision of health security would need to keep pace with the future contexts. 

Piyasakol said healthcare reform would also focus on easing overcrowding at big, well-equipped hospitals.

One reform would see 12 types of surgery performed on a one-day basis at no fewer than 15 per cent of major hospitals by the end of this year, according to the plan.

After several surgeries, such as those for haemorrhoids and biliary tract stones, most patients can leave hospital almost immediately after the operation.

“When patients can go back home within the same day of their surgery, it means there will be no problems finding a bed or a room for other patients who need to stay in the hospital,” Piyasakol said.

Another reform would see specialised clinics operating beyond normal working hours at major hospitals, including large and crowded ones, and not limited to facilities at medical schools. “Patients using the services beyond normal hours will have to pay more but they will get fast services,” he said. 

Overcrowding could also be eased with the implementation of a referral system that allowed large hospitals to transfer patients back to smaller hospitals for recuperation and rehabilitation, he said. Another change could see an increase in the number of family-medicine units.

A collections centre had also been established to help hospitals collect money, Piyasakol said. 

“This is meant to ensure that hospitals receive money owed to them,” he said. 

Sometimes doctors were so busy that they failed to double-check payment amounts and their hospitals ended up receiving less than what they were owed, he said. “The centre has helped with such cases,” he added. 

The Public Health Ministry has tried to help hospitals increase income and lower expenses in other ways as well. “For example, specialised clinics working beyond normal hours can generate income,” he reiterated. “Efficient use of electricity and resources can save utility bills.” 

Executives at the 120 hospitals that were reported to be operating with serious deficits had already received additional training so that they could better manage resources and improve work efficiency, Piyasakol said. The government, he added, had allocated Bt5 billion in the budget earlier this year to help address the problem.

“At present, only 87 hospitals are still considered to be in a serious financial crisis,” he said.

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