THURSDAY, March 28, 2024
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Thai universal healthcare: Should it be a right with responsibility?

Thai universal healthcare: Should it be a right with responsibility?

In 2002, universal healthcare coverage was initiated by the Thai Rak Thai government. Nicknamed the Bt30 healthcare programme in reference to the cost of each medical visit, the scheme gave 49 million people living both above and below the poverty line almost free access to healthcare services.

Universal healthcare was overwhelmingly welcomed by the rural poor, especially in the North and Northeast (Isaan) – the political base of the Pheu Thai Party and its predecessor Thai Rak Thai. The policy remains a cornerstone of Pheu Thai’s platform, allowing it to maintain support and popularity by portraying itself as representing the rural poor. 
Since 2002, however, discussion on revising universal healthcare has been politicised and become politically sensitive. Increasing numbers of people have begun to perceive healthcare as an absolute right, with little consideration of it as a personal responsibility. This has triggered concerns over public expenditure on the programme.
It is undeniable that a universal healthcare scheme is necessary, and it was originally introduced in compliance with Section 52 of the 1997 Constitution. Indeed, at that time the public was not fully aware that universal healthcare was a constitutional right that the state must provide. 
Most supporters of Thai Rak Thai perceived universal healthcare as a gift from the party, failing to realise it was a duty and responsibility of their representatives to pursue such a policy. This allowed the party to establish a personal bond with them – which in fact is typical of Thai political culture regardless of who is in government. 
Since 2014, the National Council for Peace and Order (NCPO) has pushed for reform of the universal healthcare bill in order to introduce a co-payment scheme. This is partly because so many hospitals and doctors are complaining about the financial burden on the system, and claim that the people have been “spoiled” by the system and are now making too many unnecessary hospital visits. 
However, it is too simplistic to view the rising number of hospital visits and conclude that the universal healthcare scheme has spoiled the people, since the costs of healthcare are not just a medical bill for the rural poor. 
Patients, especially the rural poor, incur expenses every time they access medical treatment, including for travel and lost income from not working. Such expenses are a serious financial burden for a large number of patients and mean that rural people often can’t access hospital treatment even when they need it. However, this fact is generally missing from the healthcare debate among doctors and the middle class.
“I have to get up at 1am to get here early for the hospital queue,” reports a villager who travelled from a district of Khemarat to the hospital in the city of Ubon Ratchathani recently. “Travelling from a rural part of the province to the hospital is not that easy. Sometimes we have to contribute Bt100 each to rent a truck to take us to the hospital. There are many things that we have to pay for to get here [hospital]. Paying the small amount of Bt30, or not paying at all, really helps us.” 
Healthcare should be free and considered a right for the rural poor, particularly for the 10.5 per cent of population that lives below the national poverty line – but not for all. For those who can afford it, healthcare should be considered a responsibility, for which a co-payment scheme should be applied.
In addition, Thailand is now considered to be an ageing society, with about 7.5 million people or 11 per cent of the population over the age of 65. The World Bank estimates this figure will rise to 17 million by 2040. Public expenditure on healthcare will almost certainly rise as a result, presenting a big challenge for which the government must be prepared.
The introduction of a co-payment scheme by the NCPO makes clear financial sense for the government. However, the validity of the move has been undermined by the priorities set for public expenditure under this administration. The NCPO has demonstrated that its spending often does not synchronise with the needs of millions of Thais. Recent examples include the US$393 million spent on submarines from China, and the agreement to purchase four Black Hawk helicopters from the United States. The NCPO claims these purchases are important for national security, despite the country not being at war.     
In his 2016 speech at the UN general assembly, Prime Minister Prayut Chan-o-cha highlighted the importance of healthcare: “We also have a continued policy of providing quality healthcare services for all.” 
So where does the government’s priority lie now – with national security or with human security? This is an important question that must be answered by the military leadership. Can a country be secure without a healthy population? Can the economy prosper with a populace that is left prey to illness? 
Another important question is how much the junta can successfully reduce the public financial burden of healthcare through the introduction of a co-payment scheme. This is not entirely a question of spending priorities, however, but also a matter of political games, in which politicians will play an important role. Providing social welfare is always rewarding for politicians and those in power, because such policies help ensure they maintain public popularity. 
Exactly how much individuals will need to contribute to the co-payment scheme has not yet been finalised. However, this scheme must not become a barrier to accessing healthcare for those who live in poverty. 

Titipol Phakdeewanich is dean of the Faculty of Political Science at Ubon Ratchathani University, and a visiting fellow at the Centre for the Study of Globalisation and Regionalisation at the University of Warwick in England. 

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