The government must put its money where its mouth is to keep the hugely popular Bt30-per-hospital-visit scheme viable
Of all the populist policies on the Thai Rak Thai party platform in the run-up to the previous general election in 2001, the Bt30-per-hospital-visit scheme was by far the single biggest vote-grabbing promise. Millions of voters were persuaded by this – and other populist policies – winning the party a landslide victory at the polls four years ago. To Thaksin’s credit, he proceeded to fulfil virtually all of his promises, including the setting up of a universal healthcare coverage in October 2001.
Some 45 million people not already covered by the Social Security system or Civil Servants’ Medical Benefit Scheme are eligible for the universal coverage plan. The generous healthcare plan – which provides a full range of medical treatment, including major surgery – proved to be an instant hit among the populace. This partly explains the enduring high popularity ratings for the prime minister and his ruling party.
The most innovative aspect of Thailand’s universal coverage is the use of a per-capita payment system similar to that of the Social Security Office’s health-insurance scheme. Under this system, healthcare providers are paid directly by the government in accordance with the number of registered patients under their care. Healthcare providers are expected to manage their budgets and balance their books on their own.
As a precaution against cost escalation as more and more are brought into the scheme and utilise the healthcare services more frequently, the capitation rate was originally set at Bt1,202 for each person for 2002, and then allowed to increase gradually: to Bt1,414 in 2003, Bt1,447 in 2004, and Bt1,700 in 2005.
An annual adjustment to the capitation rate is necessary if access to the scheme is to be expanded and the quality of healthcare services maintained or improved.
Since its inception, some economists and public health experts have voiced concern that the universal healthcare coverage, together with other populist policies, could pile up a mountain of national debt. Some outspoken administrators of public hospitals have even gone so far as to proclaim publicly that the Bt30-per-visit medical service is driving their hospitals into the red, if not into outright bankruptcy.
The complaints are growing louder. The Thaksin administration, apparently under pressure to divide the limited taxpayer money in its coffers on competing populist projects, has reneged on its promise to provide the necessary funds to keep the universal healthcare plan functioning smoothly as intended.
In 2003, the government earmarked only Bt1,202 for each person covered by the healthcare scheme, instead of Bt1,414; only Bt1,308 for last year, instead of the proposed Bt1,447; and Bt1,510 for this year, instead of the scheduled Bt1,700.
The shortfall in funding for the universal healthcare plan is starting to cause some serious damage. Out of all 819 participating state hospitals, 265 now collectively owe their pharmaceutical and medical-equipment suppliers – not to mention utility companies – a total of almost Bt1.4 billion. Many are hopelessly in debt, while others are on the brink of bankruptcy.
Thaksin and his campaign strategists gained tremendously in the 2001 election and are once again about to ride a wave of popularity – afforded them to a large extent by the universal healthcare scheme – to victory in the February 6 election.
The universal healthcare scheme is the best thing that has ever happened to the public, particularly those unfortunates on the lower rungs of the economic and social ladders. The Thaksin administration – which everyone expects to be returned to power after this next election – must act responsibly. Other populist projects must be scaled back, with their funds diverted to universal healthcare, or the public must be told the truth: that there is a desperate need to make adjustments to the healthcare scheme in the near future, in order to avert potentially disastrous and long-term financial liabilities.
Published on January 25, 2005