30-baht healthcare under attack

A disagreement has emerged over whether the 30-baht universal healthcare scheme should continue in its current form.

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Under the leadership of permanent secretary Narong Sahametapat, the Public Health Ministry floated the idea of having people "co-pay" 30-50% of the cost of healthcare services, saying the programme is unsustainable.   

On the other hand, the National Health Security Office (NHSO), the scheme's architect, argued the state budget spent on the project was a mere 7% while its benefits were overwhelming.

The 30-baht healthcare scheme was adopted by the self-exiled former prime minister Thaksin Shinawatra in 2001 and became nationwide the next year, bringing 20 million people who had in the past not covered by any healthcare scheme into the social safety net.

Under the programme, every Thai can be treated at a state hospital and approved medical facility at the cost of 30 baht for each visit. The government pays the budget to each facility yearly based on the number of people registering to use it.

The scheme initially drew strong resistance from the medical profession, partly because it took away most of the budget normally going to the ministry and state hospitals to the NHSO which in turn paid them by the number of patients they actually treated.   

Like most developments in Thailand over the past 10 years, there is a political angle to the latest discord.

Dr Narong has made no secret of his strong support for the People's Democratic Reform Committee (PDRC), which tried to topple the government of Yingluck Shinawatra, Thaksin's sister, in late 2013 to early this year.

The conflict began on May 31 when the idea was floated at a meeting between ministry officials and Adm Narong Pipattanasai, a deputy chief of the National Council for Peace and Order (NCPO).

Dr Narong said later today there was no discussion in detail and the idea was not the resolution of the ministry.

But since then, Dr Narong, in his capacity as public health minister, has not called a routine meeting with the NHSO board.

"It's not true that the universal healthcare scheme is unsustainable. The government allocates only 7% to the programme and it is the money well spent. It helped bridge the poverty gap," Nimit Thien-udom, an NHSO board member told Matichon Online.

"Our programme has been commended internationally for really helping the poor. If the government wants to reduce the cost, conscripts with the gold card must also shoulder the burden," he said.

That the public health chief does not call the meeting makes people lose opportunity because new benefits could not be approved, he said.

"The hepatitis C drug has not been approved and patients risk developing liver cancer if they don't get it. Once they get cancer, the treatment cost will skyrocket," he said.

The drugs pending approval of the board are Tastuzumab for breast cancer, Peginterferon for heptitis C, leukaemia drugs Nilotinib and Dasatinib, and Dacarbazine for Hodgkin's lymphoma.

"The board once decided the drugs could be distributed once the drug committee approves them without having to wait for the board's approval. The NHSO should have the courage to make good on this. Don't let the public health permanent secretary hold people hostage," he said.

Mongkol Na Songkhla, a former public health permanent secretary and minister during the Surayud Chulanont government, posted on his Facebook today about the conflict.

"I'm deeply concerned about the news the ministry's management prohibited hospitals and officials from cooperating with the NHSO and proposed scrapping the principle aimed at separating buyers and service providers to pull the power back to the ministry," Dr Mongkol wrote.

The principle is a good one because it ensures the budget will not be used for other purposes. It will be closely monitored by the buyer (NHSO) for utmost public benefit, he argued.

"The universal healthcare scheme was initiated by Dr Sanguan Nittyarumpong and the alliance of nationwide public health networks. It's not 'another wreck' of the Thaksin regime as accused. But pushing the idea to become a public policy needed support from a government. And in the past, the idea had been proposed to all big parties.

"I insist this is not a populist policy. It's the responsibility of the state to take care of its people as is the intention of our public health forefathers." he concluded.

As for ongoing policies, Dr Narong said today the ministry was reforming its work process by decentralising into health service zones, focusing on providing integrated services within the zones and minimising referrals or transfers.

He urged the ministry and the NHSO to agree on the use of a national key performance index. 

As buyer of the services, the NHSO will pay and evaluate the performance of each medical facility based of the agreed indicators.

Dr Narong also suggested the universal coverage budget should be limited to four categories — outpatients, in-patients, health promotion and disease prevention and emergency aid under Section 41 — instead of spreading through several small funds.

Source: Matichon Online

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