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Health reform hopes renew

Prime Minister Srettha Thavisin's decision to establish the National Health System Development Committee has raised high expectations for healthcare reform in Thailand.

Undoubtedly, the country’s globally acclaimed universal healthcare scheme resulted from the political resolve of the former Thai Rak Thai Party which Pheu Thai succeeded. With Pheu Thai taking the reins, all eyes are on potential advances in the universal healthcare system.

The committee is charged with developing an efficient national healthcare system to address health challenges and emerging health emergencies, as well as to ensure policy coordination with other stakeholders and state agencies.

Under the leadership of the prime minister and Paetongtarn Shinawatra, Thaksin’s daughter and heir apparent, as deputy chair, the committee comprises top decision-makers from key ministries, the National Health Security Office, medical associations, the Bangkok Metropolitan Administration, the National Consumer Council, and the Office of the Economic and Social Development Council.

Serving as secretary is Dr Surapong Suebwonglee, a prime mover of the 30-baht universal healthcare scheme, now the gold card system. In short, it is a national health superboard with the necessary authority to drive meaningful change.

Currently, Thailand has three healthcare systems with varying levels of care and state financial support, leading to systemic disparities. The universal health system covers about 48 million people at a cost of 3,988 baht per person.

In contrast, the Civil Servants’ Welfare System covers only five million people but costs 18,000 baht per person. The Social Security System, covering 16 million registered workers, requires contributions for healthcare and other welfare benefits, unlike the other two systems.

With the committee’s objectives to enhance healthcare efficiency and ensure health security for all, one of its main challenges is addressing these disparities and improving cost-effectiveness.

It will not be an easy task. A cabinet resolution in 2012 aimed at solving healthcare disparities proved ineffective. The Yingluck government’s efforts to establish a comparable national health board faced strong opposition and concerns about political interference in managing trillion-baht budgets.

To earn public trust and overcome resistance, the government must ensure inclusive decision-making, foster system flexibility, and avoid unnecessary red tape. Significantly, the health superboard must address the potential resistance from those who currently enjoy premium healthcare benefits. It must also respond to the demands of members of the Social Security System, who are the only group required to make contributions.

Simultaneously, the universal healthcare system, or the gold card system, must expand its services for the majority of Thais, reduce service backlogs, and protect healthcare workers from excessive workloads.

To rectify disparities in healthcare services, the government should amend the National Health Security Bill to align social security and civil service health benefits with the more comprehensive gold card system. Proposed changes include requiring beneficiaries to use their original healthcare systems first, with additional benefits provided only when necessary, following the standards of universal healthcare under the National Health Security System.

Prior governments attempted to limit the gold card system’s budgets through the co-payment system, arguing budget constraints. Had the co-payment scheme been implemented, 28 million people would have been deprived of free healthcare coverage.

To uphold the legacy of Thailand’s universal health care, the health superboard must make it clear that it will abandon the co-payment efforts. Instead of interfering with universal healthcare, the government should address the shortcomings in the often-misused civil servants’ healthcare system which results in continuously rising budgets. To establish an equitable system, local government employees and village leaders, currently excluded from the system, should start receiving health benefits.

For the Social Security System, its healthcare benefits should be expanded to be on par with universal healthcare, including health checkups and preventive medicine. Importantly, these benefits should also be extended to registered migrant workers.

This is a great opportunity for the government to establish a landmark policy akin to the universal healthcare system. The objective of an equitable and efficient healthcare system is reachable if the government prioritises the well-being of the people and stays committed to the mission of healthcare development and reform.

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