The Bt30 scheme truly benefits the poor, but without a radical adjustment of how it is run, it may not last much longer.

Prime Minister Thaksin Shinawatra is telling voters they should re-elect him if they want the Bt30-healthcare scheme to survive.

But health professionals believe Thaksin must be removed from the equation, or the health system as we know it will be left in tatters.

Thaksin might have introduced universal healthcare, but the scheme could well collapse if he stays in

power, said National Health Foundation secretary-general and public health scholar Dr Somsak Chunharasmi.

"For the scheme to last and work effectively, there must be several major changes to the foundations of our public-health system, but Thaksin hasn't done anything beyond the bare minimum to get it started and assure himself political gain," said Somsak.

"Incomplete implementation now leaves a lot of cracks in the system. People are wrong if they think Thaksin will fix it ... because he won't."

The scheme is the Kingdom's largest, covering 48 million of its 62 million citizens. The rest are either covered by the social security scheme or the civil servants' medical benefit scheme.

The principle of universal healthcare is to provide quality services to rich and poor alike, but Thaksin's understanding of the scheme is that it is simply aimed at poor people, said Somsak.

He said the problem with such a blinkered approach was that the scheme is effectively rendered a second-class service that nobody trusted and ultimately is destined for collapse.

Somsak was one of the public-health advocates who wanted a national health security system. He and other health activists proposed the idea to the Thai Rak Thai Party, which quickly adopted it as a flagship policy under the slogan "Bt30 for all treatment".

"We trusted him too much," Somsak said in retrospect.

The Bt30 scheme has been plagued with money troubles since its inception in 2001.

One of the greatest problems hit home at the coalface - hospitals weren't getting the money allocated to them from the central government fast enough.

And Somsak was less than impressed by the government's announcement that the annual fees for each person was to be hiked from Bt1,659 to Bt2,089 next year.

"I've stopped believing the government's numbers," said Somsak.

"No matter how much it promises, hospitals never get the full amount. The Budget Bureau has a ceiling for how much it can pay. But Thaksin has nothing to worry about, because he has already won praise from his constituencies."

False promises have also frustrated Dr Surachet Satitniramai, Prachinburi's chief provincial doctor.

He said even with the funding "increase", hospitals would still have to cut corners, because the budget was not going to increase in real

terms.

"Running a hospital is not only about treating patients, there are other activities and they come with costs. The Budget Bureau may have to allocate more money for treatment, because it's government policy, but the amount has to be taken from non-treatment activities such as hospital maintenance. Some hospitals haven't even received enough to pay their security guards for some months now," he said.

Thailand Development Research Institute economist Viroj Na Ranong said if the government was serious about establishing universal healthcare, it should not have introduced budget cuts, which effectively limit the quality of service offered.

"On the contrary, the budget should follow the objective of providing everybody in the country with health security," said Viroj.

"But because the government wanted to spend less, the scheme has been plagued with quality problems. In fact, Thailand's economy is capable of providing people with quality care."

Viroj said the scheme was made even more vulnerable by conflicting government policies. For example, by emphasising Thailand's potential role as a medical hub, the Bt30 healthcare scheme is immediately threatened, he said.

And the same policy will endanger the Bt30 scheme because demand from foreign patients will drain the government sector of medical professionals and pull other resources away from Thailand's limited pool of medical expertise.

Health activist Supatra Nacapew, who is on the board of the national health security's quality control committee, could not agree more when it comes to conflicting policies.

In relation to the "medical hub" plans, she accused Thaksin of maintaining a conflict of interest - for keeping the quality of the health security scheme at the margins, so people continue to pay for treatment if they want decent quality.

"Why would Thaksin's family and cronies have invested so much in private hospitals if not to land windfalls from its policies?" she asked.

"Also, in the free-trade agreement [FTA] with Japan, Japanese civil servants may be treated in Thailand with a promise of a 70-per-cent reimbursement from their government. This means hospitals are hunting Thailand's best and brightest medical minds to prepare for business expansion," she

said.

She added that her group and other health advocacy activists had also been fighting against the Thai-US FTA because the agreement would curtail Thai people's timely access to cheap, generic drugs.

"The survival of the national health security scheme is based on access to cheap generic drugs produced in our country," she said. "With such a limited government budget, no hospital can afford to prescribe imported drugs," she said.

Next: what needs to be done for the scheme to truly provide people with health security.

Nantiya Tangwisutijit

The Nation