The appointment of respected economist Dr Ammar Siamwala to head the team to make the assessments and recommended necessary changes in the scheme is the first important step. Next the government must tell the public the truth that the healthcare programme, one of the world's most generous, cannot continue in its present form without imposing long-term financial liabilities on the country. Virtually no nation can sustain such universal healthcare indefinitely because the cost of providing services will eventually overshoot the government's ability to fund it. And Thailand is no exception.

This interim government, which came to power after the coup, must prove it has what it takes to make such a difficult decision that could have a negative impact on people's expectations that they can continue to benefit from the healthcare scheme virtually free of charge. It cannot be emphasised enough that even if the programme were operated at a high level of administrative efficiency, somewhere down the road the government would have to decide either to make judicious cuts in the benefits to everyone, or demand a sizeable increase in co-payment from all patients, or to make financially well-off people pay a fair share of their own medical bills - to ensure financial sustainability of the scheme over the long term.

Already the Public Health Ministry has announced that it will scrap the token Bt30 payment because it added up to unnecessary administrative costs. That has left the Surayud government with the only option, which is to require people who can afford it to make substantial payments much higher than Bt30. Only this will allow the state to recover much of the total cost of medical services.

The universal healthcare programme covers all Thai citizens not already covered by existing health insurance schemes, such as those provided by the Social Security Office, Civil Servants Medical Benefits Scheme and the state enterprise workers' healthcare programme. As such, many financially well-off people also take advantage of the universal healthcare scheme, which was designed primarily to help society's poor and disadvantaged.

It is obvious that the universal healthcare programme could benefit from better targeting to make sure poor people who really need help get all the help they can get, while people who can afford to make payments for treatment out of their own pockets do so.

The problem with Thaksin, who introduced the scheme in 2001, was that he was dishonest with the public and had grossly mishandled the programme by not providing adequate funding. He kept the scheme under-funded and understaffed because he had to divert taxpayers' money for healthcare towards other wasteful populist projects.

As a result, many government hospitals were left teetering on the brink of bankruptcy. State hospitals, the main healthcare providers of the universal medical service, have often had difficulty getting reimbursed for costly medical treatments and medications that they provided to patients. The quality of healthcare has been compromised, and the morale of doctors and nurses at state hospitals is at an all-time low.

The interim government has already injected much-needed funds to enable state hospitals to pay off debts and to function smoothly. Now it has to make sure the scheme is truly sustainable. It has to ensure that available healthcare is a gift to the people that keeps on giving.

It has been mentioned in some quarters that it will be a complicated process to determine who, and at which income bracket, should be asked to make what amount of co-payment under the universal healthcare programme. That shouldn't be too difficult. Our personal income tax system already divides income earners neatly into categories with different tax rates. People belonging to higher tax rates should be required to fork out a higher proportion of the cost of medical services when they opt for treatment under the universal health scheme.