The hole is a metaphor for the financial problems facing the scheme that have been basically caused by inadequate funding. It's a problem that has existed right from the very beginning due to dramatic changes made to the state healthcare budgetary system.

The financial difficulties stem from the policy that forced state hospitals to tighten their belts by giving them a per-capita budget to pay for everything, including labour costs.

What the architect of this healthcare scheme policy believed was that if the hospitals were given a limited budget they would be forced to be more proactive in managing their finances rather than just waiting for the next hand-out from the government as was the case before the universal healthcare scheme.

What was initially expected to happen was that the hospitals would spend less and that would help to curb rising expenditure in the state's healthcare system. Yet, in reality, this was not as simple to achieve s expected.

Since hospital managements had no other choice but to keep their ships afloat as best they could, they have been using every trick in the book to cut costs. But it's a been losing battle.

For the more than 200 state hospitals, it's been six years of frustration since the scheme was implemented. In that time they have constantly operated in the red and whatever financial cushion they may have had in the past has been whittled away.

In order to help them cope, promises were made of a wider range of materials being supplied to them, but it never happened.

From the second year of the scheme's implementation, not once has the necessary level of funding been met. For this fiscal year, the proposed budget was Bt2,089 per head, but the approved amount was Bt1,899.69.

When the latest "captain" of the healthcare ship came on board a short while ago, the hospitals were told they would no longer have to use stop-gap measures to keep going. They were told they could expect a far bigger slice of the healthcare cake.

The new Public Health Minister, Mongkol na Songkhla, blocked hospitals from collecting the Bt30 fee per visit, which had generated about Bt1.5 billion in income per year, and raised the false hope that this year the interim government would approve sufficient funds.

Mongkol is reportedly arguing with the government about shifting about 19 per cent of the labour costs for the healthcare scheme back on to the government.

But this really is only going to give the hospitals a temporary reprieve. Whether the healthcare ship can stay afloat long enough for real repairs to be carried out remains to be seen.

Arthit Khwankhom

The Nation