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Published on January 7, 2008

Unless Thailand's universal healthcare scheme is put under tight administrative and cost control, it could place an unacceptable financial burden on the country and compromise national development. Leading economists and public health experts have warned that unless the incoming government puts the escalating costs of providing free medical services to all citizens under control, the quality of healthcare could deteriorate and the public health system could go bankrupt. Outgoing Public Health Minister Mongkol na Songkhla recently sounded the alarm by saying that universal healthcare, which was introduced in 2001 by the Thaksin administration, would not be sustainable in its present form. Either the quality of care will have to go down or users of medical services will have to cover part of the cost themselves.

The problem is that people in this country are accustomed to free healthcare and see it as an entitlement, and as such, any proposal to require them to make a co-payment will be a politically sensitive issue that elected politicians are reluctant to associate themselves with. Mongkol and the interim Surayud government should have mustered the courage to tell the public the truth earlier.

Instead of coming clean on this, the administration not only sought to conceal the fact, but also went on to mislead the public by scrapping the token Bt30 co-payment that each patient had to fork out at each visit to the doctor. It was apparent that even the military installed government felt so insecure about its popularity that it dared not speak the truth.

No country is rich enough to avoid bankruptcy if it chooses to provide universal healthcare without setting a realistic limit on what it can offer. In the case of Thailand, a middle-income developing country, the universal healthcare scheme is being offered without an increase in taxes or a requirement of co-payments from patients and virtually without limits on the services.

Public health planners are now exploring ways to improve administrative and cost control. One thing most of them agree on is that a substantial co-payment from patients each time they visit the doctor cannot be avoided and must be implemented with a serious attempt to improve the public health system in delivering services at different levels, complete with a better referral system between hospitals with different capabilities. For example, people would be asked for a small co-payment of Bt40 each time they visit a doctor at a local health clinic, which would be capable of providing primary care and dealing with minor health complaints. For people who insist on going to a better-equipped community hospital staffed by health specialists, the fee would be Bt120. Those visiting a general hospital that offers a full range of treatments would have to pay Bt400 per visit, and so on.

Such proposed pricing schemes are aimed at rationalising the use of medical services under universal healthcare to ensure greater administrative efficiency and cost control.

Thailand was fortunate to have had far-sighted economists and public health officials working together to design an affordable universal healthcare system to begin with. At the time the Thai universal healthcare system was first drawn up in the 1990s, it was seen as being within the country's financial means.

Unfortunately, the system was abused by former prime minister Thaksin Shinawatra, who cunningly repackaged the universal healthcare scheme as part of his populist platform and misled the public into believing that the government would be able to find the money to finance it indefinitely without making any changes.

The Public Health Ministry is capable of more or less setting the price of healthcare in this country despite the proliferation of for-profit private hospitals in recent years.

Even if the programme were operated with a high level of administrative efficiency, somewhere down the road the government would have to decide whether to make cuts in services, demand a sizeable increase in co-payments, raise taxes or make financially well-off people pay their fair share of their bills. The least the outgoing government can do is set the groundwork for the next government by educating the public about the need to make the change and why such a move is vital for the long-term sustainability of universal healthcare.