The government is obviously overburdened with medical schemes, but is reform proceeding as it should?
Critics of the Cabinet-approved bill to set up the country’s first “super-board” to govern all healthcare schemes have expressed doubt about its genuine objective, especially with regard to the future of the current universal healthcare scheme covering 48 million citizens.
The universal healthcare system is the largest of the three systems currently on offer, with a budget this year of Bt140 billion. The others are the social security system covering about 13 million employees, with an annual budget of about Bt50 billion, and the state healthcare system serving five million civil servants and their families, with an annual budget of Bt70 billion.
Under the proposed legislation, legal authority over all three healthcare plans will be consolidated to allow the government to restructure them. The so-called super-board will consist of 45 directors who mainly represent the government, state agencies and healthcare professionals, with just three or four seats reserved for representatives of non-governmental organisations, and they are supposed to protect the interests of universal-healthcare beneficiaries.
For years, the universal healthcare system has been a major welfare benefit for the majority of low-income people. Their dependence on and access to reasonably priced public health services are essentially guaranteed. However, such a system is costly to the state, with budget reimbursements constantly on the rise and this year reaching Bt140 billion. The increases are likely to continue in coming years and as such pose a serious fiscal issue for the government.
Efforts have been under way to reform the universal system to ensure that only citizens in genuine need qualify for free-of-charge healthcare services. The aim is to ease the burden on the state budget, especially with regard to ever-rising future budget requirements, given the challenges that must be met as the population becomes predominantly elderly. Thailand is now an ageing society, entering an advanced stage of it, and the cost of welfare will reach new peaks.
One of the reform goals is to require middle- and upper-middle-income earners to pay a share of their own expenses for healthcare provided under the universal system. So far, the government has built a national database covering 11 million or so low-income earners – people earning less than Bt100,000 per year – who would be eligible for free healthcare.
Regarding the social security system’s healthcare benefits, there are now about 13 million members who co-pay based on their salaried income. Civil servants and their families use the state healthcare system, which provides the most generous benefits, resulting in the highest cost per head. There are about five million beneficiaries in this system whose expenses are as much as Bt70 billion – an average cost of Bt14,000 per person per year compared to an average of Bt2,916 under the universal healthcare system covering 48 million people and Bt3,846 for about 13 million people under the social security system.
As the bill on consolidation of power governing all three healthcare systems goes before the National Legislative Assembly prior to its enactment, critics are concerned that the interests of those served by the universal healthcare and social security systems are unlikely to be adequately defended.