August 22, 2014 01:00
By Thanapat Kitjakosol
THE Private Hospital Association has recommended that the huge annual per-head subsidy paid under the National Health Security Office (NHSO) scheme should not continue, with the government covering actual treatment costs.
The proposal was made at a recent Bangkok seminar on public healthcare reform ideas to possibly be sent to the military rulers.
Other drastic changes also proposed that all migrant workers should contribute to either the NHSO or the Social Security Office (SSO) scheme like Thai employees. Foreign tourists should also be required to sign accident or health insurance on arrival when entering Thailand, according to PHA chairman Dr Chalerm Harnpanish.
Under the NHSO scheme, in projects like the Bt30 universal healthcare or gold card scheme, the government has spent Bt180 billion each year, calculated from the Bt2,956 per-head subsidy for 49 million eligible people, who are not company employees or registered as taxpayers.
The amount will rise even further when the per-head subsidy rate reaches Bt3,060 in the near future.
Private hospitals have turned away from the NHSO scheme because they have higher operating costs and are not reimbursed fully for treatment of eligible patients. Government hospitals, which have been provided with both normal budget and subsidies through either NHSO or SSO schemes, manage to operate at lower costs.
If all of more than two million migrant workers were registered, they should be required to contribute to the NHSO, which means that both private and government hospitals in turn received their money to give them service and treatment, Chalerm said.
On humanitarian grounds, private and government hospitals are required to treat migrant workers unconditionally in case of emergencies, while being able to reimburse their treatment costs through NHSO or SSO schemes, usually at vastly reduced rates. This also applies to treating foreign tourists for emergencies or sickness, but their treatment costs would be covered through accident or health insurance if or when a fund was established that would make such policies available or mandatory by a new law.
Citing another PHA proposal, Chalerm said non-employed people, such as vendors, farmers or taxi motorcyclists and cabbies, should be registered and asked to contribute to the SSO - instead of leaving them eligible under the unsupported NHSO as they have been since the Bt30 universal healthcare scheme was established in 2001.
On the long-standing problem of the huge spending to support expensive medical bills for active and retired civil servants, Chalerm said they should be allowed to seek or receive treatment at hospitals at only two locations - those located near their workplaces or near their homes - not currently at every government hospital at the civil servants’ will.
He said such an open condition has long encouraged the officials to seek or receive treatment at multiple hospitals as out-patients, resulting in treatment costing the government more than 2.5 times that spent on in-patients.
The civil servants’ medical fund costs Bt60 billion each year to serve only five million officials and their eligible family members.