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NHSO a shining example of what can be done if we join hands

Given the People's Democratic Reform Committee does not have a clear method to reform political and social inequality, the setting up of the National Health Security Office stands as a shining example of what can happen when stakeholders join hands for the good of the country.

The NHSO, one of Thailand's main health insurers, was set up in 2002 as a public organisation in a bid to eliminate inequality in accessing healthcare services by developing health security and providing universal healthcare coverage.

Establishment of the NHSO stemmed from an attempt by a small group of doctors to spark healthcare reform and provide adequate medical services to everyone.

Dr Sa-nguan Nitayarumphong, a former secretary-general of the NHSO, played a prominent role in establishing universal healthcare coverage. He spent over 30 years of his life developing the healthcare system.

Before the establishment of the NHSO, he had conducted several studies since 1990 to find a proper way to set up an equal healthcare system and deliver reform.

At that time the government, led by former Democrat prime minister Chaun Leekpai, had drafted the National Health Security Bill and Sa-nguan was part of a working group that drew up the bill.

The House of Representatives did not approval the bill. But Sa-nguan continued looking at ways to set up a National Health Security Fund by running pilot projects at hospitals in several provinces, and learning from his mistakes to develop a successful model.

Before the general election in 2001, Sa-nguan delivered a yellow paper explaining the concept of national health security and the possibility of setting up the fund with a budget of Bt30 billion.

In trying to sell the idea he talked to several political parties, including the Democrats and Thai Rak Thai.

His national health security policy was rejected by the Democrats but welcomed by Thai Rak Thai, which won the election with Thaksin Shinawatra at the helm. Thai Rak Thai then developed the proposal into its populist policy as the 30 baht health scheme, which provides universal healthcare.

The policy was welcomed by health officials including Dr Mongkol Na Songkla, a former permanent secretary of the Public Health Ministry.

The project started in 2001 as a pilot project in six provinces and expanded to 15 provinces and then nationwide.

During the first three years of the NHSO, it was strongly opposed by several groups of doctors and medical workers, as they had to shoulder more work.

Moreover, many healthcare units, especially the Public Health Ministry, were worried that they would have no budgetary control over funds allocated by the government, as the NHSO would be designated as the authorised agency to manage funds.

The NHSO has slightly improved its management and services over the past 12 years but is still not perfect.

Sa-nguan died of lung cancer in 2008 but his legacy lives on.

The NHSO welcomed all stakeholders to participate and develop a universal healthcare scheme that benefits all Thais.


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