A nurse gives a rose and chats with an elderly patient at the Police General Hospital during Valentine's celebrations. The 30-baht health scheme, now under threat, has assured almost all Thais of competent and professional health care. (Photo by Patipat Janthong)

New law threatens universal healthcare. Also a threat is medical tourism & better pay for doctors at private hospitals.

UNIVERSAL HEALTHCARE

Medical tourism vs. universal healthcare for all Thais

Private hospitals poaching state doctors

21/06/2017

Surasak Glahan & Suchat Sritama

Since universal healthcare coverage was introduced to Thailand in 2002, it has provided cheap medical care, heavily subsidised by the government, to about 48 million Thai people, a huge fraction of the population, who pay just 30 baht for each medical treatment.

But that scheme now appears to be under threat. The key phrase here is "appears to be," because no one knows for sure. As an unelected government, the current military regime does not include the media, civil society and the public in the decisionmaking process (informing the public and getting the public's feedback) so it is impossible to know for sure what is happening.



CO-PAYMENTS: POSSIBLE REDUCTION OF UNIVERSAL COVERAGE

The main issue is the end of universally subsidised healthcare and the beginning of co-payments where patients pay for more of their medical treatment.

The current draft bill to amend the National Health Security (NHS) Act, the pillar of Thailand's universal healthcare scheme, aims to have medical service providers better represented on the board of the National Health Security Office (NHSO), which oversees the universal healthcare scheme.

This threatens to undermine the independence of the NHSO which has acted as an advocate for patients.

Many want the "co-payment" wording removed from the new law as it could allow the NHSO board -- if dominated by medical professionals such as doctors, as proposed by the bill -- to change the rules ofthe scheme.

One idea floating around now is to have patients pay 30% of the bill, putting many treatments out of reach of low-income earners and even middle-class earners.

CANCER EXAMPLE: PAY FOR YOUR TREATMENT OR ELSE

Under one scenario a cancer patient, for example, may be given two choices:

1. Opt for a more advanced life-saving treatment and pay more of the total cost, or...

2. Pay 30 baht for a basic level of service which might not be much.

The poor would have no choice.

Middle income families might have to sell off their assets to get the better treatment.



GOVT & MEDICAL PROFESSIONALS VS. THE POOR



Much of the public is growing anxious as the government and medical profession have been critical of the rising cost of universal healthcare coverage.

Admittedly, the universal healthcare scheme has not been implemented perfectly, and improvements are needed.

For example, civil society has proposed the bill should be changed to enable the NHSO to buy medical supplies in bulk to reduce prices.

The state should also come up with measures to attract and keep medical professionals by offering them benefits that are competitive with private hospitals (see below on the exodus of medical professionals to private hospitals).

PRAYUT'S 'KEEP IT FOR THE POOR' NOT POPULAR



The most controversial idea came from Prime Minister Prayut Chan-o-cha in April 2015 when he asked the wealthy to opt out of the scheme and keep it for the poor.

This remark was not met with a warm reception. Many said this would simply turn the scheme into a welfare package leading to a decline in the quality of health services.



Gen Prayut did not give up.

Instead, he has issued another Section 44 order requiring a rejigging of the act. This led to the controversial bill we are now faced with. A number of so-called public hearings have been arranged, but it is unlikely the regime will make any more changes.



The universal heathcare scheme has won praise internationally for helping to bridge inequality among rich and poor in Thailand.

Moreover, patients are currently not at risk of bankruptcy as a result of expensive treatments.

People in Burma, for example, typically do sell off everything and go bankrupt to save the lives of loved ones.

Thailand's private hospitals are attempting to lure state hospital doctors with attractive remuneration packages.

The packages, which are up to three times higher in value than what public hospitals offer, are intended to secure the best resources to drive long-term growth.

This is according to Sopon Mekthon, permanent secretary of the Ministry of Public Health.

THAILAND LACKS MEDICAL SPECIALISTS: DOCTORS & NURSES



Thailand's hospitals lack specialist doctors and nurses.

"Thailand produces 2,500 of these professionals a year -- fewer than the target of 3,000 set by the government," according to Suthorn Bavonratanavech, chief of orthopaedics and trauma care network at Bangkok Dusit Medical Center Plc (BDMS).

Mr Suthorn, who is also the faculty chief at Bangkok Orthopedic Center of Excellence said, adding that many nurses prefer to work at private hospitals.

DOCTORS EARN 70,000 to 200,000 BAHT PER MONTH AT PRIVATE HOSPITALS

Doctors working at state hospitals receive offers to move to private hospitals with triple the salary plus benefits (remuneration).

Doctors can earn from 70,000 baht to more than 200,000 per month at a private hospital, a doctor who asked to be unnamed said.

GOVT PLANS TO INCREASE MEDICAL TOURISTS VISITING THAILAND

This year, the Ministry of Interior approved 90-day visas for patients and medical visitors from Cambodia, Laos, Myanmar, and Vietnam (CLMV), as well as China, compared with 14-90 days granted previously.



Medical tourists from these countries, with a maximum of three companions, will be granted 90-day visas. The policy is also an expansion of a former agreement, which accorded 90-day visas to medical tourists from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates -- the Gulf Cooperation Countries (GCC).



The policy is aimed at promoting Thailand as a regional hub for medical tourism.



Since the government implemented the second phase of the medical visa scheme, the Ministry of Public Health has compiled a list of 120-130 hospitals and healthcare centres that can provide confirmation letters to visitors seeking medical treatment...

The medical tourism industry generates about 40 billion baht per year and continues to grow.

It is also booming in Malaysia creating competition between Thailand and Malaysia. Singapore and South Korea are the most sought-after medical tourism destinations in Asia.



Locals constitute 70% of private hospital customers in the country, but foreigners are expected to contribute 30% of the private hospital's revenue in 2017, up from 27% last year.

For a list of recent medical tourism investments in Thailand see the original article here.

To summarize the situation, medical tourism uses private hospitals and private hospitals lure doctors and nurses away from government hospitals where the public is provided medical treatment under the universal healthcare coverage.

In the past, the National Health Security Office (NHSO) maintained a high degree of independence to act as a patient advocate, working for patients and their healthcare needs rather than hospitals and the healthcare industry. This has led to inefficiencies and some healthcare facilities have been put in a financially precarious position. However, going back to the old pre-2002 system without universal coverage for the poor would, however, most likely prove very unpopular and could very well be met with protest and electoral backlash.

http://www.bangkokpost.com/opinion/opinion/1272631/dont-turn-nhs-act-into-a-tragedy



http://www.bangkokpost.com/business/news/1272527/medical-worker-shortage-constrain-hub-plans