Govt fails to head off health plan fight
Assurances on fate of 30-baht scheme fail to move activists, writes Penchan Charoensuthipan
Aconflict over the controversial amendments of the National Health Security Act looks set to escalate into a “war” between proponents in the government camp and health activists who question attempts to shake up hospital finances.
Varakorn Samakoses, who chairs a committee revising the law, vowed last week the changes would go ahead despite the protests.
On the opposing side, the Foundation for Consumers’ secretary-general, Saree Aongsomwang, backs the campaign by a network of activists from various patient and civic groups against the changes. She urges them to “fight and fight to the finish to maintain righteousness”.
She wants the law to preserve equal access to medical treatment under the Universal Health Care Coverage (UC) scheme, more commonly known as the gold card scheme.
Ms Saree says the law changes pave the way for the government to water down this right.
Prime Minister Prayut Chan-o-Cha recently exercised his special power under Section 44 of the interim charter to allow the amendments, which he believes will unlock an impasse in the implementation of the scheme, said Sopon Mekthon, the public health permanent secretary.
The impasse arose after a previous inspection by the Office of the AuditorGeneral prohibited hospitals from spending their capitation budget of about 3,100 baht per patient on items such as electricity bills because they are not considered expenditure directly related to the care of patients as stated in the law, said Dr Sopon.
“If we won’t amend the law, we won’t have running water and electricity,” he said.
Meanwhile, National Health Security Office (NHSO) secretary-general Sakchai Kanjanawattana said Section 44 intervention is needed to improve clarity in the interpretation of the law so the UC can continue at least until the law undergoes a major amendment.
The planned amendments will never result i n the UC being terminated, he assured.
The protesters, who did not share his confidence, do not object to the Varakorn committee’s efforts to ease the legal impasse to let hospitals freely manage their capitation budget.
However, other proposed amendments, including a change in the National Health Security Board, cause more concern.
On the one hand, authorities promise the change will result in more sustainable UC funding management.
On the other, activists fear changes to the personnel of the board which inevitably result in a change in the direction of the scheme.
The board comprises representatives from state agencies, medical service providers, patients and civic groups.
Critics of the changes are worried more seats may be given to those overseeing the budget rather than people’s representatives.
Gen Prayut announced last week the amendments will not affect patient benefits as the changes are not aimed at imposing a co-payment regime in which patients would pay part of their medical bills to help relieve the government’s financial burden.
However, “the co-payment may come anyway” if there is a change in the UC policy in the future, Ms Saree warned.
Her worries appear to have substance when considered in a broader context. The government earlier asked low-income people to register with the state for welfare assistance.
The tally has reached 14 million people. The database gives authorities a potential weapon in their bid to target state assistance.
Ms Saree is worried only the officially-registered poor will end up enjoying the right to free medical treatment under the scheme, while others who earn more may be subject to co-payments.
FOUNDATION FOR CONSUMERS SECRETARY-GENERAL
The UC scheme was introduced in 2002 for people who are neither private sector employees nor state officials, to grant them access to health care and receive state health subsides.
The National Health Security Act has been in place for 15 years, so the amendments are not a surprise.
Even protesters agree on the need for some changes, which include stricter regulations to bar people from sitting on two different boards under the National Health Security Office.
Another proposal to separate salary payments for medical staff from the capitation budget could help ease hospitals’ financial woes, said Suksanti Phakthamnak, a preventive medicine doctor at the Sing Buri public health office.
His province was given a UC budget of 355 million baht last year, but after the salary deductions, it has only 27 million baht, or 184 baht per capita, left for patients, he said, adding the problem arises under the outdated National Health Security Act.
Hospitals in the province have to solve the problem by delaying payments to their staff and medical companies.
In the long run, a change in the way these matters are treated financially under the law is needed, he said.
Otherwise, “hospitals can’t survive and patients, both gold card-holders and those under other medical schemes, will be hit”, Dr Suksanti said.
Meanwhile, in Ms Saree’s view, the UC is still value for money as it accounts for only 17% of the country’s gross domestic product.
The conflict over the amendments will add to the government’s problems as it grapples with public concern over the patient’s basic rights to health care, she said. ‘’The people deserve a victory,” Ms Saree said.
Fight and fight to the finish to maintain righteousness. SAREE AONGSOMWANG