Charity run masks govt health failure

It was quite inspiring to see rock star Artiwara Kongmalai, aka Toon Bodyslam, address one of the key problems in our public health system. He recently announced he was embarking on a charity run to raise funds for procurement of medical equipment for 11 state hospitals which serve as regional medical centres.

He plans to run from Nov 1 to Dec

25 — from Yala’s Betong district up to Chiang Rai’s Mae Sai, covering a distance of 2,191km in 55 days. His aims for total public donations of 700 million baht. While his project specifically addresses the shortage of medical supplies in those hospitals, it has also triggered a debate over a bigger issue — the government’s inadequate budget allocation for healthcare.

This is his second project. Last year, he raised over 85 million baht for Bang Saphan Hospital from a 400km charity run from Bangkok to Prachuap Khiri Khan. While Toon is doing it for a good cause, the issue of under-financing in public healthcare is likely to evaporate from public debate once he has completed his run on Christmas Day.

Unfortunately, the issue has remained unresolved for over a decade. It’s not because the state doesn’t have enough money to finance public hospitals better; it does. The real problem stems from how governments prioritise their budget spending. And the prioritisation of the current military government has drawn much criticism, thanks to its increased defence spending.

While the government has kept the Universal Healthcare Coverage (UC) scheme underfunded, its shopping list for weapons and military hardware has grown. The defence budget for the 2018 fiscal year increased by 4.2% from last year, accounting for 7.7% of the total budget of 2.9 trillion baht. Meanwhile, the Education Ministry gets 17.%, a 0.6% drop from last year, and the Public Health Ministry gets a 4.7% portion, a 3.9% increase.

Big as it is, the defence budget excludes other arms and military hardware purchases the government has committed to spend in the coming years such as the planned 36-billion-baht procurement of three Chinese submarines. Since the 2014 coup, the UC scheme has been cast in a negative light. Even though it has been praised globally for providing access to healthcare to 80% of Thais, coup leaders and some government officials have blamed the scheme for being a “national burden” due to its “excessive spending”.

Early this year, the scheme’s operator, the National Health Security Office, requested a budget of 141 billion baht to finance the UC in the 2018 fiscal year. But the military regime reduced it to 128 billion baht. The missing 13 billion baht — nearly the cost of one Chinese submarine — could do a lot to improve health services and better support public hospitals.

In mid-2015, Prime Minister Prayut Chan-o-cha called the scheme “populism” during an interview with reporters. He blamed it for causing deficits at state hospitals. But what is their main source of funding? Shouldn’t it come from the state? As the scheme has remained under-financed, some hospitals try to survive financially. Some open traditional massage services and acupuncture clinics as extra business lines to get additional income. Inburi Hospital in Sing Buri, for example, created a rejuvenation centre to earn income from beauty services and surgery. Last year, Umphang Hospital in Tak launched a drug reuse campaign asking for donations of unexpired, leftover drugs.

Some hospitals raised donations for new buildings and procurement of medical equipment. But they eventually found themselves facing another problem — a shortage of medical personnel to run the facilities. When submitting requests for state funding, public hospital operators have to go through a tedious process of approval. Sometimes it can take years, depending on the request. This contrasts with the regime’s speedy approval of arms purchases which in some cases have passed through a “special method” that bypassed the mandatory procurement process.

Toon Bodyslam’s charity run is a good cause which has unfortunately been exploited by critics of the UC scheme who say he wouldn’t have to run if the scheme hadn’t exhausted public health funding. The Public Health Ministry even came forward to praise his campaign as a good example of cooperation between the public and private sector. In fact, the ministry should have tried harder to raise money for public health from the government.

The rocker’s two-month run alone will not fix financial problems in public healthcare, unless the real player, the government, takes action.