Don’t turn NHS Act into a tragedy

How would you feel to be a destitute patient waiting to be treated at a state hospital? You might feel desperate, bitter and embarrassed as you kept one eye on the clock knowing you were only going to get a second-rate service.

Fortunately, tens of million of Thais have escaped this sad state of affairs for years as universal healthcare coverage was introduced in 2002. It has since provided cheap, heavily subsidised medical care to about 48 million people who pay just 30 baht for each treatment.

But that scheme now appears to be under threat.

The draft bill to amend the National Health Security (NHS) Act, which acts as a pillar of the aforementioned scheme, could pave the way for the state to force low-income earners back to this unpleasant scenario. For some patients, the cost could be devastating.

Why? Because the bill wants to see medical service providers better represented on the board of the National Health Security Office (NHSO), which oversees the scheme. Many fear this will give patients less negotiating power while enabling medical professionals to come up with new rules to make the poor pay higher contributions.

Under this scenario a cancer patient, for example, may be given two choices: opt for a more advanced treatment by contributing more of the total cost (the state would subsidise the rest), or pay up to 30 baht for whatever basic level of service the state provides.

The poor would in all likelihood only have one choice. Others may have to sell off their assets if they want to enjoy better treatment.

This may be the worst-case scenario, but the bill’s implicit threat remains and those covered by the scheme cannot afford to be complacent.

Although the NHS Act says patients may split the cost of their medical care with the state, the only type of copayment the state requires under this scheme is a fixed fee of 30 baht.

But many want the “co-payment” wording removed from the act as it could allow the NHSO board — if dominated by medical professionals, as proposed by the bill — to capitalise on it by changing the rules. One idea floating around now is to have them pay 30% of the bill.

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

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 regime’s criticism of this and other “financially undisciplined” schemes initiated by the governments of Thaksin Shinawatra and his sister Yingluck look more and more like a smokescreen to cover up its recent decisions to green light huge defence budgets to procure submarines and tanks.

It is the true that the universal healthcare coverage scheme has been gobbling up more money. But so has the defence budget, which has doubled in the last decade.

The scheme has won praise internationally for helping to bridge inequality among rich and poor. Moreover, patients are not at risk of bankruptcy as a result of expensive treatments.

Admittedly, it was not 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 competitive benefits.

The rising cost of public health spending should not be seen as a financial burden, but a necessity. There is even the misleading notion that forcing patients covered by the scheme to start paying higher costs for treatment will get rid of hypochondriacs and unnecessary hospital visits. But poor people and low-income earners mostly go to hospital because they really need treatment, not just because it’s there and it is cheap.

We should worry about providing our citizens with affordable health care, not the size of the state’s coffers. Managing those is their cross to bear.