HEALTH CARE

Dual-track system

The general public generally has reacted favourably to the government policy of giving all Thais access to basic medical services despite several notable drawbacks

By CHAROEN KITTIKANYA

Three years after the launch of the 30-baht sytstem, more than half of those entitled to the universal helath-care scheme have not used its services due to concerns about poor quality and lack of trust.

The 30-baht universal health-care programme, one of the headline policies behind Prime Minister Thaksin Shinawatra's sweeping electoral victory in January 2001, has won the applause of the general public despite criticism from some professionals in the field.

Launched in April 2001, the programme is unprecedented in that without directly affecting the economy, it enables all Thai citizens, rich or poor, to have access to at least some basic medical services.

According to the agency handling the programme, the 30-baht health-care scheme now covers 46.81 million people or over 70% of the population, and 1,051 service units nationwide.

Prior to the scheme's introduction, a large segment of the population had no comprehension of health insurance or saw any need for it. Many viewed health services as an expense that had to be paid out of their own pockets and were not aware that it served as a safeguard against large bills.

Under the programme, the government set aside a per capita budget of 1,447 baht for the 2004 fiscal year. The National Health Security Office is now seeking the government's approval to increase the budget to 1,510.50 baht for next fiscal year to reflect the operating costs of the service providers.

The programme has been allocated about 15-17 billion baht per year in the current fiscal budget.

But with regard to this programme, the saying "You get what you pay for" holds true.

Over the three years since it was implemented, more than half of those entitled to benefits under the 30-baht programme chose to shun the available services because of their poor quality and lack of trust in the drugs provided that were cheap and mostly over-the-counter medicines.

According to research done by the National Economic and Social Advisory Council, as many as 53% of the 5,000 people surveyed said they preferred to obtain drugs from pharmacists than from facilities covered by the scheme.

In addition, 45% of those surveyed who had used the scheme said they were dissatisfied with the services provided by their designated hospitals.

The survey also showed that many members of the public were unaware of the benefits to which they were entitled.

For example, only 10% of those with disabilities in the survey group knew that they were entitled to physical therapy, while only 2% of the elderly were aware that they could claim for dentures.

The advent of universal health scheme has resulted in increased workloads at low pay for many health-care employees and prompted many doctors to switch careers where the pay is better.

Even leading social critic Prawase Wasi, himself an internationally recognised medical specialist, voiced objections to the programme. He warned that the government's efforts to provide low-cost universal health care had led to a critical situation for health services, particularly because the budget allocation earmarked for covering conditions relating to HIV/Aids, drug addiction and even victims of road accidents had already been spent.

The quality of care under the scheme, which requires a person to pay just 30 baht for a visit to a hospital or a clinic, is lacking due to its limited budget allocation.

But not all the effects of the project are negative.

For one thing, the programme has helped rejuvenate the health-care sector, which had long been neglected.

The scheme in the future will be an election tool for political campaigns, putting the spotlight on the sector, similar to what is seen in the United States, Canada and Germany, according to Dr Pongsak Viddayakorn, Bangkok Hospital's president.

The 30-baht programme is expected to lead Thailand's medical service sector in the future onto a more clearly defined dual-track system, with one depending mainly on government subsidies, and the other funded by fee-based services The dual-track system is now just in the early stages. But the trend is getting clearer with one group of hospitals, which are mostly state-run, tending to focus on cost reductions, generic drugs and making limited investment in upgrading medical equipment. A second distinct group of hospitals is increasing capital, investing in new medical equipment and honing skills primarily to capture cash-rich patients.

According to Dr Prongsak, the privately owned hospitals would rather play a critical part in fulfilling the government's goal of becoming the regional medical hub, as they are more attuned to catering to international patients.

But everything is not rosy on that front as well.

State assistance is also desperately needed particularly in developing a comprehensive marketing strategy and in giving the sector the necessary funds in order for it to stay ahead of the competition from rival countries, especially Singapore.

Import tax exemptions for medical equipment, which currently range from 5% to 30% are being sought as well.

Singapore is one of Thailand's main competitors in this service sector and its government has widely opened the market with more flexible immigration regulations, aggressive marketing and service privileges to attract foreign patients.

Singapore hospitals have recently teamed up with hotels and travel agents to offer health tourism packages to promote their services to wealthy people from the Middle East, their latest target customers. The city-state is targeting for a five-fold increase in the number of its health tourists to a million a year by 2012.

In contrast, Thai health-care providers currently receive relatively little support from the government, and at the same time they compete heavily with each other.

More importantly, based on infrastructure, only about 10 of the most highly capitalised hospitals from a total of 350 in the country are capable of providing international-standard health and medical services to foreign patients, according to experts.

But for Thailand, its competitive advantage in this sector is pricing. Health-care costs are 50% cheaper than in Singapore, three times cheaper than in Hong Kong and five to 10 times cheaper than in Europe and the US.

Last year, 630,000 foreign patients came to Thailand for treatment, generating 19 billion baht in foreign-exchange income. This number could rise to 800,000 this year, with revenues exceeding 20 billion baht while next year, one million foreign patients could very will spend 30 billion baht on medical services here.