Cracks In Universal Healthcare Coverage Emerge
BMI View: Countries that look to Thailand as an example of how to implement universal healthcare coverage must address the potential effect of inequality, which causes disparate healthcare coverage and benefits for the population. We maintain our view that full-spectrum universal healthcare coverage will be unsustainable due to the rising burden of diseases and increasingly ageing populations in Asia Pacific. Consequently, we continue to expect governments to cut their health funding, especially when confronted with slowing economies.
Since 2004 Actual medical expenditure under Thailand's Civil Servants' Medical Benefits (CSMB) scheme has exceeded the allocated budget, according to a report released by Thailand's Comptroller General's Department (CGD). Consequently, the government is seeking to lower the cost of the CSMB scheme. This means lowering benefits for civil servants.
Universal Healthcare Coverage
Thailand has implemented universal healthcare coverage since 2002 under three different schemes: the social security scheme (SSS), universal coverage scheme (UCS) and the CSMB scheme. Despite the CSMB scheme covering only 5mn people, or 7.2% of the population, the government spends THB15,000 (US$490) per person. This is approximately six times more than what it spends on the rest of the population.
The disparity between civil servants and the rest of the population was discussed in March 2012 during a National Academic Conference 'Universal Healthcare Coverage for the Second Decade'. In the conference, experts stated that standardising all three national programmes is important for providing benefits to every citizen.
|Actual Expenditure > Allocated Budget|
|Allocated Budget And Actual Expenditure For Thailand's CSMB Scheme (THBbn) (LHS), And Government Expenditure (Per Capita) On The Three Healthcare Schemes In 2012 (RHS)|
A move cutting benefits would be in line with our view that Thailand's universal healthcare coverage will be financially unsustainable in the long term.  While the move to cut back on benefits can be said to be retrogressive, we highlight that it will be equally, if not more, challenging for the government to raise funding for the rest of the population to match the funding for civil servants. It would only serve to accelerate the government's healthcare expenditure, considering that the burden of non-communicable diseases will rise with the increasingly ageing population.
Lesson For Asia
The inequality in healthcare funding in Thailand may provide a lesson to countries such as Laos and Vietnam as they implement their own universal healthcare coverage. According to the World Health Organization, there are 25 different membership categories in current health insurance coverage in Vietnam, some of which will receive government subsidies. Inequality comes into play when for example, the government subsidises 100% of the premiums for children under six years old. This means that funds were used on children from well-off families when it could have been used on other people from a lower income group. This mirrors the effect of unequal funding seen in Thailand.
Recent Developments In Thailand's Healthcare Sector
The Ministry of Health announced plans to introduce a pilot project deploying digital x-ray systems in state hospitals' laboratories. The project formed part of the ministry's efforts to reduce costs but increase efficiency. Public Health Minister Pradit Sinthawanarong stated that the government is planning to curb spending on healthcare at 3.8% of GDP.
In bid to lower healthcare costs, the CGD issued a ban on glucosamine sulphate after it found out that the government was spending more than THB700mn (US$23mn) annually to reimburse civil servants purchasing this supplement. Civil servants objected to the ban stating that it will cause adverse effects for patients with chronic disease such as arthritis [. Consequently, the department temporarily allowed them to get glucosamine sulphate with a doctor's specific instruction.
The CGD also issued an announcement making it mandatory for patients with chronic disease to get medication at only one hospital - to prevent them from getting too many medications from various hospitals. This 'hospital-hopping' has caused a THB10mn (US$326,530) financial loss annually. Subsequently, the public Health Minister Pradit Sinthawanarong instructed the CGD to withdraw the announcement forbidding civil servants from receiving glucosamine sulphate at state hospitals. His idea, however, was opposed by a board member from the National Health Security Office.
The Thai government announced it will issue health cards for Thai and migrant children under six years old. The scheme will improve basic healthcare services for children and women in the country, including the children of migrant workers. The decision came after a study found about 7% of the 5mn children under six years old in Thailand had an intelligent quotient less than normal, and the majority of migrant workers had no access to basic healthcare services. The health cards will enable migrant children to access basic healthcare services, such as free vaccinations.
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