Just a few days after a Thai Rath journalist reported on the Ministry of Finance's ideas to turn the tax-funded Universal Healthcare Coverage (UHC) into a healthcare programme for the poor, the ministry was quick to announce the report as "false". Such a reaction is no surprise.
In fact, it's something we are more than familiar with. The regime has repeatedly claimed the healthcare coverage as a financial burden. It also wants to limit the scheme's beneficiaries, despite public opposition.
The UHC, which was launched in 2002, provides free health care to 48 million people, or 70% of the population, regardless of their economic status. It has reduced household health expenditure, easing the burden caused by expensive health services. It benefits people who are not covered by civil servant welfare fund and the Social Security Fund. Altogether, all three schemes cover about 99.95% of the Thai population. Because of these schemes, many patients are able to access expensive drugs and services, including treatments for HIV/Aids, kidney failure and cancers.
With numbers of beneficiaries and health cost on the rise, state data have shown that UHC's annual budget has tripled in past 15 years, reaching 166 billion baht last year. However, that amount is equivalent to less than 1% of national GDP. While the USC is projected as a "huge problem," the government has used tax money on other schemes, including military weaponry and the government's self-promoting public relations campaigns.
The regime wants the scheme to focus on smaller numbers of beneficiaries, slamming "the rich" for exploiting the scheme and the national budget. It has never been made clear who those "rich" opportunists are. Recently, the regime has defined "the poor" as those who earn less than 100,000 baht a year or approximately 8,333 baht a month. This amount may be used as a baseline to calculate UHC beneficiaries in the future. That said, this definition of "the poor" is as problematic as it is misleading. The poor today are not just abandoned grandmothers who live alone in a wooden shack, as often portrayed on television. In reality, even white-collar workers and middle class members can experience hardship, despite salaries that surpass the poverty line.
Some are office workers who cannot not afford to pay back their student loans, or food vendors paying installments for pickup trucks. Others are low-skilled labourers, who are entitled to daily minimum wages but struggle to meet monthly expenses -- which include education, utility services and mortgages -- because prices of food and basic amenities rise faster than their incomes.
These people must deposit large parts of their incomes to secure decent life quality. When serious illnesses hit them or their family members, they are at risk of financial trouble if they have to pay for expensive health care. These real life cases are UHC beneficiaries whom the government, ironically, identify as "the rich".
It's possible that few policy-makers ever visited local hospitals as patients, or listened to the those who cannot afford expensive health service. Government officials' healthcare fees are covered by military or civil servant welfare on a semi-limitless reimbursement basis.
UHC is one of the few government programmes that uses tax money wisely and at the same time helps narrow the inequality gap, relieving people's financial burdens and allowing them chances to improve their economic status. In return, they will contribute back to society and create economic values in the long run.
Most importantly, the scheme maintains patients dignity, as they do not need to ask for mercy from the state or society. Some have to queue up for charity programmes with pharma-giants. We shouldn't revert to the hopeless situation before the implementation of UHC, in which patients had no option but to bow their heads to doctors.
Of course, there are several challenges that still need to be solved -- such as service quality, medical staff workload and more sustainable financial management. Due to the huge gap in its society, Thailand needs a welfare scheme such as UHC to allow the majority of people to survive and maintain their dignity. But as long as UHC is seen as a charity programme for the poor under the government's set definition, the allocation of health services will be based on the minimisation of resources, rather than maximisation of public welfare. Millions of people will be left behind and trapped in poverty because of high health expenditure.
Paritta Wangkiat is a Bangkok Post columnist.
