THAILAND: GOVERNMENT MEDDLING COULD PUT A RISK THE HEALTHCARE

Yingluck Shinawatra

Prime Minister Yingluck Shinawatra says the reforms will help rein in health spending, expected to top 1 trillion baht in the next decade. However, opponents believe the government has a hidden agenda to interfere with the National Health  Security Office (NHSO) that oversees the universal health (gold card) scheme. The government also plans to reform the civil service medical benefit scheme and the social security fund scheme, which covers all workers. Some critics say the government intends replacing the universal healthcare scheme with the 30-baht system introduced by the Thaksin Shinawatra administration. Public Health Minister Witthaya Buranasiri, the NHSO board chairman, on Friday denied reports of political interference at the agency, after declining to comment about the controversial issue for months. He insisted the Yingluck administration did not have any policy to dissolve the universal healthcare scheme as claimed by the Rural Doctors Society, but rather improve the quality of the entire national health system.

Power games at the NHSO board are not surprising as it has authority over hundreds of billions of baht. The political divide runs deep between the health service purchasing camp, comprising rural doctors and representatives from NGOs, and the health service provider camp including doctors, the medical council and private hospitals. Kriangsak Vatcharanukulkiat, chairman of the Rural Doctors Society, claims there is a "four-step ladder" plan to end the universal healthcare scheme and rewrite the National Health Security Act 2001 so politicians can administer the Public Health Ministry budget. Dr Kriangsak said the National Health Security Act that was passed by the Thaksin government endorsed the NHSO as a health service purchaser to oversee the budget. It empowers a group of doctors at the Public Health Ministry to distribute funds to state hospitals, doctors and other health care professionals."The model of a health service purchaser-provider split upsets doctors with a conservative mindset at the ministry," Dr Kriangsak said.



Kriangsak Vatcharanukulkiat



"They are working with an alliance of commercial-orientated doctors, pharmaceutical giants and policymakers to complete their 'four-stepped ladder' mission of dissolving the National Health Security Act and the universal health coverage system once and for all," he said. The cabinet's approval of Pradit Sintawanarong, a real estate developer with political links, to sit on the NHSO board as an expert on traditional Thai medicine along with six other new members was seen as a completion of the first step towards the ultimate goal. Dr Kriangsak said the Rural Doctors Society will not tolerate this bloc of politicians and commercial-orientated doctors holding sway. Any appointment of a chair to the agency's 13 sub-panels by the public health minister would be closely watched by the society and supporters of universal health coverage, he said.

They fought Mr Witthaya's appointment of Waranuj Hongsaprapas, adviser to the Budget Bureau, as chairwoman of the sub-panel on financial and treasury development, until she was forced to step down. Ms Waranuj was picked by the NHSO's political bloc and was expected to reduce per-head discrepancies between the three health insurance schemes. Dr Vichai Chokewiwat, an NHSO board member representing the elderly, walked out of a meeting last Tuesday during Ms Witthaya's appointment of public health permanent-secretary Paijit Warachit as chairman of the sub-panel on strategic planning. Dr Vichai said such political interference went against the principle of the NHSO board acting independently of Public Health Ministry executives. He and Nimit Tienudom, director of the Aids Access Foundation and an NGO member on the board, quit their roles in opposition to political interference.