Bangkok Post, November 26, 2017
Thailand’s universal healthcare coverage (UHC) scheme is confronting its most critical time since its introduction in 2002. For over a decade, the scheme has been praised all over the world for its achievement in providing healthcare access to over 48 million out of 66 million people, filling the gap left by the social security scheme and civil service welfare.
But since the 2014 coup, UHC has become a target for military government leaders and bureaucrats who often blame the scheme for having a poor financial model that causes trouble for medical providers.
The debate about the scheme’s pros and cons led to an ongoing amendment of the National Health Security Act that has created a controversy about the future of UHC.
Prime Minister Prayut Chan-o-cha once described universal health care as a “burden” on finances. He called it “populism” and ironically asked which government invented this scheme.
UHC is often dubbed as the masterpiece of Thaksin Shinawatra, who launched the scheme with the slogan “30 baht treats all diseases”. It is mainly funded by tax on a capitation basis.
The 30-baht fee was revoked in 2009 by the Democrat-led government, which renamed the slogan to “free treatment for 48 million people” in a move seen as a political attempt to sweep an icon of Thaksin out of the scheme.
But in a political war where UHC is seen as nothing but Thaksin’s populism, the name of the man who was behind the scheme’s success is sometimes forgotten. Sanguan Nitayarumphong is a rural doctor and.. and a pragmatic problem solver who led the scheme’s invention until it caught Thaksin’s attention.
In the 1980s, he began his ambition to establish health care for all after witnessing the experiences of patients who couldn’t afford medical treatment. He tried convincing everyone — people, governments, bureaucrats and politicians in many political parties including the Democrats, Chart Thai, Sereetham and Thai Rak Thai — that UHC could be achievable..in Thailand..
But Thaksin got Dr Sanguan’s idea the most. He promoted universal health coverage in his election campaign and introduced it immediately after his landslide election victory in 2001.
“The scheme is certainly populism,” says Suwit Wibulpolprasert, a prominent doctor who went along with Dr Sanguan in a quest to set up universal health coverage. “But it has been operated very well and became state welfare eventually.”
Dr Sanguan laid the foundation for UHC, dubbed the best-organised welfare scheme ever devised in Thailand. He changed the whole perspective of Thai health care from a system only available to people who. who could pay or those granted doctors’ patronage to the present system of equal rights for all.
Although UHC was born without politics, the scheme’s politicisation is undermining the health and opportunities of the whole population.
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