Thailand's universal health program is being criticized by health professionals, who point to rising hospital debt and the large-scale resignations of doctors from the system. The head of the program, tells Ron Corben in Bangkok that reforms are under way.
Thailand's low cost universal health scheme, introduced by Prime Minister Thaksin Shinawatra's Thai Rak Thai Party, has long been the target of criticism.
The scheme, known as the 30-baht service, charges patients the equivalent of 75 cents a visit. It was a key element in the party's landslide election victory in 2001, and remains a cornerstone of party policy.
Initially, it was aimed at ensuring health coverage for about 12-million low-income Thais, primarily the rural poor. But the government soon extended the program, which now covers 48 million people, or 80 percent of the country's 63 million-strong population.
Medical professionals accuse the government of haste in implementation. Some public hospitals have run up huge debts, and hundreds of doctors, especially those in rural areas facing heavy workloads, have quit.
Dr. Sanguan Nittayarumphong, the secretary-general of the National Health Security Office, says reforms in financing and health service delivery are being implemented. He says budgeting procedures have already been made more realistic.
"We allocate budget according to the number of people that each hospital, or each region responsible, whereas, in the past, we just allocate according to the number of hospitals that we have," Sanguan says. "So, this is a big reform."
The government has also increased payment to the hospitals to close to $40 per patient per year, compared with $30 at the scheme's start five years ago.
From covering just basic health care, the scheme has been extended to higher-cost surgery, treatment for AIDS and cancer, and dental work.
Sanguan acknowledges that expansion of the scheme placed too heavy a workload on hospitals and staff.
"It's true. I admit it, the scheme has a problem: we have more workload," Sanguan says. "It's like when you have a dam, and you open the dam, the water just come in, because, before you are not going to provide free care for all - but now you provide free care for all. The more overload of work causes more problem to health personnel."
Thailand already faces a shortage of doctors, with just one medical practitioner for every four-thousand people.
The government, Sanguan says, aims to increase the number of medical and nursing graduates. Special incentive payments have been introduced for doctors working in isolated regions, where monthly salaries had been as low as $400.
But he admits there is still a lot of work to be done before the system works well.