If we are to listen to what the National Health Security Office (NHSO) has told us, everything has been running smoothly with the universal healthcare programme, better known as the 30-baht scheme.
What about reports that member hospitals are facing mounting debt? That is just a “routine budget adjustment”. Partnered clinics are closing down? That is, the NHSO claims, because of their failures to comply with the rules.
Indeed, the official prospects of the 30-baht scheme appear so rosy that the newly-appointed Public Health Minister, Pattana Promphat, promised to improve the free kidney dialysis treatment for more than 100,000 patients nationwide within the next two months, following a directive by Prime Minister Anutin Charnvirakul.
The problem, however, is people who rely on the 30-baht “gold card” scheme — along with its partnered clinics and hospitals — see a different reality. On social media platforms, complaints abound from gold card members who must travel farther to newly-assigned clinics after their original ones either closed or substantially curtailed services due to a lack of funding.
A similar scenario is unfolding among partnered hospitals, some of which claim to have operated in the red for so long they have been forced to stop taking referrals. In these cases, the burden falls directly on patients who depend on the welfare scheme and are apparently left to fend for themselves.
Earlier this year, the Ministry of Public Health acknowledged that many state hospitals are struggling under the weight of financial debt — a severe challenge affecting healthcare services nationwide. At the heart of the financial crisis is the 30-baht scheme, where the allocated funds could not keep up with the increasing medical costs.
News reports say the 10 most indebted hospitals recorded a collective loss of 1.9 billion baht in the first quarter of this year alone. Among the hardest hit is Khon Kaen Hospital, which reported a deficit of 1.2 billion baht.
The issue was brought into sharp focus last week when Mongkutwattana Hospital announced it would suspend services for universal healthcare cardholders transferred from their primary care units, citing an overdue debt owed by the NHSO.
In response, NHSO secretary-general Jadej Thammatacharee attributed the problem of overdue debts to budgeting regulations. He said a service unit receiving lower assessment scores will be allocated a smaller budget, a situation that might be misunderstood as a deficit.
Although the NHSO promptly assigned other referral hospitals to people affected by the disruption at Mongkutwattana Hospital and expressed its willingness to take into account public feedback, the office also acknowledged its patient referral system remains problematic in some areas.
But the problem seems far more critical than the NHSO is willing to admit. There is a fundamental question whether the NHSO’s per-patient allocation of over 8,000 baht is adequate considering medical costs and the fact Thailand will soon become a fully aged society.
Some academics suggested the NHSO prioritise strengthening its core services before expanding into more advanced treatments to appease the public.
As the Thailand Development Research Institute (TDRI) recommended in a research paper this year, the NHSO needs structural reforms. These include increasing transparency in governance, decision making and budgeting, from planning to allocation, and upgrading technology to improve reimbursement rules and reduce errors on transaction checks.
While the NHSO board and subcommittees have broad authority, their structure lacks proper checks and balances as required by the National Health Security Act.
TDRI researchers who inspect NHSO found some members serve multiple overlapping terms across committees, which slows down decisions on which services and benefits should be included in the gold card package.
Meanwhile, a systematic, transparent assessment of the cost-effectiveness and impact of each benefit is still missing.
The universal healthcare programme is undeniably one of the country’s most progressive and respected policies.
However, the NHSO must look beyond its complex regulations and consider the situation on the ground.
Only when the regulator appreciates the real-world challenges that patients and hospitals face can this vital policy be made truly efficient and sustainable.