BANGKOK POST Issued date 27 January 2015
SPECIAL REPORT: Hospitals threaten boycott in battle over universal coverage, writes Paritta Wangkiat
Healthcare reform is on the public’s wishlist after last year’s coup but is causing conflicts among health authorities, inevitably affecting the public interest.Attempts to change the financial model underpinning the universal coverage healthcare scheme (UC), proposed by the Public Health Ministry’s Permanent Secretary Office (PSO), is at the centre of the conflict.
The PSO, which oversees 884 state hospitals nationwide, says the existing budget model, managed by the National Health Security Office (NHSO), has led to suffering among health staff.
The NHSO rejects that, saying its management of the universal health scheme focuses on health benefits rather than budgetary concerns.
The NHSO plays the role of “healthcare services purchaser” from hospitals, mainly those under the supervision of the PSO, for the UC’s 48 million members.
The conflict started last year when the PSO, led by permanent secretary for health Narong Sahametapat, criticised the NHSO’s budget management, which he said causes suffering for health staff. They are often overloaded with work due to large numbers of “unnecessary” patients, he said.
Dr Narong said the UC scheme’s poor budget allocations resulted in financial crises for some state hospitals, particularly ones in rural and border areas which provide humanitarian services for many underprivileged people and migrant workers without any payment from the UC.
There are two parts to the UC’s budget. First, the capitation payments which the NHSO allocates to hospitals at a flat rate of 2,895 baht per patient; and second, a budget targeting chronic disease treatment and prevention such as kidney dialysis, hypertension, diabetes and HIV/Aids.
According to the PSO, the NHSO should allocate the second part of the budget to hospitals so they can distribute money as they see fit. The NHSO does the job currently.
The concern arose after the Budget Bureau, under the NCPO’s direction, cut the UC’s budget for 2015 from 183.1 billion to 153.2 billion baht as requested by the NHSO. The PSO said that without changes in budget management, the spending cut would hurt state hospitals.
The conflict intensified this month as the directors of hospitals under the PSO said they would boycott the NHSO by not joining in its meetings or activities.
Sutas Sriwilai, president of the Regional and General Hospital Society, said state hospital operators nationwide had also agreed to stop sending health services data to the NHSO even though it is essential for budget reimbursement. The boycott will end only if the NHSO agrees to comply with Dr Narong’s proposal of “health zones” – a grouping of healthcare service areas, except Bangkok, into 12 zones, said Dr Sutas.
Each zone, led by a health inspectorgeneral, will share resources among hospitals in its area, including medical
staff, specialists, equipment and budgets.
Under the proposal, the PSO will manage the UC’s budget in each zone itself. The PSO said patients would have no need to crowd into big hospitals or join long waiting lists for services. Budgets would be better allocated based on need, instead of mainly based on population.
The plan, however, has drawn opposition from the NHSO and health activists, particularly when news emerged that it had the backing of Pradit Sintavanarong, public health minister under the Yingluck Shinawatra administration.
They said the proposal is an attempt to shift the huge UC budget from the NHSO’s responsibility to the PSO where politicians can meddle with it. “Imagine if the patients’ money [via the UC scheme] is used to purchase healthcare services from hospitals but ends up being managed by hospitals. How can patients have bargaining power for better services?” said Vichai Chokevivat, an NHSO board member who opposes the PSO’s plan.
“Hospital operators may focus on spending that money to expand their facilities instead of improving access to healthcare,” he said.
The Rural Doctor Society also opposes the plan and has threatened mass protests if health zones go ahead.
After the May 22 coup, the National Council for Peace and Order deputy chief Adm Narong Pipattanasai, overseeing social issues, assigned the National Health Commission Office to design a new approach for UC management. The office came up with the “people-oriented health zones” proposal. Healthcare services will be managed jointly in the zones by the Public Health Minister, PSO, NHSO, the Comptroller-General’s Department, Interior Ministry, Social Development and Human Ministry, local administrative organisations and civic groups.
Public Health Minister Rajata Rajatanavin has asked the agencies for details on the UC scheme and the health zone proposal. A decision is likely in three weeks.
“Poor budget allocation has resulted in financial crisis for state hospitals, particularly rural ones.
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