Thailand universal healthcare in trouble? The implications for Thai locals and expats

For many years, the Thailand universal healthcare program was lauded for its pioneering and innovative nature. Many other countries in the Southeast Asia region, as well as elsewhere in the world, saw in Thailand an example of what could be done to address the healthcare needs of a country’s people, even when it is not the richest country around. However, over time some weaknesses in the system have begun to show through its lustrous veneer, which has led to comments professing doom and gloom for the country’s nationwide medical landscape without major reforms. Are these concerns legitimate? What changes are being proposed, and how would they effect locals and expats in Thailand alike? Pacific Prime explores the topic below.

The Thailand universal healthcare system

The Thailand universal healthcare coverage scheme found in Thailand today was first implemented 15 years ago in 2002.  Before this time, about 25% of people in the country were without health insurance, and even those with health insurance often found that there were gaps in their coverage. Many Thai households became poor due to burdensome medical costs at that time, and an alarming number of children were dying from preventable diseases.

While not truly and completely universal on its own, the scheme does provide public healthcare subsidies for 48 million of the country’s 66 million total people. The remaining portion of the population will likely have their healthcare subsidized through the country’s Civil Servant Medical Benefit Scheme or Social Security Scheme. Since the scheme has come into force, it has been responsible for decreasing the burden of medical costs among families across Thailand, caused fewer sick days among the working population, and reduced instances of infant mortality.

At first, a 30 baht copayment was required for each patient when they visited their designated medical facility, and while this was abolished in 2006, it was once again reinstated with some exemptions in 2012. Regardless, healthcare for Thai nationals is likely to be either very cheap or free as long as they use their designated healthcare facilities. Outside of these facilities, people will be required to pay for their treatment out of pocket.

The programs mentioned above are paid for completely with general income tax, and in 2011 the cost of the scheme was a mere USD 80 per citizen eat year. While the system does not cost an arm and a leg, it does come with many of the same shortfalls that can be seen in other countries with public healthcare. These include long wait times and overworked doctors, leading to visits with the doctor that patients feel are too short and informal.

Potential changes to Thai healthcare

In 2014 a military coup reformed Thailand’s governmental landscape, and with new leadership came new ways of thinking about healthcare, its trajectory, and how it should be handled going forward. In general, there was more skepticism among this new administration that the financial model behind the Thailand universal healthcare coverage scheme was poor and causing problems for care providers. As unfortunate as it may be to say, universal healthcare in Thailand is currently caught in the crosshairs of new leadership that believes the program to be a populist holdover from a bygone era, and it is now politicized in a way that could see moves made to water it down.

Even so, many believe the complaints of the scheme are well founded. Politicians and doctors alike site that the program is causing hospitals to run financial deficits, and even accused the National Head Security Office (NHSO) of corruption, although this claim was not found to be credible by the Office of the Auditor General. As well, the fact that the scheme’s budget has tripled from 2003 to 2017 has led to criticism that the program is unsustainable.

This led to the creation of a committee in January of 2017, with the goal of improving the Thailand universal healthcare coverage scheme.

So what changes have been proposed? In the past, some in power have stated their belief that Thailand should make the effort to provide healthcare for the poorest in the country, but that others should have to make arrangements to address their own medical costs. Indeed, the current government’s leadership has already taken steps to bolster support for the poor, having issued welfare cards to 11.4 million people, as well as the announcement of various other programs in support of the needy.

However, the committee’s other recommendation is different. They would like to see a greater representation of medical professions of the NHSO board; increasing from 9 to 13 seats. The concern with this is that patients will be under-represented as a result, and that scheme budget allocation will end up going to where doctors want it rather than to where patients need it.

What this means for Thai locals

Findings suggest that citizens are seeking care outside of the Thailand universal healthcare coverage scheme, which suggests that all of the services that they need cannot be found within it.

On the other hand, for Thai citizens, constant tweaking of the scheme by leadership that has a dubious level of faith in it could potentially lead to coverage issues further on down the line. In this instance, having private health insurance in place already could save you from issues like pre-existing conditions. Additionally, even if you are on the scheme, having a private health insurance policy can allow you to receive higher quality and more efficient healthcare at your choice of medical facilities, thereby making having to adhere to a designated hospital a thing of the past.

What this means for expats

Thailand is a pretty unique location for foreigners coming to the country and subsequently seeking healthcare, as the country is such a major medical tourism hub. While they can seek out care at hospitals that Thai natives would use, there is an entirely separate network of private hospitals that cater specifically to the needs and tastes of visitors to Thailand. Many of these hospitals have amenities on par with a 5-star hotel and resort, as well as highly trained medical staff who are often foreign trained and fluent in English or other languages like Chinese, Arabic, Russian, and Japanese.

Even if expats choose to use public hospitals, they are unlikely to be subsidized in any way unless they have joined the social security system and been assigned a hospital. This means that any costs incurred will have to be paid by them out of pocket, or with their own private health insurance plan.

Make sure your health is protected

If you’re an expat, whatever changes are made to the Thailand universal healthcare coverage scheme, you are still going to need to private health insurance plan in order to ensure that you can receive the best quality care while in the country.

If you think that obtaining a private health insurance policy may be right for you, contact the helpful insurance agents at Pacific Prime Thailand! They can advise you on the best plans available for your needs on the market, give you a free quote, and even provide a plan that provides coverage all over the world, including in any hospital or doctor’s office in Thailand itself.