Kriengsak Chareonwongsak people should receive state assistance

Consideration 2: Determining who should be partially responsible for their own medical costs. At least four groups of people should receive state assistance.

Firstly, those with contagious diseases such as tuberculosis, dengue fever, malaria, cholera, leprosy, pertussis, smallpox, and anopheles, which form a public social hazard. Individuals suffering from these diseases may not have the motivation to take preventive measures, or even after initially contracting it, to deal with it quickly without passing it on to others. As a result, the state should provide free innoculations against these highly contagious but preventable diseases. Those with highly infectious diseases must have access to competent medical help thereby preventing the spread of such diseases. On the other hand however, those with less infectious diseases, such as venereal diseases, need to be handled differently. Such individuals would be responsible to take preventive measures and to pay for any medical costs they incur.

Secondly, the state must cover the costs of the disadvantaged and destitute, such as the disabled, children, poor, elderly and so on. Often these people are abandoned by their own families and become a burden to society. The state’s Public Assistance Scheme does help to defer medical costs for those on low incomes and others such as children and the aged; however, this plan is still not available to everyone who needs it. A 1999 report released by the Ministry of Public Health shows that only 5.5% of the elderly, 7.3% of children below the age of five, 11.1% of primary and secondary school children and 1.5 % of disabled have taken advantage of this program. As a result, distribution of the Public Assistance Card must be improved to enhance the effectiveness of the card in providing health care services for the most needy.

Thirdly, those with incomes below the poverty line, that is, lower than 10,932 baht per year should have their health costs covered. The 4.4 million people in this group should be given free medical aid through the existing state welfare systems, including the Public Assistance Card. Centralized information centers should be established to collect lists of people below the poverty line incomes, such as poor farmers or slum dwellers in urban areas. These lists would be given to the various social agencies and medical facilities so that users could choose the clinics and hospitals they prefer. 

Fourthly, those with incomes higher than the poverty line but lower than the survival line that is, those with incomes between 10,932 and 14,623 baht per year. This group would also struggle to pay medical costs when their incomes fall below the survival line and would be unlikely to have sufficiently high incomes to purchase private insurance plans. Thus, Thai citizens in this category should pay as much as they are able for their medical costs and the state should cover the balance. The government should allow this group into the 30 baht payment scheme whereas the rich cannot qualify for the 30 baht payment scheme thereby ensuring no abuse of the scheme occurs.

If we use the above criteria we can cover everyone under the various health care systems, whilst having equity at the same time. They would bring many benefits including reduced long-term monetary burdens, release from the need to raise taxes for the upper classes, a more even distribution of medical services for all the people in Thailand and, in the end, a more equitable health care system that can truly meet the needs of all Thais.

Professor Dr Kriengsak Chareonwongsak
Executive Director, Institute of Future Studies for Development (IFD)
kriengsak@kriengsak.com, http://www.ifd.or.th