Thailand's Cheap Health Plan Fails to Deliver by Phairath Khampha 16 April 2002 If Buajan Wongwienma loses her husband to cancer, she could be excused for blaming her loss on the shortcomings of a health service to which the couple looked for help. Mrs Wongwienma's husband, 57-year-old rice farmer Boonlop, fell ill in January 2002. When he went to the regional hospital in nearby Chiang Rai, he was treated under the newly-introduced 30 Baht health plan - one of the flagship reforms of Thailand's populist Prime Minister Thaksin Shinawatra. Under the scheme, hospitals are obliged to treat patients for a flat charge equivalent to about 70 US cents per visit. After checking his entitlement to treatment under the scheme, staff at the hospital carried out an examination, and diagnosed lung cancer. Mrs Wongwienma says that was about all they did. And another poorly thought out Thai government scheme ended up doing moree damage than if it had never been implemented. Getting what you pay for "When we went to the hospital, the doctors took his blood pressure and gave him some pills," says Mrs Wongwienma. "They couldn't give him injections or any of the specialist treatment he ought to have had. "But then again, what do you expect for 30 Baht?" Chiang Rai regional hospital joined the 30 Baht scheme in October 2001. In the main out-patient waiting room, large blue signs advertised the main features of the plan. People registered as members show a special laminated gold card when they arrive in the waiting room, before being allowed to see a doctor. Pensioner Mrs Kam Rakkatkit was one of the patients in the waiting area. For her, the 30 Baht scheme offered regular, inexpensive treatment for her high blood pressure. "I applied to join because I was no longer covered by my son's health insurance plan," she says. "I think the scheme's very good for poor people, but maybe the rich should pay more." Scant resources The fact that wealthier Thais now contributed virtually nothing towards public health care was seen as one of the scheme's major flaws. It now meant that hospitals had to cover the bulk of their costs from a subsidy paid them by the central government, based on the number of patients they were able to register. Renu Srismith, the director of Chiang Rai regional hospital, said maintaining services at her 714-bed facility had left her with a spending gap of about $3 million. "Our budget is insufficient compared to our labour costs, which are now about 200 million Baht ($4.6 million) a year," she explained. She added that unless the government responded quickly to her request for contingency funding, cost-cutting measures would be inevitable. "Maybe we will have to do some down-sizing," she says. A number of large hospitals around the country had already been forced into action. Closures Newspapers in Thailand reported the closure of some wards, and cases where staff were laid off because hospitals were unable to pay salaries. Complaints of sub-standard treatment were growing. Sometimes, hospitals required to provide a costly course of care would simply refer the patient to another hospital. Many such tactics carried echoes of Britain's troubled National Health Service, on which the 30 Baht scheme was originally modelled. They also gave rise to a mounting stream of criticism directed at the government. Economist Ammar Siamwala said that the government had rushed into making reforms to the health service without ensuring they would be effective because it was looking for political support from the masses. On the surface this looked like a great idea, but like most government schemes, they are thought out improperly with political blinders being worn. Other critics described the 30 Baht scheme as a political gambit gone wrong. Backlash Mr Thaksin's promise of cheap, universal health care helped him to a landslide victory in parliamentary elections in early 2001. It was just another classic Thai political empty promise, of which there is no dearth. Now his ministers were struggling to stave off disappointment with the results. "We cannot carry out reform in one month or even one year," argued Health Minister Sudarat Kaeyurapan. "We need at least two years." Ms Sudarat said rural health facilities - hitherto disadvantaged financially compared to urban hospitals - were starting to see some benefits. For patients like Mr Boonlop, it would probably be too late. He was now receiving treatment at a fee-paying clinic, but doctors say he would not have long to live. And as the number of people who feel let down by the state health system grew, so the political problems for the government mounted as well.