From the civil society to the Prime Minister
For the development of Universal Coverage Scheme in the next decade

Health Systems Research Institute (HSRI), in collaboration with its partners, jointly hosted the Conference entitled “Universal Coverage Scheme in the Second Decade” from 21 to 22 March 2012, at Rama Gardens Hotel, Bangkok, Thailand. The conference was aimed at providing opportunities for knowledge and experiences sharing among networks concerned such as academics, patient networks, service providers, local government, and the civil society.   

The opinions surveyed from participants in this conference were summarized into ten concerns and ten recommendations for improving health security systems, to be proposed to Ms. Yingluck Shinawatra, Prime Minister, and more than 1,400 participants. Details were as follows:

Ten Concerns:

1. The government’s plan to revive the policy of the 30-baht co-payment:* The government should not quickly implement this policy and it is necessary to prudently review before implementing this policy.

2. The budget for health promotion and disease prevention: Compared with health care budget, the budget for health promotion and disease prevention has increased very little, leading to limited development of these 2 areas. It may reflect that the government do not pay attention and do not recognize their importance.

3. Quality of services: The participants called for the government to pay more attention to both the quality of and the access to health care services because only access to services but low quality does not help improve health care systems. And, if the doctors provide only a few minutes for each patient, it is not different from inaccessibility of health care services.

4. Harmonization of health insurance schemes:  The participants did not agree with the harmonization of three health insurance schemes, i.e. Social Security Scheme (SSS), Universal Coverage Scheme (UCS), and Civil Servant Medical Benefit Scheme (CSMBS). However, they agreed with the reduction in differences of these schemes. Actually, it is not necessary to harmonize these three schemes, but the government should develop standard systems for managing these schemes, which should be implemented separately.

5. Guidelines for primary health care development of the Ministry of Public Health (MoPH) and the National Health Security Office (NHSO) are still different, causing the confusion among health practitioners.

6. Preparation of reports for requesting the budget from the NHSO increases the burden for health practitioners, causing reduced duration for providing services to patients.

7. Responsible areas of the MoPH and the NHSO: They are still different, contributing to difficulty for coordination.

8. Management of Sub-district Health Fund: Sub-district Health Fund should be managed not only by the local government (Sub-district Administrative Organization) or sub-district health promoting hospitals but also the community people. The people should be encouraged to participate in managing Sub-district Health Fund for health promotion, contributing to enhanced capacity of the people as well.

9. Health problems of migrant workers and their health care systems: At present, there are health insurance systems for registered migrant workers who are required to pay insurance premium. The problem is that no one pays much attention to the quality and coverage of services. And, if migrant workers suffer from infectious diseases, Thai people will be affected by such diseases. Thus, the government should recognize that migrant workers must be provided with better health care services because they are part of Thai economics and health systems.

10. Clarity of decentralization to local government in the future: If there is the decentralization in accordance with the Constitution, where do health agencies stand?; whether they will be part of local government? These are concerns among the people in the system regarding their future.

Ten Recommendations   
 
Recommendation 1 :
All health agencies should enhance coordination and collaboration during working with partners. In the absence of good coordination, it increases the burden to heath staff and difficulty to success.

Recommendation 2 :
Health personnel should approach the people, not waiting for the people to receive services at health facilities. There should be the guidelines for increased number of family doctors. Due to a shortage of doctors, there should be the development of various methods for preventing illness among the people and reducing the number of patients seeking services at health facilities.

Recommendation 3 :
The government should revise regulations and limitations for increasing more flexible management of Sub-district Health Fund.

Recommendation 4 :
The NHSO should allocate some budget for capacity building of personnel since the quality of services depends on the capacity of personnel.

Recommendation 5 :
The government should promote decentralization and encourage participation of the people and the civil society for increasing their powers for negotiation and decision making.

Recommendation 6 :
The government should expand the issue of health development beyond direct causes, covering social determinants of health such as believes or attitudes and behaviors of some groups in the society such as different views in sexual relations between male and female, affecting differences in behaviors and health.

Recommendation 7 :
The government should increase measures for encouraging the people to develop good health behaviors and promoting self-health care such as tax reduction measures for the people who do not smoke cigarettes, do not drink alcohol or do physical exercise, including tax exemption for importers who invest in health promotion, etc.

Recommendation 8 :
Occupational health benefits: It means the problems of illness, resulting from working environments. The civil society requests the government to include occupational health in the benefits package of the Universal Coverage Scheme. For this case, it is related to Social Security Scheme because most people are employees of business enterprise.

Recommendation 9 :
The government should reduce the construction of hospitals in urban areas and enhance the recognition of importance of rural areas.

Recommendation 10 :
Employers should be responsible for health expenses of migrant workers.

* The Universal Coverage Scheme (UCS) has been implemented in Thailand since 2002 with co-payment of 30 baht per visit, so this scheme was entitled “the 30-Baht Scheme.”  Then, in 2006, the government cancelled this policy, so the patients can receive services free of charge.