The National Health Security Office (NHSO) also emphasised that the Universal Health Coverage (UHC) scheme remained unchanged – even though the new draft charter had passed the referendum – and there would be absolutely no direct co-payments under the UHC scheme.

NRSA spokesperson Air Vice-Marshal Chalermchai Krea-ngam denied a report yesterday that the NRSA had approved co-payments under the UHC scheme, Social Security scheme, and Civil Servant Medical Benefit scheme. But he admitted there had been suggestions from some NRSA members to improve healthcare in Thailand by applying a co-payment.

“As the constitutional draft has passed the referendum, the NRSA has arranged a meeting among members to discuss the future of our healthcare system. Some members suggested that we should improve our healthcare by applying a co-payment to all health schemes, but this idea was still not the official conclusion of the NRSA,” Chalermchai disclosed.

He said that NRSA was trying to create measures to develop all three health schemes to meet with the new health standard, which is guaranteed for all Thai citizens by the draft charter.

“Article 55 of the draft constitution states that the state must supply quality healthcare to all Thai people, so we are trying to develop our health schemes to achieve this goal and make all three schemes equal in quality of service,” he said.

“Contrary to rumours, I maintain that the UHC scheme will not be revoked, but we must find a way to make it sustainable and improve its quality.”

NHSO acting secretary-general Dr Prateep Dhanakijcharoen also confirmed the UHC scheme would remain the same for now, even though the draft constitution had been passed.

“If there is any improvement in the UHC system, it will have to pass study and discussion first. However, we must find a way to make the scheme sustainable. The indirect co-payment through taxes or VAT is another good decision, but there will not be direct co-payment at the hospital, for sure,” Prateep said.

“As of now, everything remains the same. All people can still access health service through the UHC scheme. Furthermore, we will also get more budget – up to 1.61 per cent – for next year.”

Earlier, there was the concern over Article 47 of the draft constitution, which stated that poor citizens had the right to receive free healthcare. Previously, some had doubted about the situation of poor people, and worried that the right to access free healthcare for all people would be diminished.

Nimit Tien-udom, a former NHSO board member, commented on the co-payment decision by the NRSA. He said co-payment was not the only option to improve our healthcare system, because it was mismanagement of the healthcare budget that had caused inefficiency in the system.

“Many academic studies indicated solutions to improve our healthcare system. They [NRSA] should study more of this research. However, if there was no other option but to choose co-payments, it should be an indirect co-payment in order to minimise any impact on the people,” Nimit stated.

He warned that if the government decided to collect co-payments at service points, numerous problems and conflicts would follow. A lot of people would go bankrupt because of healthcare expenses.

“We have come a very long way in the efforts to ensure health coverage for all people. Let’s just not step backwards,” he added.

The issue over co-payment and equalisation of all three health schemes has long been a hot debate among all stakeholders in the healthcare system – and there was still no conclusion on the debate yet.