Advocates applaud the move, claiming some 6 million current and retired civil servants and their families will receive the same benefits at a budget the government can afford.

According to the Finance Ministry, CSMBS expenses have soared each year despite efforts to curb costs, and the growing burden on public coffers has made it necessary to transfer health-insurance provision to private companies. Insurance firms would be better able to cut fraud and control the budget.

Critics of the move complain that CSMBS members will end up facing too many restrictions in accessing their rights to medical care. They lament the fact that many retirees had been willing to accept relatively low salaries as junior officials in exchange for guaranteed health security under the CSMBS.

Former public health minister Mongkol na Songkhla says CSMBS beneficiaries must stand up against the plan or else their rights will be affected.

Jiruth Sriratanaban – head of the Thailand Centre for Health Services System and a lecturer at Chulalongkorn University’s Department of Preventive and Social Medicine – writes that there is no evidence Thai insurance firms could manage a healthcare scheme any better than the state. In other words, there’s no reason to believe private-sector control would lower the cost of management and of individual cases while at the same time maintaining CSMBS members’ current access to medical services and preventing greater burden on state hospitals.

Jiruth has over 18 years’ experience in the field, most recently as a member of the sub-committee on reform for healthcare financing and health security.

He asks how authorities can prevent both a temporary halt on expensive treatments until next year, and the use of management expenses to negotiate a hike in budget or insurance premiums in following years.

Jiruth insists that the current practice of “open-ended” expense coverage for civil servants and family members should be maintained and subscribers’ rights not be reduced. The proposal was not included in the private sector-arranged healthcare policies, which also come with annual caps on benefits and coverage.

Jiruth said private health insurance is also limited in regard to long-term risk management for different life stages. He said firms were motivated by a focus on expense control for the particular year covered by the insurance policy, rather than investing to prevent risks and lower medical expenses in the long term – which should be a key objective of a national healthcare scheme.

Having the private sector manage the Civil Servant Medical Benefit Scheme could impinge on overall budgetary control. This was because private companies might not be able to set prices and compensate medical expenses at the lower-than-cost rate, which the Comptroller General’s Department is doing.

There is also the risk of disagreements between the Finance Ministry and health insurance companies over medical payments per diagnosis related groups, or getting hospitals to accept them. These could lead to complaints or lawsuits over alleged favouring of private sector profit-making, leaving state hospitals to shoulder the losses, according to Jiruth.

Any other change in payment mechanism to motivate insurance firms under the legal context set by the Finance Ministry would be difficult to realise if there were no changes in benefits provided to the subscribers, Jiruth said.

He added that insurance companies could implement a resource-utilisation review and management to control expenses without lessening subscribers’ right to services, but that would require a sophisticated information system and personnel with sufficient expertise.

He pointed out that the limited number of experts made it difficult to believe firms could prepare themselves for the task in less than a year.

The Finance Ministry expects the transfer of CSMBS management to occur in 2018.

Switching to the private sector would lead to a cost burden as firms would have to pay tax and meet profit targets – which could be higher than 10 per cent, Jiruth said. If privatisation was deemed worthwhile to solve the scheme’s “leakage”, then the leakage loss had to be worth more than the private sector’s cost and profit sum, he added.

The Finance Ministry should now proceed by releasing all details of the plan, including insurance firms’ preparations for CSMBS management.

Let’s make it clear to all sides how the plan will benefit current CSMBS beneficiaries, the government and the insurance firms. To do so, we need transparency about the management fees that insurance firms will demand and the coverage they will offer.

What contingency plan is in place if insurance firms demand a higher budget for managing the CSMBS later on?

The public has a right to know these details.