ONE OF the most important healthcare laws is being revised amid concerns expressed from all sides.

Many are worried that the revisions will disrupt the National Health Security Office (NHSO) and the universal healthcare scheme, which has long been under its care. Other critics fear that the amendment to the National Health Security Act – as framed by the draft National Health Security Bill – will fail to solve problems that have long plagued the scheme and hospitals that support it.

The matter is of paramount national importance because the scheme covers about 48 million people in Thailand.

“For now, I hope people affected by the legal amendments will be able to make their voices heard,” Dr Thira Woratanarat, a lecturer at the Chulalongkorn University’s Faculty of Medicine, said about the bill.

As of last Friday, people have been invited to comment on the bill on websites operated by various authorities, including http://www.lawamendment.go.th. Comments will be accepted until June 18.

Authorities also intend to organise four public hearings on the draft law between Saturday and June 18. Representatives from various sectors will also be invited to public-consultation sessions regarding the draft on June 20 and 21.

Yet Thira believed more efforts were needed to hear what people really wanted.

He pointed out that the elderly, physically challenged, poor and IT-illiterate would not be able to access the process.

“You need to create more channels for people to learn about the proposed legal amendments. You  need to create forums for people to express their views. Let’s do something like ‘Public Speak Out’ sessions,” the medical lecturer said, referring to a public-education campaign conducted in South Africa to address the Aids epidemic.

14 major differences to current law

There are 14 major differences between the law currently in place and the draft bill. Among them are the definition of “public health services” and the representation of medical-service providers on the National Health Security Commission (NHSC).

Aids Access Foundation director Nimit Tien-udom attacked the bill, saying the NHSC would be unlikely to side with patients if medical-service providers were disproportionately represented.

Nimit joined the People’s Health Systems Movement rallying outside the United Nations building in Bangkok yesterday to demand that the new National Health Security Bill be scrapped. The group’s representatives also planned to hand a letter of objection to Prime Minister Prayut Chan-o-cha at Government House.

However, Dr Churdchoo Ariyasriwatana, a member of the Medical Council, pledged to submit a letter in favour of the changes to the United Nations and Prayut today.

“We agree with the proposed changes and in fact we even believe more changes should be made,” she said. “We also wish to express our support for the co-payment system.”

During the past 15 years, the universal healthcare scheme – which initially kicked off as the Bt30-per-medical-visit scheme – has offered almost all kinds of medical treatment for free. The NHSO received a budget for the scheme and chose how to pay participating hospitals.

Most such hospitals are state-run, and many have complained about the financial burden. Some have reported they were unable to get reimbursements in some cases because the NHSO had ruled that the cases failed to meet the prescribed criteria, leaving hospitals to shoulder the financial burden.

Churdchoo said the current law gave too much power to the NHSO, which set up rules that restricted doctors’ decisions to prescribe treatment and resulted in a drop in medical quality.

Complicated and unreasonable reimbursement criteria imposed |by the NHSO had influenced |doctors’ decisions to choose treatments and medicines, she added.

She also disagreed with free treatment for all, saying co-payments were a better option. People who could afford to pay for their healthcare should be required to, while |people who could not afford to pay should receive help, she said.

“With the co-payments, we won’t have to quarrel over whether we have enough of a budget for the scheme,” Churdchoo said.

Thira said he was worried various sectors would fight over the proposed changes to the law because of divisions among themselves, and fail to protect the “public interest”.

“Don’t fight for power. Don’t rush to complete a task assigned without fully contemplating its impacts. If you disagree on some points, turn to each other and talk to find a consensus,” he said.