Developing nations watch Thailand's bold healthcare plan

By correcting this bias toward hospitals over primary care, which is common to many developing nations, government planners want to encourage people to seek care close to home. "It's the development of family medicine that's going to balance the costs [of universal coverage].... As family healthcare grows, you'll get an increase in access, but a more focused and lower access to secondary and tertiary care because people will realize that they're getting quality [local] care," says Monica Burns, a social security specialist at the International Labour Organization.

Doctors agree that more primary care is needed, but question whether the government is prepared to spend enough to make it work. Thailand already invests more in healthcare than many of its neighbors, who often rely on employee and private insurers for coverage. Nations such as Korea and Taiwan that do provide full coverage are significantly better off than Thailand, which has a per capita GDP of just over $2,000.

"The government doesn't have the money, and it's not the right time to do it," says Dr. Somsak Lolekha, a US-trained pediatrician who heads Thailand's Medical Council. "Making everything free isn't good because people just want more and more.... They should take responsibility and pay their share."

Under the new system, healthcare providers are compensated according to the number of registered patients they have.

This system, known as per capitation, is the way Britain funds its public healthcare service. In addition to an allowance of 1,200 baht ($30) per patient, resource-strapped hospitals can draw on a $122 million contingency fund and claim fees for referral patients.

Dr. Sanguan Nitayarumphong, deputy permanent secretary at the Ministry of Public Health, says that government spending on health is likely to rise over the next two years before leveling out due to greater efficiency in the system.

He says Thailand spends $4.4 billion on healthcare, of which roughly half is government spending and the rest is out-of-pocket payments and contributions by workers and employees to a social fund.

"If the government really wants to invest in people, it has to spend more," says Dr. Sanguan.

"Thirty baht is not a magic number. It can be changed," he says.

One wild card for Thailand and other Asian nations is the AIDS epidemic. Thailand has an estimated 1 million HIV-positive cases and 200,000 AIDS sufferers. Only women and children infected with the virus are eligible for treatment under the 30-baht plan, but activists want the government to provide retroviral treatment for all sufferers.

Sen. Jon Ungpakorn, a long-time campaigner for healthcare reform, says the government should raise its allocation to 2,000 baht per patient in order to guarantee that all diseases are covered, including AIDS.

He argues that unless the 30-baht scheme really is comprehensive, middle-class patients won't use it and therefore may not be willing to fund it through progressive taxation.

"We don't want this to become a third-class form of healthcare for the poor," Mr. Jon says.

"The quality of the service will be critical. If the quality of the service is good ... then it would mean many more people would use it."

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