New Mandala

13 responses so far ↓

• 1 Jon Fernquest // Feb 8, 2007 at 12:00 am

  Thanks. This is really helpful.

• 2 Michael Connors // Feb 9, 2007 at 2:20 pm

  I was at a ‘people’s platform for democracy’ meeting the other day. Some comments were made about the excessive amount of funds from the health budget that are assigned to public servants. A medical doctor present, who works in the system, said this was fiddling the accounts. Because most of the health schemes are poorly funded, when civil servants use the health system they attract premium charges and levies on all manner of things – this allows the health system to then fund other activities.
  Just a thought – I would have looked at the figues and taken them at face value.
  Michael

• 3 jeplang // Feb 10, 2007 at 1:22 am

  A recent issue of the Asian Studies Journal has an article written by two Japanese researchers on the results of interviewing a number of people in the Khon Kaen [spelling?] area on the 30 baht scheme. Conclusion-respondents thought it was a good scheme.

  I must warn one or two posters that the researchers did not sample thousands of people distributed over all provinces,nor did they make any mention of the respondents being supporters of Mr.T..

• 4 Srithanonchai // Feb 10, 2007 at 3:30 pm

  Here is another piece on the 30-baht programme.

  http://www.tdri.or.th/library/quarterly/text/s05_2.pdf

• 5 hpboothe // Feb 12, 2007 at 2:48 pm

  Mr Conners: having looked in depth at government figures, research methodologies, and private company financial accounts, I would strongly urge everyone NEVER to take any figures “at face value”. Unquestioning acceptance of figures allows analytic laziness and willfull manipulation to seep into policymaking often with tragic consequences. Health care is a case in point – the underlying data use to calculate health care costs is appallingly bad. Let me give you an example – if you compare birth records from Bangkok hospitals to census data of the age distribution in Bangkok, you get a disparities of over 100% – that is the numer of people between ages x and y is over twice from one set of records as from another. Now, you can accept a disparity of perhaps up to even 30% as differences between official records of residence vs. actual domicile, but 100%? Clearly there are severe data problems in the system – so how can you even begin to calculate health care costs when you’re not even sure how many people you’re dealing with?

  jeplang – the 30 B plan brought cheap health care to rural people through a shift to primary care and government subsidies. As the beneficiaries have no direct contact with the liabilities (the definition of moral hazard), it’s not surprising that they would approve. If you gave me something that someone else had to pay for, I’d approve too. The question here is one of sustainability, which cannot be answered by opinion polls.

  The TDRI article is more on the mark. It clearly shows through some fairly simple analysis that the funding mechanisms behind the scheme are unsustainable – the same conclusions reached by the BMJ article. This isn’t rocket science – the same as been shown in any systematic review of health care financing. That the TRT plan never made such analysis and never took the global experience in health financing into account in creating their 30-B scheme is what makes me believe that this was intended more as a short-term vote-grabbing ploy than a serious attempt to solve rural health care issues.

  Best regards,

  HP Boothe

• 6 Srithanonchai // Feb 12, 2007 at 7:14 pm

  HP: Your conclusion is certainly correct. Moreover, before the 30 baht plan was introduced, we already had the health card program and free care for the poor (though bureaucratized). TRT could have improved on these things–but this would not have had the broad electoral effect aimed for.

• 7 Srithanonchai // Feb 14, 2007 at 9:47 pm

  30-baht program: two more recent articles.

  1) Viroj Na Ranong and Anchana Na Ranong. 2006. “Universal Health Care Coverage: Impacts of the 30-Baht Health-Care Scheme on the Poor in Thailand.” TDRI Quarterly Review, September, pp. 3-10.

  One of their conclusion reads, “Although the number of people who seek health care has increased substantially following the implementation of the 30-Baht Scheme, our fieldwork suggests that the health-seeking behaviors of the poor have not changed much after the Scheme started, as most of them have rather limited choices. For most people, including the low-income group, the financial costs for health care did not change drastically after the implementation of the 30-Baht Scheme. However, most people feel more secure with this Scheme in place, as they now have an insurance against a drastic or catastrophic illness that they could suffer in the future.” Field research was done in 2001 and 2003 in seven provinces.

  2) Chalermpol Chamchan and Mizuno Kosuke. 2006. “Assessment of People’s Views of Thailand’s Universal Coverage (UC): A Field Survey in Thangkwang Subdistrict, Khonkaen.” Southeast Asian Studies 44 (2):250-266.

  The study was done in only one village with 80 respondents (9-20 March 2005). Unsurprisingly, most of them very much liked the program. The lower-level income goups spent proportionally more on health care than the higher-income-groups=inequity; also unsurprising. Before the introduction of the 30-Baht scheme, most were covered by the medical welfare scheme (12%) and the health card program (49%). 38.5% had been uninsured. The scheme improved the “ability of patients to access medical care ansd the confidence in the quality of care provided. At the same time, it raises a concern about over-utilisation..as a result of negligence in taking care of their personal health and too much dependency upon the health system, even for minor illnesses.”

• 8 hpboothe // Feb 15, 2007 at 4:25 pm

  “Although the number of people who seek health care has increased substantially…the health-seeking behaviors of the poor have not changed much…”

  I don’t get it. If more people are seeking health care, doesn’t that mean that health seeking behaviors have changed? What am I missing here?

  Generally, access to low-cost or free care increases utilization rates – you can see this in the Canadian system vs. US system. This isn’t necessarily bad, but it needs to be carefully monitored lest unnecessary visits start eating up the system (for example, there was a case in a nearby country where a campaign to educate people about leprosy resulted in masses of people showing up to free clinics for every light patch on their skins, creating total havoc).

  There is lots of talk of cost savings from preventative care, but unless you place limits on end-of-life care, much of that savings can be illusory. The problem is worst without the co-pay, so eliminating the 30-B fee will likely lead to increased strains on the system as people go to the clinic with no obligation at all.

  When you say “The lower-level income goups spent proportionally more on health care…”, I assume you mean as a percentage of their incomes?

  It is also interesting to me that both papers focus on behaviors and opinions, as opposed to what impact if any the program had on people’s actual health. Anyone look at that, or is it as irrelevant as the focus of all this research would suggest?

  Regards,

  HPBoothe

• 9 Srithanonchai // Feb 15, 2007 at 8:56 pm

  Man — did you notice that the quote distinguishes between “people” and “poor”? That’s ain’t be the same, right?

  “proportionally more” – yes, obviously, regarding their different levels of income.

  Research papers can have different purposes and foci. Nothing really surprising or interesting here.

  Yet another suggestion: Get yourself the articles and read them. TDRI will probably even have a more complete Thai-language report, in case you want to know more details.

• 10 hpboothe // Feb 15, 2007 at 10:26 pm

  Ah, I see. So the program increased health care access for people in general, but not for poor people. Yes, I did miss that, thanks for pointing it out.

  Sure, research has different purposes. Yet, I still find it curious that research on opinions is readily available while research on actual health outcomes is so rare.

  Priorities, right? I guess it’s much more important to find out what people think rather than what’s actually happening. Knowledge marches on.

  Best regards,
  HPBoothe

• 11 Srithanonchai // Feb 16, 2007 at 1:32 am

  HP: As I suggested, read the articles and the full TDRI report…, and if you read quotes, read them carefully….These are much better options than harping on your prejudices.

• 12 New Mandala // Feb 22, 2007 at 4:00 pm

  [...] evaluation of the various schemes that made up Thaksinomics. There has been some research on the 30 baht health scheme, but very little on the controversial economic stimulus schemes such as the one million baht [...]

• 13 Srithanonchai // Feb 23, 2007 at 1:19 am

  Ammar Siamwalla has been appointed chairperson of a government committee tasked with the reform of the entire health care budget. He noted that it was strange that the 4 million civil servants, including their families, would cause the state 40 billion baht in expenses per year, while only 80 billion baht per year was spent for the 48 million people covered by the 30-baht scheme. So, merely looking at the 30-baht program would be grossly insufficient (Matichon, February 20, 2007, p. 20).

  One might add here that the state’s official pay for civil servants is so low that it must be subsidized by other state budget, by corruption, by the families of civil servants, and by them not working full time to have time available for other jobs.

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