Reform of civil-servant health care benefits all

BANGKOK: The Thaksin administration should be commended for its plan to contract the Social Security Office to run the Civil Servants' Medical Benefit Scheme under a capitation system similar to the health-insurance scheme for private-sector employees. The Scheme (CSMBS) has been a wasteful health-care system that is prone to corruption and abuse by some seven million government officials and their families as well as by health-care providers.

The pay-for-service system, under which civil servants and their families pay medical bills out of their pockets and then are reimbursed from the government for the amount they have paid, is ridden with loopholes, resulting in cost escalation.

In the latest available statistics, taxpayers had to shell out over 16 billion baht a year to sustain the CSMBS. It was estimated that the government could save as much as 5.5 billion baht a year on the scheme, without compromising the quality of health care service to government officials and their dependents.

The only drawback appears to be less convenience in that each of those covered by the CSMBS will be required to register with a hospital of their choice for treatment. The move is a step in the right direction toward social equality in Thai society.

Under the capitation system, the Social Security Office (SSO) pays a fixed sum per insured person per year to public or private hospitals contracted to provide health-care services. Hospitals for the insured persons thus have an incentive not to use costly or unnecessary diagnostic methods, while at the same time they are required to give cost-effective and good-quality service.

The system works well because insured persons can now choose to register to seek treatment at hospitals of their choice. That ensures that hospitals will give the best possible treatment to insured persons in the hope of getting them to register with them in the following years.

As a result, the capitation system, which is based on free market principles that emphasize cost containment, efficiency and competitiveness, has been put to good use by the SSO and private and public hospitals contracted to provide health-care service to insured persons.

The deadline for the merger of the CSMBS and the SSO's health- insurance scheme has been tentatively set for October. All well and good, except for the fact that civil servants and their families will be entitled to certain privileges not enjoyed by insured workers covered by the SSO's health scheme, according to the plan drafted by the SSO.

This is both unfair and an insult to taxpayers in general. Government officials must learn that they are not supposed to cling to the last vestiges of privilege that trace back to the days when they were the ruling elite.

The introduction of the new health scheme for government officials and their families should be a good opportunity to drive home the message that they are now supposed to serve the people properly to earn their keep and be accountable to the taxpayer.

Failing that, the Thaksin administration's good intentions -- including the admirable introduction of a low cost universal health care scheme in which low income people pay only 30 baht per visit to the doctor -- will ring hollow.

The integration of the CSMBS into the SSO's health-insurance scheme under the capitation system should serve to benefit the rest of the population, not to preserve government officials' privileges.

The inclusion of seven million additional insured persons, and with it a vast sum of money, will expand enormously the market for managed health care and create an economy of scale that should lead to better overall health care for the whole population.

-- The Nation/Asia News Network