Thailand's new healthcare policy a threat to the poor?

Healthcare policy has changed to favour private hospitals, drug companies & medical tourism. Not made public, favours business, threat to universal healthcare.

Patient receiving dialysis treatment to help sick kidneys. Not so long ago the choice families faced for such medical treatments was bankruptcy or death. (Source: Wikipedia on Dialysis) 

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COMMENTARY

Private health bias puts cash ahead of lives

5/06/2013
Sanitsuda Ekachai

When the 2011 Central Plains flood crisis ravaged industrial estates in Ayutthaya and destroyed the country's biggest dialysis solution production plant, more than 40,000 patients' lives were endangered.

Tanapol Dokkaew was among them. "We frantically searched for hospitals which could clean our kidneys," he said. "We also desperately needed dialysis solution. Without the services and the solution, we would have surely died." 

Fortunately, the Government Pharmaceutical Organisation (GPO) imported the solution in time, sold it cheaply to the patients, and saved lives.

Meanwhile, dialysis centres at community hospitals funded by the National Health Security Office (NHSO) saved countless lives of kidney patients fleeing the devastating flood. 

"During emergencies, the rich can still seek treatments from private hospitals, but poor patients cannot," Mr Tanapol said. "That's why we must keep the health systems that care for the poor."

We are joining the rural doctors' protest against the Public Health Ministry's efforts to undermine the universal healthcare system in order to promote the private hospital industry at the cost of the public.

Mr Tanapol is vice-president of the Friends of Kidney Patients of Thailand group, which has more than 30,000 members nationwide. His organisation is joining hands with cancer, heart and HIV/Aids patients' networks to back the rural doctors in their bid to oust Public Health Minister Pradit Sintawanarong.

As they see it, the various policies initiated by the health minister are part of a larger scheme to benefit private hospitals and the pharmaceutical industry.

At a glance, these policies may look unrelated: Stopping hardship allowances for rural doctors, subjecting them to a rigorous assembly-line style of performance evaluation, putting Dr Pradit's own people on the GPO board, interfering with universal healthcare budgets at regional levels, trying to introduce a co-payment system in the universal healthcare scheme, attacking and discrediting the GPO, and firing GPO boss Witit Artavatkun.

"If you look at the blueprint of the private hospitals' policies, [Dr Pradit's] policies fall into place," Mr Tanapol said.

According to the Private Hospital Association's policy blueprint, the government should:

1. Reduce the government's role in health care, from providing 70-80% of health services currently, to just 30-40% within 10 years.

2. Support private health insurance. 

3. Promote private hospital businesses by giving them investment and tax deduction incentives.

4. Support private hospitals to produce their own medical doctors through financial support from the government.

5. Allow private hospitals to carry out clinical trials on humans with support from the pharmaceutical industry.

6. Support the medical hub policy.

7. Allow hospitals to advertise.

8. Allow fast-track imports for brand-name medicines.

9. Abolish price ceilings on medical treatments and allow private hospitals to charge what they like.

10. Stop state hospitals from competing with private hospitals.

11. Make state hospitals serve only the poor and private hospitals serve the middle classes and above. 

These goals cannot be achieved if there are not enough doctors to work in private hospitals, nor if the NHSO and universal healthcare scheme continue to operate as they do now. Nor is it possible when the GPO is determined to manufacture generic drugs. When the GPO can produce a generic medicine which costs the patient only 1 baht a tablet, compared with the 70-baht price tag of an imported brand-name drug, it appears clear why Dr Witit had to go, and who was behind his sacking.

The government also faces pressure from the European Union and the United States to use a stricter copyright regime than the World Trade Organisation system in exchange for export privileges. That makes it clearer still why the GPO's compulsory licensing policy to save lives must stop and why Dr Witit was given the boot.

"When I suffered renal failure in 2005, I had to spend up to 40,000 baht a month for treatment," Mr Tanapol said. 

Back then, most patients died because they couldn't afford to clean their kidneys, or went bankrupt because of the expense.

"The NHSO listened to our needs. The costs for dialysis went down until it became free. The NHSO has done the same thing with many other treatments and the GPO has finally made drugs affordable," he added.

These systems save lives. It's a matter of life and death for us if they're destroyed.

We must fight to keep them free from political interference at all costs.

Sanitsuda Ekachai is Editorial Pages Editor, Bangkok Post

(Source: Bangkok Post, COMMENTARY, Private health bias puts cash ahead of lives, 5/06/2013, Sanitsuda Ekachai, link) 


Healthcare Policy Vocabulary

universal - involving everyone ทั่วไป
healthcare - the treatment and prevention of diseases and other medical problems
the universal healthcare system

public hospitals - government hospitals that everyone can use under universal healthcare
private hospitals - hospitals run by companies that charge large amounts for special service

rural - countryside, farming area ในชนบท, บ้านนอก
protest - a strong complaint or disagreement ประท้วง
the rural doctors' protest

Government Pharmaceutical Organisation (GPO) - the government organization producing low-cost drugs

kidney - one of the two organs in your body that clean your blood and remove waste ไต
kidney patients

dialysis - an expensive treatment for kidney disease that involves cleaning the blood (See Wikipedia)
dialysis solution - the liquid that is used by a dialysis machine to clean the blood

bias - to prefer some people or things over others; favouring certain things rather than others
private health bias

cash - money เงินสด
put cash ahead of lives

Private health bias puts cash ahead of lives

crisis - an urgent, difficult or dangerous situation วิกฤต  วิกฤตการณ์
flood crisis

ravage - destroy
flood crisis ravaged industrial estates

production plant - factory
dialysis solution production plant

endangered - at risk or in danger of being harmed, damaged or destroyed เป็นอันตราย
patients' lives were endangered

When the 2011 Central Plains flood crisis ravaged industrial estates in Ayutthaya and destroyed the country's biggest dialysis solution production plant, more than 40,000 patients' lives were endangered.

desperately - extremely or very much อย่างเต็มที่ in a very worried or angry way อย่างสิ้นหวัง feeling or showing that you have little hope and are ready to do anything without worrying about danger to yourself or others ทิ้งไพ่ตาย อย่างสุดชีวิต อย่างเอาเป็นเอาตาย
desperately needed dialysis solution

frantically - in a very frightened way
frantically searched for hospitals

We frantically searched for hospitals which could clean our kidneys. We also desperately needed dialysis solution. Without the services and the solution, we would have surely died. 

community - the people living in one particular area ชุมชน
community hospitals

funded - given money บริจาค money provided for operation of a business or organisation ให้ความช่วยเหลือทางการเงิน ให้เงินลงทุน
community hospitals funded by the National Health Security Office (NHSO)

save lives
saved lives of kidney patients  

saved countless lives of kidney patients fleeing the devastating flood. 

countless - very many; too many to be counted มากเหลือคณานับ
saved countless lives of kidney patients  

saved countless lives of kidney patients fleeing the devastating flood. 

devastating - very harmful and damaging
the devastating flood

Meanwhile, dialysis centres at community hospitals funded by the National Health Security Office (NHSO) saved countless lives of kidney patients fleeing the devastating flood. 

undermine - make weak ทำให้อ่อนลง,ทำลายทีละน้อย,ทำลายอย่างลับ to make something or someone become gradually less effective, confident or successful ทำให้กร่อน
undermine the universal healthcare system

efforts - the work done towards achieving some goal; people trying to accomplish something, achieve a goal ความพยายาม
the Public Health Ministry's efforts to undermine the universal healthcare system

promote - help advance, become successful and profitable
private hospital industry

X at the cost of Y  - X gains while at the same time Y loses
promote the private hospital industry at the cost of the public

We are joining the rural doctors' protest against the Public Health Ministry's efforts to undermine the universal healthcare system in order to promote the private hospital industry at the cost of the public.

oust - to force to leave a position of power ขับออกจากอำนาจ ที่ถูกขับออกจากอำนาจ
oust the Public Health Minister

bid - an attempt to do something ความพยายาม
bid to oust the Public Health Minister

nationwide - throughout a whole country ทั่วทั้งประเทศ ทั่วประเทศ
more than 30,000 members nationwide

network
patients' networks - organizations that bring patients together so they can better work for and fight for their rights

joining hands with - when two groups become one (join) and do some activity together
organisation is joining hands with patients' networks

back - help, support
back the rural doctors in their bid to oust the Public Health Minister

Mr Tanapol is vice-president of the Friends of Kidney Patients of Thailand group, which has more than 30,000 members nationwide. His organisation is joining hands with cancer, heart and HIV/Aids patients' networks to back the rural doctors in their bid to oust Public Health Minister Pradit Sintawanarong.

benefit - to help someone มีประโยชน์ต่อ
scheme to benefit private hospitals

initiated - created; started ริเริ่มโดย
policies initiated by the health minister

pharmaceutical - connected with the production of medicines เกี่ยวกับเภสัชกรรม, เกี่ยวกับยา
the pharmaceutical industry

scheme - a plan that is developed by a government or large organisation in order to provide a particular service for people แผนการ โครงการ
part of a larger scheme to benefit the pharmaceutical industry

As they see it, the various policies initiated by the health minister are part of a larger scheme to benefit private hospitals and the pharmaceutical industry.

hardship - when life is difficult and unpleasant (usually due to a lack of money)
allowances - money given to people to help them pay for the things they need
hardship allowances 
stopping hardship allowances for rural doctors

performance - how well or badly something or someone works  
performance evaluation

assembly-line - in a factory the mechanical process of workers doing one thing at a time to make a good being produced
assembly-line style

rigorous - very strict and thorough
subjecting them to a rigorous assembly-line style of performance evaluation

the GPO board - the group of people how lead, guide and make high-level deicsions for an organization
putting Dr Pradit's own people on the GPO board

universal healthcare budgets
interfering with universal healthcare budgets at regional levels

co-payment system - when you pay extra to get some things that are not included in the system
trying to introduce a co-payment system in the universal healthcare scheme

discredit - say things to look bad (tell the public about bad things to ruin their reputation) 
attacking and discrediting the GPO

firing - taking a person's job away from them (because they have done something wrong, allegedly)
firing GPO boss Witit Artavatkun

At a glance, .... - just looking at quickly without a lot of analysis ...
At a glance, these policies may look unrelated

At a glance, these policies may look unrelated: Stopping hardship allowances for rural doctors, subjecting them to a rigorous assembly-line style of performance evaluation, putting Dr Pradit's own people on the GPO board, interfering with universal healthcare budgets at regional levels, trying to introduce a co-payment system in the universal healthcare scheme, attacking and discrediting the GPO, and firing GPO boss Witit Artavatkun.

blueprint - plan; an early plan or design which explains how something might be achieved แผนงานที่ละเอียด; 2. a photographic copy of an early plan for a building or machine พิมพ์เขียว, แผนงานที่ละเอียด
the blueprint of the private hospitals' policies

"If you look at the blueprint of the private hospitals' policies, [Dr Pradit's] policies fall into place," Mr Tanapol said.

policy - a plan of action to guide decisions and achieve outcomes นโยบาย (See Wikipedia)

According to the Private Hospital Association's policy blueprint, the government should.

role - the purpose, work or influence of someone or something in a particular situation บทบาท
the government's role in health care
reduce the government's role in health care

Reduce the government's role in health care, from providing 70-80% of health services currently, to just 30-40% within 10 years.

insurance - when you make regular payments to a company, who will make large payments to help you if you have a problem in the future such as an accident or are sick (See Wikipedia) การประกันภัย
health insurance

private health insurance - health insurance from insurance companies (not the government)
support private health insurance

incentives - rewards for behaving in a certain manner สิ่งกระตุ้น  รางวัล ผลตอบแทน
tax deduction incentives - make people do thing by offering a lower taxes if they do

investment - taking your money and putting it into projects to make a profit or earn interest (buying stock shares, bonds, real estate)
investment incentives - offer things to make people want to invest

Promote private hospital businesses by giving them investment and tax deduction incentives.

financial support - help by giving money สนับสนุน
Support private hospitals to produce their own medical doctors through financial support from the government.

clinical trials - the scientific testing of new medicines to see if they cure disease
Allow private hospitals to carry out clinical trials on humans with support from the pharmaceutical industry.

hub - the central or main part of something where there is most activity จุดศูนย์กลาง
medical hub - a plan to make the country into a center for medical tourism
Support the medical hub policy

medical tourism - when people from rich countries travel to poorer countries to get low-cost  medical treatment (See Wikipedia)

fast-track - a special system to make things fast
fast-track imports - a special system to make imports of some good fast

brand - a type of product made by a particular company ตรา, ยี่ห้อ
brand-name medicines
Allow fast-track imports for brand-name medicines


Abolish price ceilings on medical treatments and allow private hospitals to charge what they like.

state - government รัฐ
state hospitals

Stop state hospitals from competing with private hospitals.

middle classes

Make state hospitals serve only the poor and private hospitals serve the middle classes and above. 

universal healthcare scheme

determined to - wanting to do something very much and not letting anyone or any difficulties stop you ตั้งใจจริง, ซึ่งมุ่งมั่น
generic drugs - the simplest and cheapest king of drugs without a brand
the GPO is determined to manufacture generic drugs

patient - someone who is receiving medical treatment คนป่วย, คนไข้
the drug costs the patient only 1 baht a tablet

the GPO can produce a generic medicine which costs the patient only 1 baht a tablet, compared with 70-baht price tag of an imported brand-name drug,

clear - easy to understand
X is behind Y - X caused Y, X did Y secretly 

sacking - being fired, losing your job; forcing someone to leave their job ปลดคนงาน
the person behind the sacking

it appears clear why he had to go, and who was behind his sacking.

These goals cannot be achieved if there are not enough doctors to work in private hospitals, nor if the NHSO and universal healthcare scheme continue to operate as they do now. Nor is it possible when the GPO is determined to manufacture generic drugs. When the GPO can produce a generic medicine which costs the patient only 1 baht a tablet, compared with the 70-baht price tag of an imported brand-name drug, it appears clear why Dr Witit had to go, and who was behind his sacking.

pressure - trying to force someone to do something ความกดดัน
face pressure from the US

copyright - the legal right to control the production and selling of a book, play, film, photograph or piece of music ลิขสิทธิ์  (See Wikipedia) ลิขสิทธิ์ a patent
copyright regime

compulsory - required, must do because the laws says you must ภาคบังคับ ที่จำเป็นต้องทำ
licensing - getting official permission from the government to do a certain activity
compulsory licensing

The government also faces pressure from the European Union and the United States to use a stricter copyright regime than the World Trade Organisation system in exchange for export privileges. That makes it clearer still why the GPO's compulsory licensing policy to save lives must stop and why Dr Witit was given the boot.

renal failure - kidney failure (if both kidneys fail then death results unless there is a transplant)

treatment - the process of providing medical care การรักษา
medical treatment

"When I suffered renal failure in 2005, I had to spend up to 40,000 baht a month for treatment," Mr Tanapol said. 

afford - to have enough money to be able to pay for something มีเงินพอจับจ่าย ซื้อหา มีเงิน/ทุนพอ
afford to clean kidneys

bankrupt - when a business or person runs out of cash and fails and the assets are sold off by a court (liquidation) (See Wikipedia)
went bankrupt from the high expense of medical treatment

Back then, most patients died because they couldn't afford to clean their kidneys, or went bankrupt because of the expense.

affordable - not expensive ไม่แพง does not cost too much, so you are able to buy
affordable drugs

"The NHSO listened to our needs. The costs for dialysis went down until it became free. The NHSO has done the same thing with many other treatments and the GPO has finally made drugs affordable," he added.

matter - a situation or subject which is being dealt with or considered เรื่อง, ภารกิจ, งาน
a matter of life and death - people will live or die depending on which decision is made

These systems save lives. It's a matter of life and death for us if they're destroyed.

interference - the process of deliberately becoming involved in a situation and trying to influence the way that it develops การเข้าแทรกแซง
political interference

at all costs - very important goal, so do anything to achieve this goal

We must fight to keep them free from political interference at all costs.