‘The poor would be doomed’

The debate heats up in the circle of Thai health advocates when news broke recently that the Universal Healthcare Coverage (UC) scheme — or the 30 baht gold card — may be revoked or modified to require a higher co-payment, as part of an amendment to the national health security law.

For middle- to lower-class Thais, this news leaves them in a huge panic as the state healthcare benefit, which has been implemented for 15 years, is what many rely on when they fall ill. Right now the scheme covers 48 million Thais who do not fall under the two other healthcare schemes, Civil Servant Welfare, for government officials, and the Social Security Scheme, which covers registered employees. For poor Thais, they certainly cannot afford steep medical bills at hospitals.

To get people’s opinion on the amended law, formal public hearings were held in all four regions. Three out of four hearings were scrapped because health activists either walked out or gathered at the venue to protest. Prime Minister Prayut Chan-o-cha has insisted that the 30 baht gold card will not be terminated. He assured Thais can still benefit from the gold card scheme although the National Health Security Act has been amended.

The amendment is aimed at dealing with money misspent by some medical service providers, said Public Health Minister Piyasakol Sakolsatayadorn, so it has noting to do with the gold-card holders. But health activists have raised concerns whether the public has enough say in this amendment.

While the controversy keeps going, let’s hear voices of people from various occupations who benefit from either one of the country’s healthcare privileges to see what they do when they get sick and their take on the 30 baht gold card scheme.


PRANEE THEPPARAT

Age: 50
Occupation: Housekeeper

Where do you go for medical treatment?

I usually go to the hospital regardless of severity, but I visit different hospitals depending on the condition.

What health benefits do you use?

The 30 baht scheme covers my treatments at Klong Toey hospital and Charoenkrung hospital. It just makes things more convenient.

What about your family members?

My family consists of my husband and our only son. Both of them are also eligible for the 30 baht healthcare programme. Since my husband uses it, there is no need for us to make use of any social security schemes.

What if the 30 baht gold card is cancelled?

If they were to cut it, the impact will be extensive and those who will be significantly affected are the ones with low incomes. It’s already a struggle for them to pay for travel expenses since they live far away in rural areas and that struggle is going to increase if they have to start paying for their healthcare.


PANOM NIJJAREON

Age: 60
Occupation: Unemployed

Do you go to hospital often?

I have diabetes and high blood pressure and asthma. I go to hospital once every three months. I usually use the 30 baht gold card, but I live in Nakhon Nayok so my card covers public hospitals in Nakhon Nayok only. I moved to Bangkok to take care of my grandchild. Luckily, my husband is a veteran, so I can use my husband’s veteran medical care programme in Bangkok.

Once I had a sore throat and went to Chulalongkorn hospital, and I was charged around 30,000 baht. My husband and my son-in-law asked Nakhon Nayok hospital staff to help us with the document so after that my medical expenses at Chulalongkorn hospital was covered. So I paid only 30 baht after that. Without the 30 baht programme, I would’ve been in serious trouble.

What do you think if the government scraps the programme?

I want it to continue because there’s lots of poor people. Rich people don’t use the programme. They want good medicine and they can pay. The 30 baht programme benefits the poor and the middle class.

Do you agree if patients have to help the government pay for their medical expenses?

At Nakhon Nayok hospital, at 8am every day, poor people who come to see a doctor for diabetes treatment can have free boiled rice with chicken. There is a donation box in case people want to donate extra money. People who have more should help others who have less. But it should be their choice.


WARAPORN THONGCHALEE

Age: 43
Occupation: Roti and coffee vendor

What health benefits are you entitled to?

I am a 30 baht gold card holder, which also covers my daughter as well. What I like most about this programme is its emergency policy. It allows two visits free of charge each year in case of emergency. There was this one time when I accidentally cut myself while handling a knife and blood was just gushing. This was treated as an emergency when I visited the Chulalongkorn-associated clinic and I didn’t have to spend a single baht.

What if the 30 baht gold card is cancelled?

I’ve heard that they’re going to cancel the programme but I personally hope they don’t. Withdrawing the 30 baht scheme will strike a blow to those with low incomes. Not only will they have to pay for getting from home to hospitals, which is already expensive for them, they’ll have to pay for their medical expenses as well.


ANUWAT WANAKAEW

Age: 52
Occupation: Construction worker

Do you usually go to hospital when you’re sick?

If it’s not really serious, I don’t go to the hospital. I usually go to a walk-in clinic, but I have to pay by myself.

What do you think of people’s reactions after they heard there might be no more 30 baht gold card?

They should wait for more information from the government. Wait until things become clearer.

Some people suggest the programme should change from covering all Thai citizens to low-income people only. What is your view?

How would you define poor people? People who earn 6,000 or 4,000? 10,000 or 20,000? In my opinion, it’s hard to say who is poor.


VIRACH SIRINAI

Age: 40
Occupation: Security guard

What do you do when you get sick?

I’ll go the a public hospital and use the 30 baht gold card. But I don’t usually get sick so I rarely use it.

What if the 30 baht gold card is cancelled?

I don’t know how to put it, but I want it to continue the way it is right now because we have been using the programme for a long time. If there is any reform we may have to shoulder medical expenses. Household expenses will increase, which will be a burden for us. I spend 300-400 baht daily already. If the gold card programme is here to stay, I can still make ends meet.

From one-to-10 how much would you rate the necessity of the 30 baht gold card scheme?

Nine.

How much do you usually spend on a trip to hospital?

I usually take a bus to the hospital because I can’t afford taxis. Food, medicine, and other stuff — there is a lot I have to pay for. If I can avoid it, I won’t go to a hospital. I’ll go to a drugstore.


SOMAPA SAE-HENG

Age: 47
Occupation: Market food vendor

Where do you go for medical treatment?

I’m a regular at the Bangkok Christian Hospital because that’s where I can make use of my medical benefits and privileges.

What health benefits do you use?

I’m covered by a social security scheme. This comes as a result of my husband, who is a lawyer. His job is actually a privilege itself when it comes to healthcare and medical bills. Our daughter also gets the same kind of coverage as we do.

What if the 30 baht gold card is cancelled?

Ever since it was implemented, the mortality rate in the country has steadily declined and people are living longer because of the inexpensive healthcare. But by taking it away, the government will be putting a burden on those whose incomes are below average. Low-income earners are really dependent on this programme. The problem with the programme is that it also covers those who are capable of affording basic healthcare, wealthy people if you will, and these people don’t give much attention to the privileges and benefits they’re entitled to. Sometimes they might miss appointments or not pick up medication simply because they have access to better standards of healthcare. Because of this, poor people are the ones paying the price.


BOONLERD JAMREONWITTAYAKUL

Age: 67
Occupation: Grocery store owner

Which hospital do you usually go to when you’re sick?

Ramathibodi hospital. I use the 30 baht card. I have high blood pressure and I have to see a doctor every three or four months. Last year I went to hospital because my eyes hurt. I would have been charged 9,000 baht, but with the card I paid 30 baht. The programme is the best.

What do you think if the programme is revoked?

I think it shouldn’t be cancelled. The government should help us poor people. The programme is absolutely necessary.


PRANEE LEMPAK

Age: 69
Occupation: Laundress at Klong Toey slum

Which hospital do you normally go to?

The staff at Charoenkrung Pracharak Hospital treat us well. Even the janitors and guards are always helpful. After surgery or major admission, they never just rush you out. They always make sure you are well enough to leave the ward.

Do you have any chronic health conditions?

I have heart disease and had two balloon angioplasty in the last few years. Both didn’t cost me a single baht, all because of the healthcare card. The first time I got transferred to Yanhee hospital because back then my doctor hadn’t yet got the degree required in heart surgery.

Have you heard that the government might revoke the 30 baht health coverage?

Rumour has it that they’ll call the programme off. But I doubt they will do it for real. The people wouldn’t let them. Lately they’ve even increased the medical allowance from 1,500 baht to 3,200 baht [how the budget is allocated per head]. The card is really a friend in need to the needy.


LAULA SAELAU

Age: 45
Occupation: Street food vendor

Do you find your 30 baht card convenient?

It is pretty quick and easy and saved me a lot of money, too. You hand them your card and it’s like the process is automatic. Without it, you have to queue up at the public welfare counter and that’s a pain in the neck.

What’s your take on the scheme?

Poor people have less access to medical care. The rich are off the hook with their health insurance. Where I came from, despite having the 30 baht card, people only go to the doctor when they can’t bear it anymore. Otherwise they brush it off saying it’s no big deal. Sometimes it is and it’s too late. Some died. The hospital is a long ride from home so the cost is already high. Some newborns died during home birth because of delivery problems. Sometimes mothers didn’t make it either. These days things are better with the road construction and basic infrastructure.

What if the 30 baht gold card is cancelled?

I’ve read on social media that the coverage might probably end soon. The poor would totally be hard-pressed to come up with all the excessive amounts of money for healthcare. But actually, the news we get is unclear. It’s hard to know what exactly is going on.


SOMBAT PALASAT

Age: 50
Occupation: Food vendor

Where do you go for medical treatment?

If I’m working, then I usually go to the Police General Hospital because it’s not far from my shop. If I get sick during an off day, I go to the Mahaesak hospital.

Do you have any family members? What health benefits do you use?

Both of these hospitals are covered by the 30 baht gold card scheme. My two sons are also 30 baht card holders.

What if the 30 baht gold card is cancelled?

That’s the worst thing the government could do. I don’t agree with it at all. There are some people who can’t afford basic healthcare and it’s already expensive for them to travel from home to the hospital alone. These people live pretty far away from the nearest hospital and it takes them hours just to see the doctor. And I don’t think they’d be able to afford their treatment if the government were to get rid of this programme.


JAREONCHAI SODKAEW

Age: 52
Occupation: Construction labourer

What would you do when you get sick?

If it’s not serious, I’ll buy medicine at the drugstore. I’d go to hospital only when it’s really serious.

Do you benefit from the 30 baht scheme?

My wife is a public servant. So I don’t need this programme. But I think the government shouldn’t cancel it. Many people don’t have the same privilege I do.


UBON ORNKAEW

Age: 62
Occupation: Street food vendor

How often do you use the 30 baht card?

I always use the health card. I go to the Klong Toey Medical Clinic to get the monthly check-up and medication for my diabetes, hypertension and dyslipidemia.

Do you also go to the clinic for minor stuff like a cold?

I also pop in there if I get a headache or a sore throat. If something more serious comes up, they send me over to Charoenkrung Pracharak Hospital. If my blood sugar level goes too high, they have me tested every Monday until it’s down to normal again.

What if the 30 baht gold card is cancelled?

That would be harsh. The poor would be doomed because each medical appointment costs a fortune.