Universal health coverage (UHC) has gained momentum across the globe in recent years, especially after the United Nations began promoting it as one of its health targets under the Sustainable Development Goals to be achieved by 2030.
Healthcare reform has been undertaken in many countries such as the Philippines, Indonesia and Kenya which have drawn closer to achieving UHC. Some other countries including South Africa and Vietnam are committed to it.
This Thursday is UHC Day -- the anniversary of the first unanimous United Nations resolution calling for all nations to provide affordable and quality healthcare for all.
In Thailand, a UHC scheme was introduced in 2002 under the Thaksin Shinawatra government. Initially named the 30-baht universal healthcare scheme, it is funded by tax revenue and provides coverage to over 48 million people regardless of their financial circumstances.
It was previously criticised as a "populist" policy. As time goes by, it has proven the criticism was wrong. It has become the country's most valuable state welfare service, enabling people to realise the benefits of a social safety net.
The achievement in Thailand and the UHC commitments made by other countries echo a critical message that nations do not have to wait until they are rich and developed to provide social safety nets for their people. They can start right away, with the right kind of health financing system that fits their given resources.
In Thailand, the UHC has enabled people to use healthcare services without worrying about financial obstacles like they had experienced before. It has helped them to live with the possibility of treating diseases, to resume to work after treatment and to live longer. Most importantly, it gives them a sense of hope and financial freedom they had not experienced before.
With the UHC, those from poor or low-income families do not have to spend all their savings on medical treatment for their loved ones or go bankrupt because of expensive medical bills. With free healthcare, they can keep those savings for other purposes such as business investment or further study. It has given them a chance to leap out of a vicious cycle of debt and poverty and move up the social and economic ladder.
A survey by the National Health Security Office shows the number of households suffering from catastrophic health expenditure declined from 7.1% in 1990 to 2.3% in 2017. The number of families falling into poverty due to out-of-pocket medical payments also fell from 2.3% in 1990 to 0.2% in 2017.
However, some negative impacts of the scheme have been observed too. As medical care is free, many people have crowded outpatient departments of public hospitals seeking treatment for all kinds of ailments including mild sickness. Many health practitioners have complained about excessive workloads and not being able to spend sufficient time diagnosing each patient because there were many others waiting, raising concerns over a decline in the quality of health care services.
Some have also raised concern over increasing funding for the UHC scheme which has tripled from 56 million baht in 2006 to 166 million baht this year. But the current funding is still lower than 1% of gross domestic product. Some health economists thus suggest that spending on UHC is not excessive.
Indeed, no public healthcare system is perfect. There is always a trade-off between healthcare access equity and health service efficiency. But I believe there are always solutions including improvement in the management of health systems.
For example, the UK's National Health Service has set a rule that patients must initially consult the general practitioners they registered with. Patients who go to hospitals directly without referral by general practitioners are charged. This helps screen out unnecessary hospital visits.
In Taiwan where national health insurance was set up in 1995, information and communications technology is integrated into its healthcare system.
The Taiwanese government has developed a cloud-based system in which health practitioners can trace patients' past medical and prescription records, limiting unnecessary patient visits and prescriptions.
There are many other good practices out there we could adopt to sustain our UHC. However, the sustainability of the scheme also requires solid political support from governments.
Luckily, the UHC has survived many regime changes over the past decade. It's part of the global movement towards creating more equal societies.
It reminds us that universal healthcare is a practical and possible idea, not just development jargon.
Paritta Wangkiat is a Bangkok Post columnist.