Sustaining healthcare in volatile times

Health care is pivotal for human well-being. Yet in today's precarious world, it is pressured by diminishing resources, demographic variables, warfare and violence, and environmental degradation. Sustaining health care thus requires insightful planning and implementation, no less for Thailand and the Association of Southeast Asian Nations (Asean) regions.

- Vitit Muntarbhorn

The motivating factor is the global recognition that every person has the right to the highest attainable standard of health, with the State under an obligation to respect, protect and fulfil such right geared to maximum commitment of its resources.

This is enhanced by a global treaty on the issue , the Covenant on Economic, Social and Cultural Rights, to which Thailand is a party. That right does not imply the state must guarantee that everyone is healthy, but the state is obliged to adopt a variety of measures to ensure that health care services are generally available to all the population, with assurance of accessibility, affordability, acceptability and quality. This is now encapsulated by the global Sustainable Development Goals 2015-2030.

Thailand has been much lauded globally for its exemplary universal health care scheme which provides a medical safety net for the population based on three components: the so-called 30-baht or gold card universal health coverage, the bureaucracy’s medical-cum-pension scheme, and the social security scheme. The first element draws from the national budget. The second is a civil service-based savings mechanism, while the third depends upon tripartite contribution from the State, employers and employees.

The 30-baht scheme covers the broadest spectrum of the population and it is now over two decades old. It has been much appreciated by the general public for facilitating access to health services at little or no cost.

It is administered by the National Health Security Office with flexibility, and this helps to avoid much of the bureaucratic paperwork that would hamper servicedelivery. The large number of community health volunteers was also rightly commended by the UN Special Rapporteur on Health who visited Thailand recently.