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Kannika Damrongplasit and Glenn A. Melnick Early Results From Thailand’s 30 Baht Health Reform: Something To Smile About Health Affairs, May/June 2009; 28(3): w457-w466. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Thailand's 30 Baht Health Care System Never Worked

Patrick A. Holert   ( 1 April 2009 )

Thailand's Political Context

John A. Grima   ( 22 April 2009 )

Thailand's 30 Baht Health Care System Never Worked 1 April 2009
Patrick A. Holert, Managing Director Sun Capital Research, Bangkok, Thailand Send comment to journal: Re: Thailand's 30 Baht Health Care System Never Worked patrick{at}suncapitalresearch.com Patrick A. Holert	Having lived in Thailand for more than ten years, I believe that this paper has substantial shortcomings in its research methodology and that this has led to very misleading conclusions by its authors. In terms of methodology, the authors appear to have relied solely on government data. They have avoided considering issues of quality and sustainability, which would have required that they actually spend considerable time in Thailand. By neglecting to consider quality of service, the authors have ignored the fact that hospitals, public and private, frequently refuse to treat patients altogether under the 30 baht program. Regardless of people's needs, many hospitals simply tell people, “you are fine, go home and rest.” Contrary to the authors' findings, supply constraints are a serious issue for public hospitals in Thailand. As a reported 13.6 million uninsured people became newly covered over 2001 to 2005, there has been an influx of patients into public hospitals. This has resulted in long queues for services as well as an exodus of doctors seeking lower workloads and better pay at private hospitals. It is simply not true that “informal payments” are not being made in the national health care system. As many doctors in public hospitals also work in private clinics and private hospitals, they readily present their patients with a dose of medical reality. Patients can either wait for a considerable time to be served at a public hospital, which has old or inadequate equipment, or they can pay up for quality service at a private clinic or private hospital.
Thailand's Political Context 22 April 2009
John A. Grima, Director of Planning Urban North Region, Intermountain Healthcare Send comment to journal: Re: Thailand's Political Context j.grima{at}comcast.net John A. Grima	That the data are government data is a strength of this study, not a weakness. By using survey data collected from all across the country, the authors ensured that they achieved a broad perspective of evaluation that is not limited to a cultural mileu in which people could be found by and respond to ad hoc survey research. You cannot tell it from the text, but these articles present politically volatile findings. They validate Thai health reform, and Thai health reform came about solely because of ex- Prime Minister Taksin Shinawatra, who was deposed in a "coup for the rich," as it has been characterized. Taksin hasn't gone away, and it is modestly risky for researchers who hope for secure careers in Thailand's elite universities to publish this sort of thing. Good for them.