Double standard de protection sociale en Thailande ou comment le Premier ministre se doit d'avoir un gros 4x4

Si vous lisez l'article ci dessous vous comprendrez l'utilité d'un 4x4 blindé pour le premier ministre
http://www.bangkokpost.com/opinion/opinion/185255/double-standards-in-health-care


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En anglais:

THAILAND

Double standards in health care

• Published: 7/07/2010 at 12:00 AM
• Newspaper section: News

It is undeniable that one of the causes of the recent protests in Bangkok is the inequality that pervades our society, admittedly a society with double standards. Today, every sector must take part in returning happiness to the Thai people.

Thailand's health care system is an example of the double standards practised in our society. Our health care system lacks fairness and equality. For example, public health resources including budgeting, physicians, nurses, hospitals and modern technology are allocated mainly to Bangkok and major cities. In 2005, the physician-patient ratio in Bangkok was 1:700 while the ratio in the Northeast was 1:7,015. In Bangkok, the number of specialists in certain disciplines is actually higher than those in the 75 other provinces combined.
If we were to compare health data between two provinces, say, Ratchaburi and Sakon Nakhon, we would see that Ratchaburi has a population of 821,603 while Sakon Nakhon's population is 1,113,064. However, the amount of health care resources provided in these two provinces differs greatly. In Ratchaburi, public hospitals have a total number of 2,095 beds, 229 physicians and 1,750 general nurses. In Sakon Nakhon, which has 281,461 more residents than Ratchaburi, the public hospitals have a total of 1,185 beds, 114 physicians and 939 general nurses. In other words, Sakon Nakhon has roughly just half the number of beds compared to Ratchaburi. This is only one example of the inequality present in the Thai health care system.
If we were to look deep into the health security systems, the same type of inequality exists. There are gaps between the systems in use. The benefits and budgeting per year provided by the government differ greatly among the systems.

Dare she ask for more? A mother cradling her newborn child shows her ‘‘gold card’’ which entitles her to hospital services under the 30-baht health scheme.

Thailand currently has four main health security systems:
1. CSMBS (Civil Servant Medical Benefit Scheme), covering about 5 million people.
2. SSS (Social Security Scheme), covering about 9.8 million and about to receive another 5.8 million from the Universal Coverage (UC) programme
3. UC, covering about 47.3 million and about to give away 5.8 million to SSS.
4. Private insurance, covering individuals who wish to purchase their insurance from private insurers: about one to two million.
All of these systems, except for SSS and the private insurance system, solely use budgets derived from income tax. In the social security system, the burden falls on the individual, the employer and the government. For private insurance, the individuals voluntarily pay the total amount of premium offered by their private insurers.
If we were to look on the surface, we would assume that systems 1, 2 and 3, that are supported by the government, should be able to cover Thai people from every class and every occupation. However, we have another health security system which involves the government purchasing insurance from private insurers and which favours a privileged group (consisting of the Office of the Auditor-General, the National Anti-Corruption Commission, the Constitutional Court, senators and parliamentarians) by offering them more benefits than other Thai citizens (see Table 1).
The data reflect that the health budget per person along with the health care benefits are very different between these privileged individuals and the typical Thai citizen, allowing the former to use luxurious private hospitals while the latter are required to use crowded public hospitals with long queues.
If we were to peruse in more detail, we would also see that the various benefits offered by the systems also differ. Expensive drugs such as Rituximab, effectively used for treating lymphoma, can be prescribed easily to the special groups of people but is very rarely prescribed to those covered by the UC or the SSS. With the same medicine, the privileged groups receive the original drug (which is many times more expensive than the equivalent generic versions).
This is the truth of Thai society.
When it comes to the right to receive health services, it starts with the welfare of civil servants/government officials and their families as a priority. Then, it is expanded towards people who need special assistance from society and social security, respectively. The latest addition which brought a massive change to Thailand's health care system was the 30-baht Universal Coverage Scheme (the UC programme today), in which all Thais are eligible to receive health services at public hospitals.
Currently the CSMBS, covering approximately 5 million people, uses a budget of 65,000 million baht or 13,000 baht per person. Meanwhile, the UC which covers 47 million people, uses a budget of only 89,000 million baht or just 1,894 baht per person - nearly a seven-fold difference. A surprise is those required to co-pay actually receive worse service in terms of quality than those covered by the UC.
Upper-class government officials in independent organisations receive an extremely high 38,000 baht-per-head budget. Ministers, parliamentarians and senators are just as privileged, receiving 20,000 baht, with a proposed increase to 50,000 baht per year. The ordinary Thai citizen, those with no special privileges, receives a budget of only 2,000 baht per head per year from the government.
These differences reflect ways of allocating resources of government services, and politics, which do not believe in equality among human beings, arguably the core of democracy.
Today, Thai society acknowledges and pays more attention to the problem of inequality in society. However, its understanding of and sympathy towards the issue is not enough. The important principle in this matter is not about begging for sympathy and pity, but about justice under an equal set of human rights. No matter what their social/occupational/political status, everybody should have an equal right and access to the same quality of services because every system uses the country's budget which comes from the same system of taxation.
Most importantly, health systems must not discriminate against people according to class or become one that is dedicated to privileged individuals. It is something that the government has to provide to people equally, with justice in mind. Being rich or poor should not be an obstacle or factor.
Is it time that we got rid of this inequality in our health care system? Thai society needs an answer today.

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Dr Pongsadorn Pokpermdee is a senior expert at the National Health Security Office. Ms Proud Patanavanich is Intern, College of William and Mary, USA.

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