Activists protest proposed amendment to the national health care law on Tuesday. Photo: Courtesy

BANGKOK — Those looking to protect Thailand’s universal health care benefits defied the junta’s assembly ban on Tuesday to protest proposed amendments to the law which would remake the much-praised system that has been in place since 2002.

If passed by the interim legislature, the amendments would gut the agency established to strictly regulate the industry and revert its oversight to ministry technocrats to make policy decisions without public input.

“It’s like going back to before 2002,” Supaporn Thinwattanakul, who coordinated today’s protest.

Junta chairman Prayuth Chan-ocha said Monday the changes were not aiming at abolishing the existing system, but that didn’t reassure activists who believe the outcome will be similar.

“Even though the system won’t be abolished [in name], it will be like it’s abolished,” Nimitr Tianudom, an activist who campaigns for affordable medicine for HIV patients and universal coverage, said by telephone.

About 100 members of a network called the People’s Health System Movement gathered for several hours in front of the United Nations headquarters before submitting their complaint to officials at the nearby Government House.

The group initially planned to gather at the Public Health Ministry, but police forced them to move, citing a newly enacted law that bans protesting near government offices, Supaporn said.

Supaporn, who called the gathering a “show of strength” rather than protest, said some leaders were reprimanded by police and soldiers for “stirring up trouble.”

“But if the people do not stand up, what will happen to our country?” she said.

The bill facing amendment is the 2002 National Health Security Act, passed under the newly elected government of Thaksin Shinawatra, who won a landslide victory on promises including medical care for all.

Thanks to the law, Thailand has a universal health care system paid for by every taxpayer. It cost 106.4 billion baht in 2015. There were 2,564 participating medical facilities nationwide in 2016.

The service, colloquially referred to as the “30 baht” system for the uniform fee, is applied to all Thais.

The legislature has also proposed radically restructuring the way health care services are managed.

Under the current system, the national health safety net is overseen by a board whose members are drawn from public health agencies, hospitals, patient advocacy groups, local administrators and medical experts. The board is regulated by a separate committee on quality control.

The lawmakers want to increase the number of officials appointed by the Ministry of Public Health, arguing centralization of power would increase efficiency. Little else in the way of clear benefits have been publicly articulated, beyond a health ministry statement it would make the system sustainable.

But Nimitr, the patients rights advocate, fears the new ratio would mean the public would lose its say in how much they’re charged and what illnesses are covered – matters strictly regulated since 2002.

“It destroys the balance of power,” Nimitr said. “The people who provide the service will sit in the board with the power to decide everything.”

Supaporn, the activist from healthcare network, said she’s worried by a plan to reduce the role of the National Health Security Office, or NHSO, such as its authority to select which medicines are purchased and how much each hospital needs to keep in stock.

Because the agency operates independently from the market, it does not only mandate the most sought medicines, but also requires hospitals to keep supplies of less common remedies, such as snakebite serum and rare antidotes.

“If the NHSO isn’t allowed to choose what to buy anymore, and the decision goes back to individual hospitals or the Ministry of Public Health, medicine will be more expensive,” Supaporn said. “And the hospitals will select their own medication, such as medication needed only by the majority of patients.”

NHSO sec-gen Sakchai Kanjanawatana declined to comment on the amendments being discussed as the matter is not yet finalized.

“Speculation is still just speculation right now,” he said.

Sakchai said the final product was unknown, but that the goal was improvement.

“The minister has reassured us that any changes will have to keep the quality the same or better. But how reality will turn out, we don’t know yet,” Sakchai said, followed by a laugh.

By giving everyone health care, the entitlement program has proven so popular that no government and no political faction has dared cancel it, despite whatever antipathy they held for Thaksin or his policies.

Still, the universal health care system is not without its opponents. A number of doctors and health professionals have long criticized the program for severely straining overwhelmed hospital staff and the cost of the program.

The NHSO has been faulted for excessive regulation. The agency has been accused of refusing to reimburse hospitals that do not treat patients in accordance with its rules.

The interim parliament said last week it’s willing to collect public opinion before it makes any decisions. Public hearings are set to take place in four provinces during the next two weeks.