Reflections on the Human Condition - Api-fellowships.org

instances where such individuals have exercised their
powers unconstitutionally. There were further efforts to
ensure that the public would have the means to air their
views by restricting the state and private monopolies of
radio, television and telecommunications. These were
significant gains, but it remains to be seen how effective
these safeguards are.
Among the other innovative provisions in the 1997
Constitution were the right of citizens to twelve years
of state-provided education and the right to health care,
albeit a modest one.
The latter entitlement in particular, as currently phrased
(below), does not obligate the state to provide a scope
of “medically necessary” care similar to what might be
available in the private sector, beyond equal access to a
certain level of publicly-provided care for Thai citizens,
and free access to this care for the indigent:
A person shall enjoy an equal right to receive
standard public health service, and the indigent
shall have the right to receive free medical treatment
from public health centers of the State, as provided
by law.
The public health service by the State shall be
provided thoroughly and efficiently and for
this purpose, participation by local government
organizations and the private sector shall also be
promoted insofar as it is possible.
The State shall prevent and eradicate harmful
contagious diseases for the public without charge,
as provided by law.
Royal Thai Constitution, 1997, section 52 (Raksasat
1998)
The Thai right to health therefore contains within itself
the possibility of two- (or multi-) tiered health care, and
its actual configuration would depend crucially on the
level of finances, staffing and other resources that can be
marshaled for the public sector.
In any case, the preceding decades of social activism
and democratic struggles had seeded various sectors
of Thai society—the bureaucracy, policy researchers
and technocrats, Thai NGOs and social activists,
academicians and public intellectuals—with liberals
and more radical elements with a shared concern
for progressive social change. With divisive tactical
differences kept in check, a mutually reinforcing
strategy of engagement-plus-agitation (triangle moves
CHANGING LIFESTYLES AND HEALTH
197
the mountain) 40 could be harnessed in the efforts to
extend health care access to marginalized communities
in Thailand. Indeed, the campaign for health care
access was just one facet of a broad-based movement to
re-conceptualize health and to lobby for national health
legislation which addressed the social and environmental
determinants of population health. (Komatra, 2005)
In response to sustained pressure from this coalition,
a National Health System Reform Committee was
formed on May 9, 2000 in the final months of the
Chuan Leekpai administration. 41
Even as this committee began work, contending
parties for the 2001 Thai general elections were
positioning themselves for electoral advantage. Thaksin
Shinawatra, a billionaire politician campaigning on
a populist platform, announced that if elected, his
government would declare a three-year moratorium
on the repayment of loans by indebted farmers, a onemillion
baht revolving fund for each village, and it
would furthermore set up a Citizen Bank and a 30-baht
scheme for health and medical care for Thai citizens.
These populist promises were evidently well received by
an electorate grappling with the aftermath of the 1997
currency crisis, and Thaksin’s Thai Rak Thai party went
on to win an unprecedented electoral mandate allowing
it to form a governing coalition with a comfortable
majority.
In his first policy speech to Parliament on 26 February
2001, Thaksin stated that the universal coverage of
healthcare policy aimed to “reduce the national health
expenditures and household health expenditures with
30 baht out-of-pocket per episode and provide accessible
and equitable quality health services”. 42
Implementing the UC policy in the aftermath of the
1997 financial crisis, one can understand the concern
over public finances, underscored by the watchful gaze
of the IMF over fiscal deficits, which had provided crisis
management loans to the Thai government.
The prospects for reducing national health expenditures,
predicated on reining in fee-for-service re-imbursements
for civil servant medical benefits and replacing it
eventually with capitation contracts, was at best an
unlikely scenario, if it were not indeed a tactical sleight
of hand to institutionalize the policy of universal
coverage. (re: UK NHS)
Up until 2002, the existing risk protection schemes for
health, which were partially or fully-subsidized by the
Ref lections on the Human Condition: Change, Conflict and Modernity
The Work of the 2004/2005 API Fellows