Taking care of the country’s aged must be on agenda

Indeed, the “haves” seem to be luckier since they don’t have to worry about financial matters. Rich elders rarely lack people around them, someone who can help them cope with the challenges of ageing. In stark contrast, the have-nots lack the financial resources to support themselves and thus cherish the attention of helpful people.

Sadly, in Thailand, the have-nots outnumber the haves. According to the Revenue Department, out of 10 million taxpaying individuals, only about 1 per cent had taxable income of Bt4 million (or more), all of it subject to the maximum tax rate of 35 per cent.

The gap is starker when people get old and suffer from illness. The wealthy usually have the financial resources to pay their medical bills, but what about the others?

Thailand has often been lauded for its healthcare scheme.

About 2.2 million Thais are civil servants, whose parents and children are also entitled to free healthcare. As of 2014 about 11 million are entitled to health benefits under the Social Security Fund. The rest are enrolled in the universal healthcare scheme.

According to the Thailand Development Research Institute, the healthcare scheme for civil servants is the best.

Despite government efforts to trim this expense, which has exceeded Bt60 billion per annum, civil servants still have access to the widest range of medicines as well as in-patient treatment.

Affirming this is research showing the medical expenses of patients in their previous 365 days, as gauged from 2007 to 2011. The average expense for those under the universal coverage scheme and suffering from cancer was Bt61,243, while that of people backed by the civil servant healthcare scheme was Bt125,998.

Worawan Chandoevwit, a TDRI researcher, explained at a recent seminar that the cost to civil servants was higher probably because they could be admitted anytime they needed to, the hospitals knowing that someone would definitely foot the bill.

Illness not only shortens one’s life span but also eats up savings that would otherwise serve one well in old age.

It would be surprising if all Thais feel they’re ready for the older stages of life. According to an international survey by US-based insurance company Cigna Corp, titled “360-degree Well-being Score”, on average only 25 per cent of Asian respondents believed they had the financial ability to meet the needs of their immediate families, or their parents’ medical costs. The top three concerns of most people regarding their physical health were cancer, heart disease and diabetes, a worry at any age but more prevalent as one gets older. There was no specific information on Thailand.

Among Thais, it could be said that if there were any segment of society ready to deal with these concerns, it would have to be those in civil service.

Worawan noted that those in civil service aged 45 to 65 regularly seek treatment, regardless of income level. Meanwhile, those in the universal health scheme seek less services when their income declines and their age advances.

Philip O’Keefe, lead author of the World Bank’s “Live Long and Prosper: Ageing in East Asia and Pacific” report, was right to express his concern that many Thais would need state support when they grow old. The household savings rate is below 10 per cent of gross domestic product, versus household debt of 80 per cent of GDP. Thailand also launched a pension scheme in the late 1998.

There is a growing call for the Thai government to do more to improve health services. At least, the benefits of all the three healthcare schemes’ should be on par. Effectively, what it means is to bring the worst scheme on par with the best. But that would be a big headache.

Based on the Social Security Fund’s medical expenses of Bt34.2 billion in 2014, it averages out to Bt3,100 per person. This is not comparable with the Bt59.6 billion spent under the civil service scheme, or about Bt27,000 per head on average. The per-head expenses under the universal health scheme, amounting to Bt141.5 billion in 2014, were even lower. The gap must be closed, but pouring more tax money into the endeavour should not be the only answer. This demands co-payments from users. Even the world’s largest economy, the United States (where the maximum individual tax rate is 39.6 per cent), has to opt for co-payments to avoid financial collapse. However, some people should be exempted given their financial status.

At present, all elders – not covered by the civil service and Social Security Fund schemes – are enrolled in the universal coverage scheme. They are also eligible for a monthly allowance from the government, though some earn hugely from property rents or contributions from their children. 

The most effective way to exclude the well-off people from state dole is to have all Thais file tax returns, regardless of their income and age. Only this would help the government channel revenue to the needy. Only this will enable all the country’s senior citizens to be cared for and age with dignity.