Bangkok Post - April 02, 2008
Apiradee Treerutkuarkul

On the other hand, the CL issue is being bullied by the export industry and pharmaceutical companies, which want the government to consider the issue carefully, as they claim the policy could adversely affect trade and exports if the United States and the European Union use the matter as a pretext for trade retaliation against Thailand.

Whether or not compulsory licensing can really extend public access to medicine (as claimed by supporters), or end up hurting the country's trade and eventually its economy (as claimed by opponents), the CL squabble is essentially the tip of the iceberg. It reflects the impact populist policies are having on the state's healthcare system and how the previous Thaksin government and now the People Power party-led coalition both failed to live up to their promise.

The universal healthcare programme launched by the deposed Thaksin government under the trademark "30-baht health scheme" has undeniably been one of the most successful populist polices of the dissolved Thai Rak Thai party.

Truth be told, however, the policy was not really the party's brainchild. The idea had, in fact, been pioneered a year earlier by a network of medical professionals, health advocates and non-governmental organisations on consumer rights protection.

To his credit, the then TRT leader Thaksin Shinawatra took up the idea and turned it into his party's campaign agenda - bringing it enormous political gains, as the party won by a landslide in the election of 2001.

Unfortunately once in government, the TRT leaders failed to allocate sufficient funds to the universal healthcare scheme for its efficient operation. Seven years after its inception, the scheme is still teetering on the verge of crisis, in which the public demand for medical services continues to rise and overwhelm medical personnel at state hospitals throughout the country.

"The PPP government has been in office for over a month but it is clear that it doesn't understand the necessity of CL policy in running the universal healthcare scheme, which has been plagued by financial problems and a brain drain of medical professionals," said Pongthep Wongwachirapaibul, secretary-general of the Rural Doctors Society.

Former public health minister Mongkol Na Songkhla himself said he would not have opted for the CL policy had the TRT-led government allocated enough money to support the healthcare scheme. It received about 96.6 billion baht funding last year.

Dr Pongthep, also director of the Nanoi Hospital in a remote area of the northern province of Nan, said that while the universal health care concept was noble in principle, it was put to work in the wrong direction from the start. The scheme was aimed at providing medical services for the young, the elderly and the unemployed. With only a limited budget of about 2,300 baht per head per patient, up from an earlier 2,100 baht, it was impossible for the state to provide medical treatment for chronic and costly illnesses such as cancer, heart disease and kidney dialysis, especially for poor villagers in remote areas.

The 30-baht programme appears even shabbier when compared to the country's other two healthcare schemes. The Social Security Office's scheme, which requires both employers and employees of private companies to contribute part of their income to support it, now has about 400 billion baht in reserve. The Comptroller General's Department also has an open-ended budget for civil servants and their family members to access free medical services without any limitations, ostensibly in compensation for the relatively low salaries they are accorded.

The imbalance in both the funding and access to healthcare treatment is unfair for the majority low and middle income population listed under the universal healthcare scheme, which is on the verge of bankruptcy due to financial shortages. This is why compulsory licensing comes in handy for developing countries like Thailand, with an annual US$3,000 GDP per capita, to effectively run universal healthcare programmes by producing or importing generic versions of a patented drug for emergency use. It is the only way for the majority of 48 million Thais under the healthcare scheme to gain access to life-saving medicine. Even though the breach of patent rights is permitted by the World Trade Organisation, most developing countries do not dare exercise the right to compulsory licensing because of trade pressure from superpower nations. This is a tragedy. Former US president Bill Clinton, speaking in support of Thailand and Brazil in issuing compulsory licenses, noted: "No company will live or die because of high price premiums for Aids drugs in middle-income countries, but patients may."

Jon Ungpakorn, former Bangkok senator and health care activist, said the PPP-led government should not be intimidated by trade-related pressure to provide essential medicines for the majority of the population.

Take the anti-Aids drug Efavirenz for example. According to a study by the National Health Security Office which runs the universal healthcare scheme, an additional 20,000 people living with HIV/Aids are expected to receive the medication after the government bypassed the drug patent in November 2006.

Undoubtedly, the issue of access to universal healthcare treatment will be a challenge for any government coming into office from now on. For all that, the CL policy will continue to serve as an effective tool to test the political will to stand up for the public's right to access life-saving medicines - at least until the government manages to solve the financial problems which threaten to compromise the state's universal healthcare system, Mr Jon said.

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