Some thoughts on compulsory health insurance …
There is a lot of talk at the moment on the possibility of Thai Immigration issuing an order making it compulsory for all Non Immigrant Visa holders to hold health insurance. We wanted to share our thoughts on this, and will do so in the following article.
First of all, the overall concept of making sure everyone has a basic level of health insurance makes sense. By doing so, Thailand can avoid situations whereby un-insured foreigners are left hospitalised and often unable to pay the bills. Furthermore, they can reduce the burden on the Thai Social Security system which is under increasing pressure from Thai Nationals as the population ages. That’s the theory of compulsory health insurance. Now let’s look the challenges which will be faced in implementation;
- Solutions are not "one size fits all"
If an order comes out which says people must have X amount of inpatient cover, and Y amount of outpatient cover, then people will be forced into plans which may not suit their circumstances. The requirements of people are different. Some have the financial means to cover a high deductible, some don’t. Some want dental and vision benefits, some don’t. There are many ways of setting up insurance policies, even with 1 provider, in order to meet the needs of the individual.
- People who are uninsurable
There are people who simply can not get insurance due to their medical history. Currently, insurance companies are not obliged to accept people onto cover. They assess an application and choose as to whether they want to offer that applicant cover. If compulsory insurance is introduced, then providing cover for the ‘uninsurables’ is crucial. Maybe insurance companies will be ordered to offer all applicants cover. This would require a change in the law, and the fundamentals of health insurance, so in my view, this is largely un-workable.
- People with Exclusions.
Health Insurance companies do not cover pre-existing conditions. Period. The older people get, the more exclusions they are likely to have on a policy. If someone gets sick and the illness is excluded from cover, then the person has to pay the bills themselves. So, the problem of people not being able to foot huge bills will remain. Agreed, the frequency may fall, but the problem will still exist. Insurers are businesses who aim to make money. They do so by betting you will not make a huge claim in each policy year. If they take on applicants where the risk of such a claim is much higher, they would quickly implode due to losses.
- Why make OPD compulsory?
Rumors suggest that people will be forced to buy outpatient coverage, alongside inpatient cover. I do not see the benefit in this. Outpatient care in Thailand is typically affordable and is not going to leave an individual in dire financial problems. Furthermore the cost of outpatient cover, especially for people over 50, makes it ineffective from a value perspective. Inpatient cover will protect against high cost critical cases which will require hospital admission.
- Controlling premiums
Health Insurance premiums for people over 60 can be very high. These can be controlled by removing outpatient coverage, taking on a voluntary deductible, and choosing a provider who uses no claims discounts at renewals. The key to this is flexible, and not rigid, plans. Outside of these factors, premiums are controlled by the market. The costs which insurers face from the hospitals are passed down to policy-holders. Therefore, the government may need to work with both hospitals and insurance providers to help control rising costs in Thai Hospitals. This is turn can help control premium increases, and keep the cost of insurance for people 60+ manageable. This would be a huge undertaking, and one which in my opinion, would fail.