By Simon Ingram in Chiang Rai, northern Thailand

If Buajan Wongwienma loses her husband to cancer, she could be excused for blaming her loss on the shortcomings of a health service to which the couple looked for help.

They couldn't give him injections or any of the specialist treatment he ought to have had

Buajan Wongwienma, wife of cancer sufferer

Mrs Wongwienma's husband, 57-year-old rice farmer Boonlop, fell ill in January.

When he went to the regional hospital in nearby Chiang Rai, he was treated under the newly-introduced 30 Baht health plan - one of the flagship reforms of Thailand's populist Prime Minister Thaksin Shinawatra.

Under the scheme, hospitals are obliged to treat patients for a flat charge equivalent to about 70 US cents per visit.

After checking his entitlement to treatment under the scheme, staff at the hospital carried out an examination, and diagnosed lung cancer.

Mrs Wongwienma says that was about all they did.

Getting what you pay for

"When we went to the hospital, the doctors took his blood pressure and gave him some pills," says Mrs Wongwienma. "They couldn't give him injections or any of the specialist treatment he ought to have had.

"But then again, what do you expect for 30 Baht?"

Cancer sufferer Boonlop Wongwienma feels let down

Chiang Rai regional hospital joined the 30 Baht scheme last October. In the main out-patient waiting room, large blue signs advertise the main features of the plan.

People registered as members show a special laminated gold card when they arrive in the waiting room, before being allowed to see a doctor.

Pensioner Mrs Kam Rakkatkit is one of the patients in the waiting area. For her, the 30 Baht scheme offers regular, inexpensive treatment for her high blood pressure.

"I applied to join because I was no longer covered by my son's health insurance plan," she says. "I think the scheme's very good for poor people, but maybe the rich should pay more."

Scant resources

The fact that wealthier Thais now contribute virtually nothing towards public health care is seen as one of the scheme's major weaknesses.

It means that hospitals must cover the bulk of their costs from a subsidy paid them by the central government, based on the number of patients they are able to register.

Renu Srismith, the director of Chiang Rai regional hospital, says maintaining services at her 714-bed facility has left her with a spending gap of about $3m.

"Our budget is insufficient compared to our labour costs, which are now about 200m Baht ($4.6m) a year," she explains.

She adds that unless the government responds quickly to her request for contingency funding, cost-cutting measures will be inevitable.

"Maybe we will have to do some down-sizing," she says.

A number of large hospitals around the country have already been forced into action.

Closures

Newspapers have reported the closure of some wards, and cases where staff have been laid off because hospitals are unable to pay salaries.

Some hospital wards are reported to have closed

Complaints of sub-standard treatment are growing.

Sometimes, hospitals required to provide a costly course of care will simply refer the patient to another hospital.

Many such tactics carry echoes of Britain's troubled National Health Service, on which the 30 Baht scheme was originally modelled.

They have also given rise to a mounting stream of criticism directed at the government.

Economist Ammar Siamwala told The Nation newspaper that the government had rushed into making reforms to the health service without ensuring they would be effective.

Other critics describe the 30 Baht scheme as a political gambit gone wrong.

Backlash

Mr Thaksin's promise of cheap, universal health care helped him to a landslide victory in parliamentary elections early last year. Now his ministers are struggling to stave off disappointment with the results.

"We cannot carry out reform in one month or even one year," argues Health Minister Sudarat Kaeyurapan. "We need at least two years."

Ms Sudarat says rural health facilities - hitherto disadvantaged financially compared to urban hospitals - are starting to see benefits.

For patients like Mr Boonlop, it may be too late.

He is now receiving treatment at a fee-paying clinic, but doctors say he may not have long to live.

And as the number of people who feel let down by the state health system grows, so the political problems for the government could mount as well.