Abstract
Purpose: In 2010, the World Health Organization (WHO) released its report about health system financing and identified universal coverage as the best way to attain the right of every human being to enjoy “the highest attainable standard of health”. Over the past decade, Thailand has successfully implemented a universal health coverage scheme for its population, while its neighbor country, Indonesia, is still struggling to achieve the same goal. The purpose of this paper is to compare the health financing systems between Thailand and Indonesia. Both countries almost have similar socioeconomic conditions and suffered from severe financial crisis during the late 1990s. The objective of this study is to examine health systems in each country and to determine lessons on how health care financing can affect the health status of a population. Methods: The study is based on statistical data from various publicly available resources. For analysis, the authors followed The Health Systems Assessment Approach: A How-To Manual Version 1.0 issued by Health Systems 20/20 supported by United States Agency for International Development (USAID). The countries were compared using three groups of indicators in health systems performance and functioning: 1. Health Insurance System, 2. Amount and Sources of Financial Resources, and 3. Health Outcomes and Health Workforce Density. Results: In comparing the health financing of the two countries, we found that Thailand initiated much earlier health systems reforms in order to achieve universal health coverage. Indonesia, while on the right track, has moved at a slower pace than Thailand. Thailand and Indonesia have shown improving trends over time in all indicators, but Thailand outperformed Indonesia, especially in the groups of indicators regarding the amount and sources of financial resources. Conclusions: One important lesson identified in this study is that health care reform is unlikely to succeed without strong political support and constant pressure from the nation as a whole, which can be represented by local organizations or professional associations. However, the mere increase of available resources devoted to the health sector does not guarantee significant improvements of health outcomes of a population.
Highlights
Since 2000, the World Health Organization (WHO) has reported on the urgency of ensuring all populations proper health insurance.[1]
In comparing the health financing of the two countries, we found that Thailand initiated much earlier health systems reforms in order to achieve universal health coverage
One important lesson identified in this study is that health care reform is unlikely to succeed without strong political support and constant pressure from the nation as a whole, which can be represented by local organizations or professional associations
Summary
Since 2000, the World Health Organization (WHO) has reported on the urgency of ensuring all populations proper health insurance.[1]. The countries that have come the closest to achieving universal coverage generally have more resources to spend on health. A group of countries belonging to the Organization for Economic Co-operation and Development (OECD), had average annual per capita expenditures on health close to USD 4,000.2 large expenditures on health is not required for a country to achieve universal coverage, for instance Thailand reduced the number of uninsured from 26.6% of the population in 2001 to 4.4% in 2005, though its health expenditure was below the average of richer countries who reached similar goals.[3] Thailand changed their method of collecting revenue from direct payment to pooling resources and used those funds to cover their entire population, especially the uninsured prior to the reform. Reaching universal coverage for low-middle income countries is achievable, but it demands commitment and investments from the government and society
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