Public Insurance and Financial Risk Protection: Lessons from Thailand

Abstract

Thailand achieved universal coverage in access to health care in 2002. Since then, there has been a dramatic reduction in the prevalence of catastrophic health expenditures reflecting the capacity of the main public health insurance schemes to protect their members against financial risk from medical care costs. This policy brief draws on evidence from a recent study of the Social Health Insurance (SHI) and Universal Coverage (UC) schemes, identifying the key features of these schemes which have contributed to the reduction in catastrophic expenditures. Qualitative approaches were applied including documentary reviews and in-depth interviews conducted with three groups of stakeholders: purchasers, providers and patients. Conclusions: The combination of deepening coverage from the comprehensive package to include high cost services, and a provider payment system which reduces the incentives for providers to avoid high cost patients, appear to have been key factors in ensuring that UC and SHI members are protected from the risk of financial catastrophe from health care payments. This predominance of the policy objectives of financial risk protection and equity across schemes is illustrated by the recent decision to extend coverage to include RRT, an intervention that does not pass the conventional cost-effectiveness threshold, but which has been shown to have an impoverishing impact on households. Having a clear policy direction on financial risk protection, a comprehensive benefit package, and an active purchasing function based on evidence and clinical monitoring capacities, together provide an important foundation for successful financial risk protection.