Abstract
Thailand achieved full population coverage of financial protection for health care in 2002 with successful implementation of the Universal Coverage Scheme (UCS). The three public health insurance schemes covered 98.5% of the population by 2015. Current evidence shows a high level of service coverage and financial risk protection and low level of unmet healthcare need, but the path toward UHC was not straightforward. Applying the Political Economy of UHC Reform Framework and the concept of path dependency, this study reviews how these factors influenced the evolution of the UHC reform in Thailand. We highlight how path dependency both set the groundwork for future insurance expansion and contributed to the persistence of a fragmented insurance pool even as the reform team was able to overcome certain path inefficient institutions and adopt more evidence-based payment schemes in the UCS. We then highlight two critical political economy challenges that can hamper reform, if not managed well, regarding the budgeting processes, which minimized the discretionary power previously exerted by Bureau of Budget, and the purchaser–provider split that created long-term tensions between the Ministry of Public Health and the National Health Security Office. Though resisted, these two changes were key to generating adequate resources to, and good governance of, the UCS. We conclude that although path dependence played a significant role in exerting pressure to resist change, the reform team’s capacity to generate and effectively utilize evidence to guide policy decision-making process enabled the reform to be placed on a “good path” that overcame opposition.
Highlights
11.8% of current health expenditure in 2015.5 Likewise, the prevalence of catastrophic health expenditure, measured by more than 10% of household expenditure, reduced from
The paper first argues that the early expansion of a strong public primary health care (PHC) system in Thailand set the foundation for future scale-up of UHC
UHC designs were facilitated by several choices which were adopted early in the reform process that later facilitated future expansions, this paper highlights how evidence contributed to Universal Coverage Schemes (UCS) design choices that were able to overcome certain “path inefficiencies” generated by previous policy choices, which has allowed further advanced steps in achieving health systems goals of efficiency, equity, and quality of care
Summary
Universal entitlement to CSO advocate all citizens’ healthcare providers, health services by all Thai entitlement to health private insurance citizens. Constitutional.[37] The state pays their own healthcare has constitutional mandate or covered by private to ensure right to health insurance. As State, legislative bodies people are coverage by public health intervention and private providers were state budget outside UCS such as TB, infectious and in favour of non-Thai pay systems[23] and foreigners vaccine preventable their own medical bills. Social Security Office advocated tax as the most concerned of inequity as progressive source to the SHI members were finance UCS. Minister realized it not payroll tax (plus equal possible to achieve UHC in share by employers and a year if UCS is financed government) for by premium contribution. Prime Minister decided on Political promise of UHC general tax-financed UCS in a year, technically not through annual budget feasible to collect negotiation and approval.
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