Health systems development in Thailand: a solid platform for successful implementation of universal health coverage

Abstract

Thailand's health development since the 1970s has been focused on investment in the health delivery infrastructure at the district level and below and on training the health workforce. Deliberate policies increased domestic training capacities for all cadres of health personnel and distributed them to rural and underserved areas. Since 1975, targeted insurance schemes for different population groups have improved financial access to health care until universal health coverage was implemented in 2002. Despite its low gross national income per capita in Thailand, a bold decision was made to use general taxation to finance the Universal Health Coverage Scheme without relying on contributions from members. Empirical evidence shows substantial reduction in levels of out-of-pocket payments, the incidence of catastrophic health spending, and in medical impoverishment. The scheme has also greatly reduced provincial gaps in child mortality. Certain interventions such as antiretroviral therapy and renal replacement therapy have saved the lives of adults. Well designed strategic purchasing contributed to efficiency, cost containment, and equity. Remaining challenges include preparing for an ageing society, primary prevention of non-communicable diseases, law enforcement to prevent road traffic mortality, and effective coverage of diabetes and tuberculosis control.

The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications

“…High OOP spending among richer households highlights the potential opportunity for transforming this spending into progressive prepayments, which can be pooled across the population, to complement increases in the share of THE coming from GDP and achieve greater financing equity . Evidence shows that countries that are highly successful in providing financial protection are those that have implemented compulsory contributions based on an individual's ability to pay through taxation, earmarked contributions, or health insurance . Integrating the many existing insurance pools in Iran into one may also be necessary for improving financial protection in the country.…”

Assessment of nationwide emergency systems in Thailand, a middle‐income country setting with UHC

“…In 2014, 67% of the country's 161 000 Thai hospital beds were in the Ministry of Public Health (MOPH) facilities, 14% of beds were in other public, non-MOPH facilities, and 19% of beds were in private hospitals. 9 In regard to emergency and trauma medical care, MOPH hospitals are organized into a multitier system with 36 regional referral centers (type A hospital), 52 provincial referral centers (type S), and 34 general hospitals (type M1). Ten out of a total of 13 university hospitals are also considered as having the capacity of the provincial or regional referral centers.…”

Achievement of Metabolic Goals among Different Health Insurance Schemes in Thai Patients with Type 2 Diabetes Mellitus: a Nationwide Study

“…In 2017, CSMB, SHI, and UHC covered approximately 4.4, 10.6, and 48.0 million Thai people, respectively. 9 The expansion of health insurance coverage increased access to medicines in primary care, especially for chronic diseases, such as diabetes and hypertension. 8 However, the drug lists, budgets, and payment methods all differ among the three health coverage schemes in Thailand.…”

“…UHC has the narrowest drug coverage, as dictated by the Thailand National List of Essential Medicines (NLEM), with a closed-end budget system; SHI uses its own drug list with a closed-end budget system; and, CSMB offers the greatest drug coverage with an open-end budget system. 9 UHC and CSMB beneficiaries can receive medical service without any copayment while SHI beneficiaries have to pay a monthly deductible around 25 US dollars. Thus, the aim of this study was to investigate metabolic goal achievement in patients with T2DM compared among the three healthcare schemes in Thailand.…”