Thailand’s Universal Coverage Scheme: Achievements and Challenges
This study was funded by the Health Systems Research Institute, the Prince Mahidol Award Conference, the World Health Organization Regional Office for South-East Asia and the National Health Security Office.
Policy implications for the rest of the world
Many factors contributed to the successful implementation of the UCS policy, including political and financial commitments, a strong civil service acting in the public interest, active civil society organizations, technical capacity to generate and use research evidence, economic growth, and policies to increase fiscal space. While some countries may find this list daunting it is important to realize that all these elements can be developed over time. Countries must find their own path to universal coverage — while no blueprint emerges from this work, the Thai reform experience provides valuable lessons.
Managing the process
As important as it is to bring different stakeholders together to listen, consult, negotiate and compromise, it is essential that the leaders of the reform have the power to resolve conflicts and to drive through the necessary changes.
Otherwise countries risk getting stuck in the design stage, stalled by interest groups that feel threatened and are resisting change. Countries need a concrete plan to manage the reform process. It is also important to build capacity, not just to design a universal coverage scheme, but also to manage its implementation, including capacity for learning from the experience and tweaking the scheme as it is implemented.
Designing the system
Three design elements are essential to achieve universal coverage: extension of access to services, cost containment and strategic purchasing. Financing reform must go hand in hand with ensuring physical access to services. There is no point giving people a theoretical entitlement to financial protection if they have no access to local services or if it is too costly to access services outside the community in which they live. Thailand was in a good position to implement the UCS policy because for decades the government had invested in building local health infrastructure.
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This study was funded by the Health Systems Research Institute, the Prince Mahidol Award Conference, the World Health Organization Regional Office for South-East Asia and the National Health Security Office.
Policy implications for the rest of the world
Many factors contributed to the successful implementation of the UCS policy, including political and financial commitments, a strong civil service acting in the public interest, active civil society organizations, technical capacity to generate and use research evidence, economic growth, and policies to increase fiscal space. While some countries may find this list daunting it is important to realize that all these elements can be developed over time. Countries must find their own path to universal coverage — while no blueprint emerges from this work, the Thai reform experience provides valuable lessons.
Managing the process
As important as it is to bring different stakeholders together to listen, consult, negotiate and compromise, it is essential that the leaders of the reform have the power to resolve conflicts and to drive through the necessary changes.
Otherwise countries risk getting stuck in the design stage, stalled by interest groups that feel threatened and are resisting change. Countries need a concrete plan to manage the reform process. It is also important to build capacity, not just to design a universal coverage scheme, but also to manage its implementation, including capacity for learning from the experience and tweaking the scheme as it is implemented.
Designing the system
Three design elements are essential to achieve universal coverage: extension of access to services, cost containment and strategic purchasing. Financing reform must go hand in hand with ensuring physical access to services. There is no point giving people a theoretical entitlement to financial protection if they have no access to local services or if it is too costly to access services outside the community in which they live. Thailand was in a good position to implement the UCS policy because for decades the government had invested in building local health infrastructure.