Assessing efforts towards universal financial risk protection in low- and middle-income countries

Assessing policy formulation of universal coverage scheme in Thailand

Following 27 years of debate, Thailand achieved a Universal Coverage (UC) Scheme in 2002. Underscoring its importance, studies indicate that approximately 30% of the Thai population remained uninsured the preceding year despite coverage extensions in several public and private programmes. This study focuses on understanding the policy formulation and decision processes that went into enacting the UC scheme.

To develop this understanding, policy formulation and decision processes will be evaluated against four interrelated functions of health financing:

  • Revenue generation. Adopt tax as sole source of financing UC scheme, reject contribution scheme by members.
  • Pooling. Risk was pooled across a large UC population (47 million); adopt the constitutional right to health and universality principle while reject targeting approaches.
  • Purchasing. Initial comprehensive benefit package, gradual increase level of financial risk protection by high cost catastrophic medical services
  • Solvency. Is the UC scheme financially sustainable? It is a comprehensive package and relies on a single source of funding subject to fiscal capacities and political changes. The increase in the depth and height of coverage requires resources. Who is involved, how and why has the National Health Security Office (NHSO) been successful in ensuring sufficient annual budget?

The key research question this study explores is: How and why were the four interrelated features of UC design chosen in the policy formulation process? How did the key stakeholders come to some agreement around the design features with positive equity implications?

Objectives

  • To explain and contrast how and why the four interrelated features of system design evolved.
  • To explain how and why different actors with varying power, influences and positions came together to shape these key interrelated features.

Project description

Programme: Assessing efforts towards universal financial risk protection in low- and middle-income countries

Research title: Assessing policy formulation of universal coverage scheme in Thailand

Thematic Research Area: Health Financing

Grantee Country: Thailand

Grantee Institution: International Health Policy Program, Ministry of Public Health, Thailand

Programme coordinator: Viroj Tangcharonesathien

Start date: September 2010

Status of grant: Completed


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