Work package 7
Thailand – The impact of Universal Coverage relative to other social insurance programmes
Prior to 2002, health insurance systems in Thailand were characterized by fragmentation, duplication and incomplete coverage. Government employees and their dependants were fully covered by a generous non-contributory scheme, Civil Servant Medical Benefit Scheme (CSMBS), which is solely financed by government general revenue. Private sector employees were covered by a tripartite contributory Social Health Insurance (SHI) scheme. The poor, the elderly, and children under 12 years old were covered by the Low Income Card Scheme (LICS), which was inadequately financed by general taxation. This left around 20% of population uninsured.
Universal Coverage (UC) was introduced in 2002. Funded principally from general taxation, UC was intended to cover those groups previously entitled to care through the LICS and the uninsured. It operated with a flat rate charge of 30 Baht per visit/hospitalisation but the new government that came to power in November 2006 removed this. Civil servants and private sector employees continue to do be covered by CSMBS and SHI respectively. These operate with different financing arrangements, contribution rules and benefit packages compared with UC. For example, UC does not cover the costs of renal dialysis and some expensive chemotherapy, leaving enrolees more exposed to catastrophic payments than are members of CSMBS and SHI. Elections scheduled for the end of 2007 present a prospect of revision to UC. For example, extending the benefit package to cover renal replacement therapy is currently high on the policy agenda.
- To identify the impact of UC on health care utilization, health payments, catastrophic medical expenditures and household consumption and living standards.
- To compare the effect of different benefit packages and coinsurance rates on health care utilization, health payments and catastrophic medical expenditures by comparing these outcomes between UC enrolees and members of CSMBS and SHI.