Thailand implemented a Universal Coverage Scheme of national health insurance in 2001 to finance equitable access to health care. After the Universal Coverage Scheme was introduced, the number of uninsured in Thailand fell substantially and use of health centers and community hospitals increased among lower income groups, according to a study that analyzed data from the Thai national health and welfare surveys in 2001 and 2005.
With the establishment of the Universal Coverage Scheme, Thai citizens are now covered by three main public health insurance schemes: the Civil Servant Medical Benefit Scheme for employees of the government and state enterprises, the Social Security Scheme for formal private sector employees and the Universal Coverage Scheme for the rest of the population. Health service utilization has shifted from tertiary towards primary health care facilities, an intended impact of the Universal Coverage Scheme.
As a result of Thailand’s universal health insurance, the number of uninsured fell from 24 percent in 2001 to three percent in 2005 and health service patterns changed. Use of public primary health care facilities such as health centers became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off.
The increasingly common use of health centers among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the Universal Coverage Scheme. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes.
Although the Universal Coverage Scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, “our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required,” the study concluded.
1. Yiengprugsawan V, Carmichael GA, Lim LL-Y, et al. Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand. Health Policy and Planning 2011; 26(2): 105-114. (open access)