PHM-Exch> Thailand's Universal Coverage Scheme: Achievements and Challenges - lessons learned

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


** ** ** **

*Thailand’s Universal Coverage Scheme: Achievements and Challenges*


*An independent assessment of the first 10 years (2001-2010)

*

This study was funded by the Health Systems Research Institute, the Prince
Mahidol
-Award Conference, the World Health Organization Regional Office for
South-EastAsia and the National Health Security Office.****

*May 2012 - Health Insurance System Research Office

*

Available online PDF [120p.] at: http://bit.ly/JZxYgN

****

“…..The assessment shows there were some extraordinary achievements in the
first 10 years of the UCS. However, the UCS is an ongoing, long-term reform
and further work is needed to address a number of challenges. Based on the
insights gained through the assessment, two sets of policy recommendations
— one set related to the unfinished agenda and one to the future agenda —
are offered with a view to sustaining and improving the UCS over the next
10 years…..”

****

*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.
****


Cost containment mechanisms are critical because unless costs are
controlled it will be difficult to cover the whole of the population and to
provide adequate services; such mechanisms ensure long-term financial
sustainability. Two such features of the UCS are the emphasis on primary
health care (which was historically weak in ****Thailand****) as the main
first level of care, and the payment mechanisms, which use capitation and
case-based payment within a global budget to fix the total cost. The third
design element, strategic purchasing, is necessary to manage the rationing
of services and to direct the provision of care to those areas where need
is greatest………..”

****

* *

*Contents

*

Executive Summary****

*Chapter 1. *Introduction****

*Chapter 2. *Setting the scene: background to the Universal Coverage Scheme
UCS reform****

*Chapter 3. *Why the Universal Coverage Scheme UCS was launched in 2001:
                  the convergence of political commitment, civil society
mobilization and technical know-how

****

*Chapter 4. *The Universal Coverage Scheme UCS policy: a brief overview****

• Goal and strategic objectives****

• Tax-financed scheme free at the point of service****

• Comprehensive benefits package with a primary care focus****

• A fixed annual budget and a cap on provider payment****

• Not poor health care for poor people

****

*Chapter 5. *New institutions and new ways of working

****

*Chapter 6. *Implementing the Universal Coverage Scheme UCS: institutional
conflicts and resistance to change
            • Purchaser-provider split: anything but cut and dry****

• Redefining institutional roles and relations: muddy and murky waters****

• Health workforce: more difficult to redistribute according to need than
anticipated****

• Harmonization of public health insurance schemes
• High levels of satisfaction among Universal Coverage Scheme UCS members
and providers

****

*Chapter 7. *Governance: good, but room for improvement****

• Participation, transparency, consensus and rule of law****

• Responsiveness and accountability****

• Effectiveness and efficiency****

• Other accountability concerns****

• Overall governance of the NHSB and its subcommittees

****

*Chapter 8. *Significant positive impacts in the first 10 years****

• Increased utilization and low levels of unmet need demonstrate improved
access****

• Decreasing catastrophic expenditures and household impoverishment****

• Difficult to measure but important impact indicators****

• Spill-over effects on the health system****

• Macroeconomic impacts of the Universal Coverage Scheme UCS

****

*Chapter 9. *Universal Coverage Scheme UCS in the next 10 years: the
challenges ahead****

• Continuing towards full implementation of the UCS****

• Managing the growth of the UCS

****

*Chapter 10. *Recommendations and lessons****

• Policy recommendations for ****Thailand********

• Policy implications for the rest of the world****

• Concluding remarks****


References****

Annex: Framework for assessing the Thai Universal Coverage Scheme**

* *

* *

*International experts: *Timothy G. Evans, BRAC University; A. Mushtaque R.
Chowdhury, Rockefeller Foundation; David B. Evans, World Health
Organization; Armin H. Fidler and Magnus Lindelow, World Bank; Anne Mills,
London School of Hygiene & Tropical Medicine; Xenia Scheil-Adlung,
International Labour Organization.****

*Thai secretariat team: *Viroj Tangcharoensathien and Walaiporn
Patcharanarumol, International Health Policy Program; Pongpisut
Jongudomsuk, Health Systems Research Institute; Samrit Srithamrongsawat,
Aungsumalee Pholpark, Patchanee Thamwanna and Nutnitima Changprajuck,
Health Insurance System Research Office.

****

* *
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