From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <span dir="ltr"><<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>></span><br><div class="gmail_quote">crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br>
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<p class="MsoNormal" style="margin-left:.5in"><b><font color="maroon" face="Arial" size="3"><span style="font-size:12.0pt;font-family:Arial;color:maroon;font-weight:bold">Thailand’s Universal Coverage Scheme: Achievements and
Challenges<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial"><br>
<i><span style="font-style:italic">An independent assessment of the first 10
years (2001-2010)<br>
<br>
<u></u><u></u></span></i></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">This study was funded by the Health
Systems Research Institute, the Prince Mahidol <br>
-Award Conference, the World Health Organization Regional Office for South-EastAsia
and the National Health Security Office.<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">May 2012 - Health
Insurance System Research Office<br>
<br>
<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Available online PDF [120p.] at: <a href="http://bit.ly/JZxYgN" target="_blank"><font color="black"><span style="color:windowtext">http://bit.ly/JZxYgN</span></font></a>
<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">“…..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…..”<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Policy implications for the rest of the world<br>
<br>
<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">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.<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Managing the process<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">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<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">the power to
resolve conflicts and to drive through the necessary changes.<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">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.<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Designing the system<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">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. <u></u><u></u>Thailand<u></u><u></u>
was in a good position to implement the UCS policy because for decades the
government had invested in building local health infrastructure.<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial"><br>
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
<u></u><u></u>Thailand<u></u><u></u>)
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………..”<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold"><u></u> <u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Contents<br>
<br>
<u></u><u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Executive Summary<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 1. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Introduction<u></u><u></u></span></font></p>


<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 2. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Setting the scene: background to the
Universal Coverage Scheme UCS reform<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 3. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Why the Universal Coverage Scheme UCS
was launched in 2001: <br>
                 
the convergence of political commitment, civil society mobilization and
technical know-how<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 4. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">The Universal Coverage Scheme UCS
policy: a brief overview<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Goal and
strategic objectives<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Tax-financed
scheme free at the point of service<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Comprehensive
benefits package with a primary care focus<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• A fixed
annual budget and a cap on provider payment<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Not poor
health care for poor people<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 5. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">New institutions and new ways of
working<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 6. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Implementing the Universal Coverage
Scheme UCS: institutional conflicts and resistance to change<br>
            • Purchaser-provider
split: anything but cut and dry<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Redefining
institutional roles and relations: muddy and murky waters<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Health
workforce: more difficult to redistribute according to need than anticipated<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Harmonization
of public health insurance schemes<br>
• High levels of satisfaction among Universal Coverage Scheme UCS members
and providers<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="text-indent:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 7. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Governance: good, but room for
improvement<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Participation,
transparency, consensus and rule of law<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Responsiveness
and accountability<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Effectiveness
and efficiency<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Other
accountability concerns<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Overall
governance of the NHSB and its subcommittees<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 8. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Significant positive impacts in the
first 10 years<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Increased
utilization and low levels of unmet need demonstrate improved access<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Decreasing
catastrophic expenditures and household impoverishment<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Difficult to
measure but important impact indicators<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Spill-over
effects on the health system<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Macroeconomic
impacts of the Universal Coverage Scheme UCS<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 9. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Universal Coverage Scheme UCS in the
next 10 years: the challenges ahead<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Continuing
towards full implementation of the UCS<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Managing
the growth of the UCS<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold">Chapter 10. </span></font></b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Recommendations and lessons<u></u><u></u></span></font></p>


<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Policy
recommendations for <u></u><u></u>Thailand<u></u><u></u><u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Policy implications
for the rest of the world<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:1.0in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">• Concluding
remarks<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial"><br>
References<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><font face="Arial"><span style="font-size:10.0pt;font-family:Arial">Annex: Framework
for assessing the Thai Universal Coverage Scheme<b><span style="font-weight:bold"><u></u><u></u></span></b></span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold"><u></u> <u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in"><b><font face="Arial"><span style="font-size:10.0pt;font-family:Arial;font-weight:bold"><u></u> <u></u></span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial;font-weight:bold">International experts: </span></font></b><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial">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.<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial;font-weight:bold">Thai secretariat team: </span></font></b><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial">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.<br>
<br>
<u></u><u></u></span></font></p>

<p class="MsoNormal" style="margin-left:.5in;text-autospace:none"><b><font face="Arial" size="1"><span style="font-size:8.0pt;font-family:Arial;font-weight:bold"><u></u> <u></u></span></font></b></p>

<p class="MsoNormal" style="margin-right:0in;margin-bottom:10.0pt;margin-left:.5in;line-height:115%"><font face="Arial"><span style="font-size:10.0pt;line-height:115%;font-family:Arial"></span></font><br></p></div></div>
</div><br>