Abstract
Universal health care coverage (UC) is an important policy by the Thai government, 75% of population covered by the Scheme, but capitation rate did not adequately match with the utilization rate and cost of services. While rely totally on government annual budget, its long-term fiscal sustainability is a worrying problem. This study was conducted in order to provide financial reform options for UC Scheme. Long term projection of total national health expenditure of Thailand between 2004 and 2020 was constructed using four models namely Demographic and Labour Model, Economic Model, National Health Expenditure Model and Government Model. Several information from various sources were retrieved for example; population and economic information from National Economic and Social Development Board, Labour statistic from National Statistical Office, National Health Account of Thailand 1994-2001 and Government expenditure from the Comptroller General’s Department, Ministry of Finance. Moreover, many possible assumptions were applied in these models and three scenarios of reducing UC expenditure and/or ensuring adequate budget for UC were created in order to illustrate financial implication. The model estimates showed that the total national health expenditure was around 3.50% of GDP in 2004, it would increase to 3.64 and 3.88 % of GDP in 2010 and 2020, respectively. The first scenario simulated the effects of the suggested revenue increases by introducing personal health tax and additional excise tax on tobacco, alcohol and beer which some proportion automatically earmarked to UC Fund. This scenario resulted in substantial reductions in the government budget subsidy to the Scheme compared to status quo. The second scenario was produced based on assumptions that Social Security Office would expand its coverage to non-working spouse and dependents of the contributors. Its effects were that the expenditure of UC reduces by around 9,210 million baht in 2005. The first and second scenarios. when combined together into the third scenario suggested, it showed that UC almost fund by itself with few budget subsidy from government. Three policy recommendations on the Scheme financial reform was provided. First, an earmarked sin tax with or without increase in the sin tax rate. Second, the expansion social security scheme health benefit to non working spouse and dependents of the contributors. This could be done without increasing contribution. The last was the reform of Traffic Accident Protection Act (TAP). The Department of Land Transport would be outsourced to collect premium from car owners, during the mandatory annual renewal of car license, this would enhance law enforcement. The scheme would cover all victims by either insured and uninsured cars.
