Abstract
The Universal Coverage policy has incorporated two major reform elements,
financial management reform and strengthening primary care which inevitably
affects health service delivery system in Thailand. This paper was aimed
to review implications of the Universal Coverage policy on service delivery system
in terms of financial implications and service provision. Review of secondary
data was the method adopted to explore the implications and the study was
conducted during 2004 - 2006.
The result revealed that the Universal Coverage scheme had a great impact
on the service delivery system. Inadequate funding in addition to change
of allocation criteria from supply-based allocation to demand-based allocation,
per capita, had great financial implications on hospitals. Big hospitals, for example,
regional and general hospital, and hospitals with relatively high concentration
of health personnel incurred financial deficit in the first year when salaries
were included in the capitation. However, the problem had been shifted
from regional and general hospitals to community hospitals and those hospitals
in the Northeast when salaries were removed from the capitation in the following
years. Change of criteria of allocation out of inadequate funding was inevitably
shifted the problem from one to another. Providing universal coverage of
health insurance apparently increased demand for care and burden of work.
Strengthening primary care policy drove more service utilization toward community
hospitals and health centers. Mobilizing doctors or professional nurses
to provide care in primary care units and health centers improved overall quality
of care. However, inadequate funding and stagnation of investment budgets
may have negative consequences on quality of care in the long run.
The Universal Coverage policy has incorporated two major reform elements,
financial management reform and strengthening primary care which inevitably
affects health service delivery system in Thailand. This paper was aimed
to review implications of the Universal Coverage policy on service delivery system
in terms of financial implications and service provision. Review of secondary
data was the method adopted to explore the implications and the study was
conducted during 2004 - 2006.
The result revealed that the Universal Coverage scheme had a great impact
on the service delivery system. Inadequate funding in addition to change
of allocation criteria from supply-based allocation to demand-based allocation,
per capita, had great financial implications on hospitals. Big hospitals, for example,
regional and general hospital, and hospitals with relatively high concentration
of health personnel incurred financial deficit in the first year when salaries
were included in the capitation. However, the problem had been shifted
from regional and general hospitals to community hospitals and those hospitals
in the Northeast when salaries were removed from the capitation in the following
years. Change of criteria of allocation out of inadequate funding was inevitably
shifted the problem from one to another. Providing universal coverage of
health insurance apparently increased demand for care and burden of work.
Strengthening primary care policy drove more service utilization toward community
hospitals and health centers. Mobilizing doctors or professional nurses
to provide care in primary care units and health centers improved overall quality
of care. However, inadequate funding and stagnation of investment budgets
may have negative consequences on quality of care in the long run.
