Abstract
Thailand has maintained a commitment to Universal Health Coverage (UC) for over 20 years, with the
National Health Security Office (NHSO) playing a central role in driving its implementation and overseeing the
delivery of health services under this policy. Although various national and international organizations have
continuously monitored and evaluated Thailand’s UC, most research has focused on health outcomes and
access to care. In contrast, assessments of the NHSO’s governance remain relatively unexplored. This project,
therefore, aims to evaluate the managerial role of the NHSO as the implementing agency of the UC policy and
to analyze the outcomes resulting from the implementation of this policy.
The evaluation of the NHSO is structured around three key dimensions: (1) governance, (2) health
outcomes, and (3) the management of the National Health Security Fund. The evaluation is guided by the
“3E” framework, which comprises Execution (implementation in practice), Evidence (evidence-based decisionmaking), and Efficiency (operational effectiveness). We draw on a range of sources, including official documents,
meeting minutes, research studies, and databases from the NHSO, the Ministry of Public Health, and other
relevant agencies. In addition, we conducted in-depth interviews with experts and representatives from
stakeholder organizations involved in the UC system, as well as surveys with service recipients across the 13
health regions to explore specific issues. The evaluation results provide an assessment of policy performance,
along with concrete recommendations to enhance the efficiency of Thailand’s universal health coverage
system.
From the evaluation of the NHSO’s governance, we found that its current structure goes against the
intent of Section 14 and 15 of the National Health Security Act, which emphasize checks and balances and
inclusive participation across all sectors. Specifically, members of the National Health Security Board and the
Quality and Standard Control Board have consecutively served multiple overlapping terms, often rotating
between the two boards. Furthermore, some board members concurrently sit on more than three
subcommittees, leading to overlapping roles between policymakers (principals) and implementers (agents),
especially when the same individuals are also involved in regional-level committees. To prevent concentration
of power, legal safeguards should be introduced to prohibit rotation between the two main boards without
an interim break after two consecutive terms, to limit each board member’s participation to no more than
two subcommittees per term, and to reconsider the appointment of central board members as subcommittee
members at the regional level.
Moreover, while the NHSO has made efforts to promote transparency and efficiency in the
management of the National Health Security Fund, for example, by incorporating empirical evidence into its
budget proposals and disclosing procurement information in a relatively comprehensive manner, certain
limitations remain. These include redundancies in the budget proposal process, unclear criteria for budget
allocation, retroactive enforcement of regulations, and delays in disbursements toward the end of the fiscal
year. In terms of health service quality monitoring, although the NHSO has efficiently coordinated complaint
resolution, there is still no real-time system for tracking the status of complaints. More importantly, a large
number of people remain unaware of the appropriate channels through which to file complaints. Regarding
data management, while the NHSO has performed relatively well in protecting personal data in accordance
with legal requirements, further improvement is needed in data sharing to support more systematic policy
development and public benefits.
The NHSO’s management reflects its central role in allocating resources for healthcare services. An
evaluation of health outcomes and social return on investment (SROI) shows that the effective coverage of
health services has steadily improved, generating positive and cost-effective social returns, particularly in
programs such as HIV/AIDS treatment and Long Term Care (LTC). In contrast, certain services, such as those for
patients with end-stage renal disease, demonstrated SROI below the cost-effectiveness threshold due to high
treatment costs. Nevertheless, the program has contributed to improved quality of life for patients and reduced
household financial burdens through the inclusion of related services in the benefit package. These findings
highlight the importance of ensuring that the NHSO is guided by efficiency, social value, and
evidence-based decision-making in its resource allocation.
