Abstract
Universal coverage (UC) is a breakthrough improvement of the health system of Thailand. Before the beginning of the UC-policy movement of the present government, the Health Systems Research Institute (HSRI) developed the proposal for the universal coverage for the drafting process of the National Health Act B.E…. It was then published in 2001. This study aims to review the implementation, successes and opportunities of improvement of the universal coverage with reference to the HSRI proposal and to come up with feedbacks to HSRI on development processes of academic work on policy issues for future application. Information was gathered by reviewing key relevant documents, interviews and brainstorming sessions. Study findings on the four primary goals of UC as proposed by the 2001 proposal indicated that, firstly, equity in distributing financial burden and health care access to necessary services improved. Secondly, however, there was no study or evidence to show definitely that efficiency in the health care system increased or decreased. Thirdly, regarding the right to choose a provider which was expected to promote quality, there has been a policy from the National Health Security Office to allow its beneficiaries to choose primary care providers in their neighborhood areas or areas around their workplaces. Nevertheless, there was no evidence demonstrating that the right to choose led to better quality. The fourth goal, which was to promote health for all, was realized obviously by the policy “Building health leads fixing health.” Nevertheless, concrete outcomes of the policy were still lacking. Regarding the proposal on system financing which asked for alignment and adequate budget to support standard health care, it was found that the financing was still fragmented. No mechanism overlooked the whole system, which comprised three main funds. The funds had diverse health benefit packages. The financial situation leads to the conclusion that total funding was not adequate. Health security of the nation remained separated into three schemes, which were different principles, organization, benefit packages and operation. The purchaser-provider-split concept was not evident yet. Management within the Ministry of Public Health confuse management of activities under the universal coverage program, particularly the distinction of health promotion and disease prevention from public health activities financed by the Ministry. Based on this study, recommendations regarding further development of UC should include the following:Review consistency and appropriateness of principles and resources, budget allocation and service arrangement under UC to be “Service of choice” or “Social safety net”. This is under the assumption that creating choice to lead to better quality should be based on competition and informed consumers, or managed competition.Set up new policies based on long-term health and epidemiology information. Set up concrete health promotion goals and associate them with the budget system, resource allocation and operational evaluation.Develop academically solid criteria for budget calculation. Support a national health account study and other related studies and develop efficient and valid financial accounting and cost accounting systems for health care providers. Monitor health status, epidemiology of illnesses, health-service seeking behaviors, and self care of the population continuously.Study cross-subsidization between health security funds at the level of health care provider. Assess financial impacts and design preventive measures for providers in case payment rates of different funds are standardized.Review needs, advantages and disadvantages of fund merging into a single national health security fund. At the same time, develop coordinating mechanisms at three levels—policy, administrative and technical—in order to ensure alignment of principles, benefit package, budget, information requirements and operation between funds. Change the structure of the National Health Security Committee to have the Prime Minister (or his deputy) as Chairman. Enhance the roles of the Health Security Committee and the Quality and Standard Control Committee, and improve internal management in the National Health Security Office and its branch office to international standard.The Ministry of Public Health should spell out its human resources management and budgeting system for both salary and operating budgets. Improve systems for estimating and allocating salary for each group of staff to ensure alignment to missions.Develop close-end payments to the disease which calculate cost on basis of quality requirement, that is set up quality-based purchasing arrangement, to reduce impact of the payment on quality of care and enable quality assurance for resource-intensive treatment. Study and plan a risk-distribution fund or account system.Link quality requirement with resources and budget need by developing resource-based practice guidelines. Develop quality assessment for health care and services, quality information for continuous quality improvement, and enable health care providers for self improvement. Empower consumers for smart decision making and install quality management systems in all heath security fund administrators.
