Puenpatom and Rosenman (2008) examine universal health coverage in Thailand:
“In 2001 Thailand became the first developing country to introduce universal health insurance coverage (UC). Six of 76 provinces adopted UC in April 2001, while the remaining provinces implemented UC in October of that year. One of the key elements of the program is capitated-based reimbursement of public hospitals based on enrolled populations in the hospitals’ service areas. Before 2001, the only capitation-based public health insurance program was the Social Security Scheme (SSS), which covered only 9% of the population in 2000. With UC fully implemented almost 90% of the population is covered by capitation. UC capitation is geographically structured so hospitals have fixed revenues based on the local population and financial viability depends on an ability to control costs. One consequence is that hospitals face increased demand from the 75% of the population previously not covered by any formal insurance system.”
This table shows the distribution of hospital beds. About 75% of all beds are in government hospitals and about 21% are in private hospitals. Most public hospitals are run by the Ministry of Public Health (MOPH). Larger regional hospitals provide tertiary and primary care services. Bangkok has a unique structure within Thailand. Most large teaching hospitals are in Bangkok and forty percent of private hospitals are located in Bangkok. Under the new UC system, patients are assigned to hospitals by MOPH.
“Physicians in Thai public hospitals are employees of the hospital and as such are paid by MOPH according to budgetary structures through the hospitals.”
Old System vs. New System
This table gives a comparison of health insurance coverage under the old an new system. In 1991, two thirds of Thais had not health insurance. By 2000, only 20.3% of Thai individuals were uninsured. After the enactment of Universal Health Coverage (UC), this number fell to less than 4%.
- Rajitkanok A. Puenpatom and Robert Rosenman (2008) “Efficiency of Thai provincial public hospitals during the introduction of universal health coverage using capitation” Health Care Management Science, v11(4).