Implemented in 2002 by the Thai government, the Universal Health Coverage (UHC) Scheme is a tax-funded comprehensive healthcare program providing all Thai citizens with essential preventive, curative, and palliative health services at all life stages.1 UHC was introduced to close existing gaps in healthcare coverage and ensure all citizens have access to effective healthcare regardless of level of income. The UHC Scheme has increased access to health services, reduced the incidence of catastrophic health expenditures, and improved health outcomes, including reduced infant mortality and increased life expectancy.2
Although health coverage has been expanded gradually since the 1970s, and various social protection and health policies aimed at helping people living in poverty have been implemented, around 47 million citizens, primarily informal sector workers from lower socio-economic backgrounds, still lacked health insurance or access to free healthcare by the year 2000. 3 Before the introduction of UHC, 25 percent of the population was uninsured, with the remaining insured through the Social Security Scheme (SSS) for the private sector or the Civil Service Medical Benefit Scheme (CSMBS) for the public sector.4 This unequal access to healthcare resulted in 17,000 Thai children under the age of five dying annually, two-thirds of whom died of preventable infectious diseases.5 Additionally, in 2001, out-of-pocket payments constituted one third of the total health expenditures for the public6 and pushed one in five of the poorest Thai households below the national poverty line of approximately BHT 31 (USD 1) a day.7
The government of Thailand and civil society proponents of universal health coverage saw an opportunity to push for change in how Thai people accessed healthcare in 1999. The Thai Rak Thai party, along with reformers in the Ministry of Public Health, along with Dr. Sanguan Nitayaramphong, who was the first secretary-general of what would become the National Health Security Office—considered the father of universal health coverage in Thailand—worked tirelessly to persuade politicians and the public to embrace universal health coverage.
Thus, by the time the Thai Rak Thai Party—the only party to promise full health coverage if elected—won elections in 2001, the stage had been set for the introduction of the UCS. The newly elected government pursued a rapid roll-out of universal coverage and within a year of victory, the entire population was covered. The Ministry of Public Health was responsible for providing health services, and a new independent entity, the National Health Security Office (NHSO), managed and operated the UCS.8 The Universal Health Coverage is implemented by the Ministry of Public Health through a network of 953 hospitals and 9,765 health centers, reaching all sub-districts in the country.9
All citizens are eligible for the UCS. To receive free access to healthcare services within their local health jurisdiction in Thailand, citizens need to register with local health authorities and obtain a “card for care.” The card entitles enrollees to free care at health centers in their home district, and contracted hospitals, as well as referrals to provincial or tertiary care hospitals in urban areas. Emergency and accident treatments away from their home districts are also provided at no cost. The scheme covers a wide range of services, including outpatient care, inpatient care, emergency care, maternity care, mental health services, and prescription drugs. The benefits package was extended to include high cost services like dental, renal replacement therapy, cancer therapy and stem-cell transplants, which has improved financial protection for citizens.10
The UCS is entirely government-funded through tax revenue, meaning it is proportionally more heavily funded by the rich than by people living in poverty. The budget is determined by the number of beneficiaries multiplied by a standard per-person rate.11 The government allocated approximately BHT 1,200 (USD 35) per beneficiary in 2002, which was later increased to BHT 2,700 (USD 80) by 2012.12 This increase was mainly driven by higher utilization of services and the escalating costs of labor and materials for delivering medical and health services.13 The total cost of the policy was USD 14,809 million in 2017 (latest data available), which accounts for 17 percent of the total government expenditure, making it one of the highest health budgets among low-and middle-income countries.14
Initially, there was a flat rate copayment of 30 BHT (USD 0.7) per visit, however this was terminated in 2006 as collection of the co-payments ultimately cost more than the revenue it generated. There are currently no costs incurred by the patients.
The UCS has led to a steady rise in use and access to healthcare. Within one year of the election victory of Thai Rhak Thai Party, healthcare coverage was rapidly upscaled from 71 percent to 100 percent by January 1, 2002.15 When the barriers to access health services were lowered, previously uninsured Thais, especially those on the lowest end of the socio-economic spectrum, increased their use of health services. Young women of reproductive age (between the ages of 20 and 30) and their children particularly benefited.16
Outpatient visits per person increased from 2.45 in 2003 to 3.22 in 2010, and hospital admissions per person rose from 0.094 in 2003 to 0.116 in 2010.17 UCS members in the poorest 20 percent of population experienced a decrease in catastrophic health expenditures (defined as out-of-pocket payments for healthcare exceeding 10 percent of total household consumption expenditure) from 6.8 percent in 1996 to 2.8 percent in 2008.18
Between 2002 and 2011, the introduction of UHC resulted in an increase in life expectancy at birth from 71.8 to 74.2 years. 19 This is a significant improvement compared to the previous decade (1991-2001), which saw a smaller increase from 70.3 to 71.8 years. 20 Moreover, over time, there has been a significant reduction in infant deaths, from more than 100 per 1000 live births before 1970 to only 9.5 per 1000 live births in 2017. 21
A review of the first 10 years of UHC (2001-2010) discovered that the households experienced a decrease in out-of-pocket healthcare expenses and fewer households suffered from catastrophic healthcare spending.22 Additionally, households that were previously uninsured saw an increase in savings. 23
The UHC has come under criticism regarding their extensive budget, making the country’s leaders question whether the healthcare coverage of the system needs to be reduced to cope with the financial burdens of the COVID-19 pandemic. Since the military coup against the government in 2014, the UHC has become a target for military government leaders and bureaucrats who blame the scheme for having a poor financial model that causes trouble for medical providers and leaves them in financial deficits. 24 The NHSO was also accused of corruption, but this was ruled out by the Office of the Auditor General’s investigation in 2014.
- 1. Sumriddetchkajorn, K, Kenji Shimazaki et al., “Universal Health Coverage and Primary Care, Thailand,” Bulletin of the World Health Organization 97, no. 6 (2010): 415–22, https://doi.org/10.2471/blt.18.223693
- 2. Ibid.
- 3. International Labour Office, “ILO Social Protection Department
- 4. Thailand: Universal Health-Care Coverage Scheme,” Social Protection in Action: Building Social Protection Floors, November 2016, https://www.ilo.org/wcmsp5/groups/public/---dgreports/---integration/documents/publication/wcms_568679.pdf
- 5. “Thailand’s Universal Health Coverage Scheme
- 6. Social Protection Toolbox.” n.d. https://www.socialprotection-toolbox.org/practice/thailands-universal-health-coverage-scheme
- 7. Limwattananon S, Tangcharoensathien V, Prakongsai P., “Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand,” Bull World Health Organ, 85 no. 8 (August 2017): 600-6, doi: 10.2471/BLT.06.033720.
- 8. International Labour Office, "ILO Social Protection Department
- 9. Thailand."
- 10. Amanda Glassman and Miriam Temin, “Thailand’s Universal Coverage Scheme,” Center for Global Development, 2007, http://millionssaved.cgdev.org/case-studies/thailands-universal-coverage-scheme
- 11. Ibid.
- 12. “Thailand’s Universal Health Coverage Scheme
- 13. Social Protection Toolbox.”
- 14. Sumriddetchkajorn et al., “Universal Health Coverage and Primary Care, Thailand.”
- 15. Glassman and Temin, “Thailand’s Universal Coverage Scheme.”
- 16. Ibid.
- 17. International Labour Office, “ILO Social Protection Department
- 18. Thailand.”
- 19. Sumriddetchkajorn et al., “Universal Health Coverage and Primary Care, Thailand.”
- 20. Wibulpolprasert, Suwit, and Fiona Fleck, “Thailand’s Health Ambitions Pay off,” Bulletin of the World Health Organization, July 2014, https://doi.org/10.2471/blt.14.030714
- 21. Glassman and Temin, “Thailand’s Universal Coverage Scheme.”
- 22. International Labour Office, “ILO Social Protection Department
- 23. Thailand.”
- Sumriddetchkajorn et al., “Universal Health Coverage and Primary Care, Thailand.”