Health Care Statistics
World Health Statistics
Country Profile
Thailand has been striving toward universal health coverage since the 1970s. By 2000, a number of public health insurance schemes, in combination with a small number of private plans, were able to cover 75% of the Thai population. By the 2000 national election, universal health coverage had gained enough momentum to become a staple of many political campaigns and in 2001, the new government made a commitment to provide health coverage for all.
Thailand has been striving toward universal health coverage since the 1970s. By 2000, a number of public health insurance schemes, in combination with a small number of private plans, were able to cover 75% of the Thai population. By the 2000 national election, universal health coverage had gained enough momentum to become a staple of many political campaigns and in 2001, the new government made a commitment to provide health coverage for all. While the health system in Thailand has strong public and private sectors, nearly 65 percent of resources spent on health and utilization of services are in the public sector.
Since the 1970s, Thailand has made a concerted effort to move towards universal health coverage. Significant progress was achieved in the past three decades, with 75 percent of the population covered through some type of health insurance by 1998. However, it was not until 2001 when a new government came into power that universal health insurance was introduced to achieve truly universal health coverage.
A summary timeline of the evolution of the health financing system in Thailand until 2001 is summarized in the table below:
| Date of Implementation | Scheme | Coverage in 2001 (Approximated) |
|---|---|---|
| 1962-86 | Gap in the progress on coverage, focus on infrastructure development | |
| 1963 | Civil servants medical benefits scheme | 9% |
| 1975 | Free medical care for low income | 20% |
| 1983 | Community financing (Health Card Phase I – II) | |
| 1990 | Voluntary public health insurance (Health Card Phase III - V) | 13% |
| 1992 | Compulsory Social Security | 11% |
| 1993 | Free medical care for children | 16% |
| 1995 | Free medical care for the elderly | 6% |
| 2000 | Total health insurance coverage | 75% |
Expansion of rural healthcare infrastructure and specifically a rapid expansion of public provincial hospitals, rural district hospitals, and health centers was initiated beginning in 1962. A strong political movement against the military government in 1973 resulted in temporary democracy in Thailand. This, combined with a global focus on “Health for All”, resulted in many policy changes, particularly a big push for a focus on primary health care, universal health coverage, and recruitment of village health volunteers and the establishment of many community-financing schemes in health (e.g., village drug funds, sanitary funds, nutrition funds). The push for expanding rural infrastructure continued into well into 1980. This push resulted in expanded access to essential health services.
This era also allowed progressive student leaders an opportunity to gain rural public health experience and management skills. This group formed the “Rural Doctor Society” in 1978. During this era, trained village health volunteers and village health communicators were used as the main tool in the nation’s primary health care strategy. Their roles were to assist health personnel in delivering basic integrated health care. The village health volunteers have played a significant role in improving access to rural primary health care services.
Between 1975 and 1992, four main insurance schemes were founded:
- The Medical Welfare Scheme (MWS): Established in 1975 under the name “Free medical care for low income” and funded through general taxation. Beneficiaries were the poor with monthly incomes of less than Baht 1,000. Beneficiaries were entitled to free medical services from public health facilities. The scheme was later expanded to cover the elderly, children, veterans, disabled, monks, and priests. The scheme was later renamed the “Medical Welfare Scheme”.
- Health Card Scheme: This was a publicly subsidized voluntary health insurance scheme, which evolved from a community financing project in its early phases. It covered the near-poor population. The voluntary nature of the scheme resulted in problems of selection bias.
- Compulsory Social Security Scheme (SSS): Covered all private employees. This scheme is financed through a tri-party arrangement, namely employees, employers, and central government contributions. Establishments that had 20 employees or more were the first group targeted. The scheme gradually expanded to cover all formally employed employees, even those working in small businesses (as small as 1 employee).
- Civil Servant Medical Benefit Scheme (CSMBS): Civil servants and public employees and their family members were covered by CSMBS. The CSBMS was fully funded from general tax revenue through the Department of the Comptroller’s General, Ministry of Finance.
Beneficiaries of the CSMBS enjoy free choice of providers and the CSMBS pays providers based on a fee for service. However, other schemes have required their beneficiaries to register and seek care at certain first-contact health facilities, either a health center or a hospital. Anyone who bypasses this system must pay out of pocket. The schemes pay providers based on global budget (for MWS and the Health Card Scheme) and capitation payment system (for the Social Security Scheme).
Until 2000, these four public health insurance schemes combined (with a small fraction of private health insurance) covered approximately 75 percent of the population.
Several options and movements originating through “technocrats” and civil societies to move the system towards comprehensive universal coverage were not successful. However these movements created critical mass and legitimacy for the universal coverage movement. Many political parties now tout universal coverage in their election campaigns. And in late 2000, one such political party won the national election with a commitment to provide universal coverage for health care through a “30 Baht to treat all diseases” scheme.
Thailand
Historical Context
Thailand has been striving toward universal health coverage since the 1970s. By 2000, a number of public health insurance schemes, in combination with a small number of private plans, were able to cover 75% of the Thai population. By the 2000 national election, universal health coverage had gained enough momentum to become a staple of many political campaigns and in 2001, the new government made a commitment to provide health coverage for all. While the health system in Thailand has strong public and private sectors, nearly 65 percent of resources spent on health and utilization of services are in the public sector.
Since the 1970s, Thailand has made a concerted effort to move towards universal health coverage. Significant progress was achieved in the past three decades, with 75 percent of the population covered through some type of health insurance by 1998. However, it was not until 2001 when a new government came into power that universal health insurance was introduced to achieve truly universal health coverage.
A summary timeline of the evolution of the health financing system in Thailand until 2001 is summarized in the table below:
| Date of Implementation | Scheme | Coverage in 2001 (Approximated) |
|---|---|---|
| 1962-86 | Gap in the progress on coverage, focus on infrastructure development | |
| 1963 | Civil servants medical benefits scheme | 9% |
| 1975 | Free medical care for low income | 20% |
| 1983 | Community financing (Health Card Phase I – II) | |
| 1990 | Voluntary public health insurance (Health Card Phase III - V) | 13% |
| 1992 | Compulsory Social Security | 11% |
| 1993 | Free medical care for children | 16% |
| 1995 | Free medical care for the elderly | 6% |
| 2000 | Total health insurance coverage | 75% |
Expansion of rural healthcare infrastructure and specifically a rapid expansion of public provincial hospitals, rural district hospitals, and health centers was initiated beginning in 1962. A strong political movement against the military government in 1973 resulted in temporary democracy in Thailand. This, combined with a global focus on “Health for All”, resulted in many policy changes, particularly a big push for a focus on primary health care, universal health coverage, and recruitment of village health volunteers and the establishment of many community-financing schemes in health (e.g., village drug funds, sanitary funds, nutrition funds). The push for expanding rural infrastructure continued into well into 1980. This push resulted in expanded access to essential health services.
This era also allowed progressive student leaders an opportunity to gain rural public health experience and management skills. This group formed the “Rural Doctor Society” in 1978. During this era, trained village health volunteers and village health communicators were used as the main tool in the nation’s primary health care strategy. Their roles were to assist health personnel in delivering basic integrated health care. The village health volunteers have played a significant role in improving access to rural primary health care services.
Between 1975 and 1992, four main insurance schemes were founded:
- The Medical Welfare Scheme (MWS): Established in 1975 under the name “Free medical care for low income” and funded through general taxation. Beneficiaries were the poor with monthly incomes of less than Baht 1,000. Beneficiaries were entitled to free medical services from public health facilities. The scheme was later expanded to cover the elderly, children, veterans, disabled, monks, and priests. The scheme was later renamed the “Medical Welfare Scheme”.
- Health Card Scheme: This was a publicly subsidized voluntary health insurance scheme, which evolved from a community financing project in its early phases. It covered the near-poor population. The voluntary nature of the scheme resulted in problems of selection bias.
- Compulsory Social Security Scheme (SSS): Covered all private employees. This scheme is financed through a tri-party arrangement, namely employees, employers, and central government contributions. Establishments that had 20 employees or more were the first group targeted. The scheme gradually expanded to cover all formally employed employees, even those working in small businesses (as small as 1 employee).
- Civil Servant Medical Benefit Scheme (CSMBS): Civil servants and public employees and their family members were covered by CSMBS. The CSBMS was fully funded from general tax revenue through the Department of the Comptroller’s General, Ministry of Finance.
Beneficiaries of the CSMBS enjoy free choice of providers and the CSMBS pays providers based on a fee for service. However, other schemes have required their beneficiaries to register and seek care at certain first-contact health facilities, either a health center or a hospital. Anyone who bypasses this system must pay out of pocket. The schemes pay providers based on global budget (for MWS and the Health Card Scheme) and capitation payment system (for the Social Security Scheme).
Until 2000, these four public health insurance schemes combined (with a small fraction of private health insurance) covered approximately 75 percent of the population.
Several options and movements originating through “technocrats” and civil societies to move the system towards comprehensive universal coverage were not successful. However these movements created critical mass and legitimacy for the universal coverage movement. Many political parties now tout universal coverage in their election campaigns. And in late 2000, one such political party won the national election with a commitment to provide universal coverage for health care through a “30 Baht to treat all diseases” scheme.
In 2002, the new Thai government passed the National Health Security Act with a great deal of popular support. It has since become one of the most important social tools for health systems reform in Thailand. The new Universal Coverage Scheme (UCS), or “30 Baht Scheme”, combined the already existing Medical Welfare Scheme and the Voluntary Health Card Scheme to expand coverage to an additional 18 million people. Through the Universal Coverage Scheme and other, existing schemes, Thailand has expanded coverage to 65 million people, or roughly 98% of the population.
In 2002, the new Thai government passed the National Health Security Act with a great deal of popular support. It has since become one of the most important social tools for health systems reform in Thailand. The new Universal Coverage Scheme (UCS), or “30 Baht Scheme”, combined the already existing Medical Welfare Scheme and the Voluntary Health Card Scheme to expand coverage to an additional 18 million people. Through the Universal Coverage Scheme and other, existing schemes, Thailand has expanded coverage to 65 million people, or roughly 98% of the population. The Universal Coverage Scheme enrolls those not covered by either the Civil Servant Medical Benefit Scheme (CSMBS) or the Compulsory Social Security Scheme (SSS)) – about 74% of the population. The table below summarizes the various population groups covered by each of the public insurance schemes in Thailand.
| Scheme | Target Population | Population Coverage (as of 2007) |
|---|---|---|
| Universal Coverage Scheme (UCS) | Every Thai citizen not covered under the CSMBS or SSS | 74.6% |
| Civil Servant Medical Benefit Scheme (CSMBS) | Government employees or pensioners and their dependents | 8.01% |
| Compulsory Social Security Scheme (SSS) | Private employees or temporary public employees | 12.9% |
| Private health insurance | Individuals and private firms | 2.16% |
| Total | 98% |
The Universal Coverage Scheme is financed solely from general tax revenue. The Baht 30 copayment was abolished by the next government in November 2006, and the system is now totally free of charge.
The UHC scheme aims to provide universal access to essential health care and reduce catastrophic expenditures from out-of pocket payments by establishing a tax-based financing system and paying providers on a capitation basis. This scheme covers 74.6 percent of the population as of 2007 estimates. The benefits package is a comprehensive package of care, including both curative and preventive care.
Public hospitals are the main providers, covering more than 95 percent of the insured. About 60 private hospitals joined the system and register around 4 percent of the beneficiaries. Private health insurance organizations play no role in this reform, and remain only as a supplemental option for high-income groups.
Since October 2003, the government has also embarked on universal access to antiretroviral drugs (ARVs). Through May 2007, more than 90,000 patients had been registered in the system.
Thailand
Summary of Reforms
In 2002, the new Thai government passed the National Health Security Act with a great deal of popular support. It has since become one of the most important social tools for health systems reform in Thailand. The new Universal Coverage Scheme (UCS), or “30 Baht Scheme”, combined the already existing Medical Welfare Scheme and the Voluntary Health Card Scheme to expand coverage to an additional 18 million people. Through the Universal Coverage Scheme and other, existing schemes, Thailand has expanded coverage to 65 million people, or roughly 98% of the population. The Universal Coverage Scheme enrolls those not covered by either the Civil Servant Medical Benefit Scheme (CSMBS) or the Compulsory Social Security Scheme (SSS)) – about 74% of the population. The table below summarizes the various population groups covered by each of the public insurance schemes in Thailand.
| Scheme | Target Population | Population Coverage (as of 2007) |
|---|---|---|
| Universal Coverage Scheme (UCS) | Every Thai citizen not covered under the CSMBS or SSS | 74.6% |
| Civil Servant Medical Benefit Scheme (CSMBS) | Government employees or pensioners and their dependents | 8.01% |
| Compulsory Social Security Scheme (SSS) | Private employees or temporary public employees | 12.9% |
| Private health insurance | Individuals and private firms | 2.16% |
| Total | 98% |
The Universal Coverage Scheme is financed solely from general tax revenue. The Baht 30 copayment was abolished by the next government in November 2006, and the system is now totally free of charge.
The UHC scheme aims to provide universal access to essential health care and reduce catastrophic expenditures from out-of pocket payments by establishing a tax-based financing system and paying providers on a capitation basis. This scheme covers 74.6 percent of the population as of 2007 estimates. The benefits package is a comprehensive package of care, including both curative and preventive care.
Public hospitals are the main providers, covering more than 95 percent of the insured. About 60 private hospitals joined the system and register around 4 percent of the beneficiaries. Private health insurance organizations play no role in this reform, and remain only as a supplemental option for high-income groups.
Since October 2003, the government has also embarked on universal access to antiretroviral drugs (ARVs). Through May 2007, more than 90,000 patients had been registered in the system.
Thailand provides an example of a country reaching universal coverage using a pluralistic approach. Thailand has a long history of multiple and varied insurance schemes, and even today, different schemes target different populations with different funding sources, administration, and benefits.
Thailand provides an example of a country reaching universal coverage using a pluralistic approach. Thailand has a long history of multiple and varied insurance schemes, and even today, different schemes target different populations with different funding sources, administration, and benefits. While the Thai system has been able to achieve great strides towards achieving universal coverage, the country aims to continually improve the efficiency and effectiveness of its health care system in several ways.
Aligning the pluralistic public health protection system: There is currently a great deal of collaboration going on among the three main implementing offices of social health insurance in Thailand today: the CGD, NHSO and SSO. However, to date there have been only a few success stories from their collaborations. The most successful example is the synchronization of member registration databases, which is a database of the three schemes enrollees that is linked with the Ministry of Interior’s database. Similar types of collaboration among the three agencies are encouraged.
Reforming payment mechanisms: Thailand is working on methods of moving the three schemes towards similar payment mechanisms for similar services. For example, the CSMBS is going to reform its payment mechanism to control for cost escalation. A standard fee schedule, systematic adjudication processes, utilization review, and medical auditing systems are being considered for implementation across schemes. In addition, case-mixed payment for some out-patient services and closed-end budgets are also targeted in the long run. The SSS also plans to reform payment mechanisms by using DRGs for inpatient and risked-adjusted capitation for outpatient care.
Linking preventive services to curative services: The NHSO together with the SSO and the CGD have already implemented the new periodic health examination as a risk stratification tool. The goal of this screening and evaluation program is to prevent the onset of disease and/or provide warning of existing disease. A further goal of the periodic health examination is to educate patients about behavioral patterns or environmental exposures that pose risks for future diseases. Once identified, risky groups will be informed of their predisposition and encouraged to join risk modification programs and undertake appropriate treatment under standard care maps.
Preparing for an aging society: Survey data from 2005 found that decreasing total fertility rates and longer life expectancies are going to contribute towards an aging society in Thailand. Therefore, Thailand is studying strategies to ensure a healthy and productive elder society. Social health protection schemes have to not only guarantee access for everyone, especially the elderly, but also actively improve health service benefits in such a way as to encourage healthier lifestyles. Long term care for the elderly is another important issue for Thailand.
Improving equity, quality and efficiency through primary care: One of Thailand’s main strategies is to strengthen primary care services and increase the availability of care. The current government has already launched medium term projects to increase the capacity of the public sector to deliver primary care centers and hospitals. However, it is still too early to say that primary care is well established in Thailand.
Thailand
The Way Forward
Thailand provides an example of a country reaching universal coverage using a pluralistic approach. Thailand has a long history of multiple and varied insurance schemes, and even today, different schemes target different populations with different funding sources, administration, and benefits. While the Thai system has been able to achieve great strides towards achieving universal coverage, the country aims to continually improve the efficiency and effectiveness of its health care system in several ways.
Aligning the pluralistic public health protection system: There is currently a great deal of collaboration going on among the three main implementing offices of social health insurance in Thailand today: the CGD, NHSO and SSO. However, to date there have been only a few success stories from their collaborations. The most successful example is the synchronization of member registration databases, which is a database of the three schemes enrollees that is linked with the Ministry of Interior’s database. Similar types of collaboration among the three agencies are encouraged.
Reforming payment mechanisms: Thailand is working on methods of moving the three schemes towards similar payment mechanisms for similar services. For example, the CSMBS is going to reform its payment mechanism to control for cost escalation. A standard fee schedule, systematic adjudication processes, utilization review, and medical auditing systems are being considered for implementation across schemes. In addition, case-mixed payment for some out-patient services and closed-end budgets are also targeted in the long run. The SSS also plans to reform payment mechanisms by using DRGs for inpatient and risked-adjusted capitation for outpatient care.
Linking preventive services to curative services: The NHSO together with the SSO and the CGD have already implemented the new periodic health examination as a risk stratification tool. The goal of this screening and evaluation program is to prevent the onset of disease and/or provide warning of existing disease. A further goal of the periodic health examination is to educate patients about behavioral patterns or environmental exposures that pose risks for future diseases. Once identified, risky groups will be informed of their predisposition and encouraged to join risk modification programs and undertake appropriate treatment under standard care maps.
Preparing for an aging society: Survey data from 2005 found that decreasing total fertility rates and longer life expectancies are going to contribute towards an aging society in Thailand. Therefore, Thailand is studying strategies to ensure a healthy and productive elder society. Social health protection schemes have to not only guarantee access for everyone, especially the elderly, but also actively improve health service benefits in such a way as to encourage healthier lifestyles. Long term care for the elderly is another important issue for Thailand.
Improving equity, quality and efficiency through primary care: One of Thailand’s main strategies is to strengthen primary care services and increase the availability of care. The current government has already launched medium term projects to increase the capacity of the public sector to deliver primary care centers and hospitals. However, it is still too early to say that primary care is well established in Thailand.