Success of UHC scheme wins praise of UK expert but challenges lie ahead

Success of UHC scheme wins praise of UK expert but challenges lie ahead

Some challenges still lie ahead as state-funded scheme evolves

The Universal Healthcare Coverage scheme (UHC) is a success story in terms of providing affordable healthcare, deputy director of the London School of Hygiene and Tropical Medicine Anne Mills says.

"The [UHC] scheme that was put in place in 2001 is a system which Thailand has managed to sustain over time, without having it collapse," Ms Mills said.

Ms Mills, who is known for her expertise in health economics, has monitored UHC and public health systems in low-and middle-income countries. Thailand's achievement in sustaining the UHC over the past 17 years is considered "unusual", she said.

The tax-funded UHC was launched five years after the 1997 Asean financial crisis. At that time, Thailand was a lower-middle-income country and there were fears that a free healthcare programme would bankrupt the government.

However, that has not happened so far. The UHC scheme is financially managed through "capitation" -- a healthcare payment method in which hospital operators are paid a fixed amount, based on the number of people living in hospital districts.

According to the National Health Security Office (NHSO), the government spent around 56 billion baht, equivalent to 1,202 baht per head, to fund the UHC in 2003.

The scheme's budget was tripled this year, climbing to 166 billion baht or equivalent to 3,427 baht per head. Yet, the UHC fund still accounts for less than 1% of domestic GDP.

"The budget has been increasing year on year but I think it remains affordable for Thailand. The country does not spend that much GNP [Gross National Product] on healthcare. It's still around 5% or 6%, which is a very reasonable level for Thailand."

International observers have praised the UHC scheme for being "revolutionary". Before the launch of the scheme, governments spent on selective poverty-relief programmes such as medical fee subsidies and handouts for the poor.

Most of these programmes were based on top-down decisions, meaning the sustainability of the programmes depended largely on the "consideration" of government officials.

However, the design of the UHC scheme has taken a different approach. The scheme is non-selective and fully funded by the government and backed by the law. This means the government must commit to allocating a budget to the scheme annually.

Since the Universal Healthcare Coverage scheme was piloted in 2001 and launched a year later, it has provided healthcare access to over 48 million people in Thailand.

"I think the decision to use tax funding was the right decision, and that's why Thailand was able to move quickly with UHC. Focusing on general taxation is critical to the progress that was made," Ms Mills said.

"In some countries, it's difficult to expand social security beyond the formal sector of employment and voluntary health insurance. Many countries are not keen to allocate government revenue to health."

However, despite its success, the UHC has come under pressure on several fronts.

An NHSO survey on health providers -- including hospital operators, doctors and medical staff -- found that 46% and 70% of respondents felt satisfied with UHC's operation in 2003 and 2017 respectively.

A similar survey conducted among UHC beneficiaries found 83% and 96% felt satisfied.

"With UHC, it's always a trade-off between managing the expectations of the health workforce and patients," said Ms Mills.

"I think no system is perfect. When you remove the prices that people pay at the point of treatment, there will be more people that can afford care. But I still believe it's important for the treatment to be free."

Some other challenges also lie ahead for the UHC scheme such as the increasing prevalence of non-communicable diseases and the shift towards an ageing population -- which are also challenges faced by high-income countries such as the UK where Ms Mills lives.

"For the elderly, you have to sometimes to plan for that. One of the big challenges is to manage the balance of health services and other available services to keep people in their own home in order to make sure they don't end up in the hospital if they don't need to be there," Ms Mills added.

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