Situation Analysis Health

Before 1995, an access to health care in Thailand is not mentioned as a basic right for every Thai citizen.  Almost 44% of total population has not been covered by any health insurance or welfare system.  They have to pay by their own, but not at full cost if they go to public hospitals because of subsidization from the government.  Those who cannot afford can get free service or deduction based on social worker discretion at public hospitals.  However, government subsidy does not match with the real expenditure and thus undermines the public hospital financial status.

In 1995, the parliament approved the amendment of the constitution.  Article 41 of the constitution states that ‘people have right to get access to standard health care and the poor can get free medical care’.  The implementation is going on with drafting relevant laws.

Criticism

Health insurance and welfare schemes vary widely in the target population, benefits package, and fund managers, source of funding, payment mechanism and government subsidy.  Hsiao W (1993) criticized that Thailand has a three-tiered health care system.  The bottom tier for the poor, of which services are rationed by limiting supply.  The middle tier for middle income people.  And the top tier for upper income persons who pay directly and freely choose their services.

Though the classification of these tiers are not fully correct, it stimulates us to look closely at what are we doing in our system and to what direction it will be.  Hsiao W further questioned on the cost-effectiveness of resource used comparing with its peer nations.

As equity, efficiency and quality of care seem to be the universal goals for every developed countries, one may question how far Thailand being from these goals.

Objectives

The objectives of this paper are:

(1) to review the extent of existing health insurance schemes on     population coverage, benefits package given, mode of health service delivery, mode of financing, quality of care and health service utilization.
(2) to assess the strengths and weakness of existing schemes in term of, efficiency and equity including moral hazards and adverse selection.
(3) to explore future development to achieve equity, efficiency and quality of health insurance system in Thailand.