Social security system can be achieved through 3 basic approaches, i.e. (a) public assistance to the indigent, (b) social service or public service to all citizen and, (c) social insurance by pooling resources and risks between members in a society. Health security in Thailand is based on a mixture of the first and the third approach and the existing health insurance and health welfare schemes in Thailand it may be categorized into 4 main groups:
1) public assistance to the indigence (the poor, the elderly, children).
2) health benefits for government employees.
3) compulsory health insurance for formal sector employee.
4) voluntary health insurance.
The following table summarizes all important events about health insurance and welfare schemes chronologically.
3.2 Public Assistance to the Indigence
The government policy to provide free medical care for the low income was initiated by the Social Action Party in 1975, together with other free public services such as public transportation, with an objective to reduce inequity in access to public service. While free public transportation failed to be implemented, the Free Medical Care for the Low Income Scheme has been continuing until nowadays and covers people more than any other schemes.
At the beginning, it was determined that a person with income below 1,000 Baht per month would be eligible for welfare benefit. During 1976=1980 there was no identification card to those eligible. The decision to provide free care was at discretion of staffs of public health facilities. The first issuance of the Low Income Card was done in 1981 and resistance every 3 years.
In 1994, the name of the scheme was changed to “Medical Welfare Scheme” for the Low Income. Apart from adjusting the income level for eligibility, no other significant change was made.
In practice, MOPH hospitals have 3 categories of assistance:
(1) Type A assistance for those who have Low Income Card or nowadays Medical Welfare Card.
(2) Type B assistance for those who have no card but are unable to pay for medical expenditure. Social workers in hospitals will interview and determine to what extent the hospitals will exempt for them.
(3) Type C assistance for monks, village leaders, veteran, members of local councils, etc. The degrees of assistance in this group vary from free service to some deduction.
Apart from assisting the low income group, the government also has policies to assist various groups of people, i.e. the elderly, children 0-12 years old. The disables.
3.3 Health Benefits for Government Employees
Health benefits have long been included as fringe benefits and privilege for civil servants. It was only during the last 5 years that civil servants were suffered as “the new poor” and health benefits were considered to be compensation for low salaries.
At first there were rules and regulations for medical allowance reimbursement for civil servants and permanent workers of the government. In 1978, the first Royal Decree for Civil Servant Medical Benefits Scheme was enacted, and 2 years later it was replaced with the present one, of which underwent series of adjustment.
Each state enterprise will have its own rules and regulations for medical benefits of its employees, of which similar to the Royal Decree for CAMBS. Only choice of health service and rate of reimbursement that differ.
