Situation Analysis Health

The HCP was originally an attempt to develop appropriate model for implementation of maternal and child care and immunization in the context of Primary Health Care(PHC).  These elements of PHC often require visits to health facilities, and therefore effective basic health services are needed in addition to community self-help.  A prepaid health insurance scheme in which benefits of MCH/immunization/curative care are ensured by “Health Card” was formulated.  The HCP was initially known as “Maternal and Child Health (MCH) Development Programmer through the Health Card Scheme”, and was implemented in 1983 on an experimental basis in 18 villages in 7 provinces.  The scheme offered 2 major benefit policies: one covered only MCH and immunization services, another was curative care.  In the course of programmer implementation, the medical care insurance component became more and more prominent.  Toward the middle of 1984, the program was renamed as Health Card Project with the following objectives:

1) To promote services for maternal and child health, family planning; other health promotion, prevention and curative services.
2) To change the role of the population and health personnel so that communities could initiate and participate in the management and health personnel would support and provide the necessary services.
3) To improve the potential of the communities in financial management and to improve the quality and effectiveness of health care personnel.
4) To reduce the number of out-patient visits at provincial hospitals and use the saved resources for more efficient activities.

The fundamental philosophy of the HCP has much to do with primary health care development at the village and tambon levels, and improvement of back-up referral facilities.  The communities through the Health Card Funds were expected to manage the premium collected; a certain percentage of funds are earmarked for village PHC and other development activities.  (Hongvivatana T et al., 1986)

The German Agency for Technical Cooperation (GTZ) supported this project in a pilot area of Chiangmai from 1984 to 1988.  After a program evaluation, the second phase started in 1990 to support 5 project provinces in implementation a new model of Health Care Scheme.  The project province considered multiple objectives of the scheme, community development and health insurance, as a failure factor.  The objective of community development succeeds in not many places, so the only objective in tee new model was voluntary health insurance.  After testing the new model in 1991-1992 and the results were report in August 1993, the GTZ terminated support to the project (Supachutikul A & Sirinirund T, 1993).  The MOPH adopted the new model of HCP at national level in 1994 under its new name, “the Health Insurance Card”, and with subsidization from the government. It was hope that the scheme will make universal coverage of the country possible.  However, some lessons and suggestions from the report of model testing were not considered seriously.

The health Insurance Card is purely voluntary health insurance scheme.  However, there are other 2 varieties of Health Insurance Cards designed to accommodate the need of providing medical coverage to those who work for the government at village level, i.e. community leaders and village health volunteers.  The card for these two groups are issued free of prepaid premium to provide coverage to them and their family members, hence these variants are a kind of fringe benefits to the government employees.  However, the government policy on health benefits for community leader was not stable.