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Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms

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  • Hughes, David
  • Leethongdee, Songkramchai
  • Osiri, Sunantha

Abstract

Thailand's universal coverage health care policy has been presented as a knowledge-based reform involving substantial pre-planning, including expert economic analysis of the financing mechanism. This paper describes the new financing system introduced from 2001 in which the Ministry of Public Health allocated monies to local Contracted Units for Primary Care (CUPs) on the basis of population. It discusses the policy intention to use capitation funding to change incentive structures and engineer a transfer of professional staff from over-served urban areas to under-served rural areas. The paper utilises qualitative data from national policy makers and health service staff in three north-eastern provinces to tell the story of the reforms. We found that over time government moved away from the original capitation funding model as the result of (a) a macro-allocation problem arising from system disturbance and professional opposition, and (b) a micro-allocation problem that emerged when local budgets were not shared equitably. In many CUPs, the hospital directors controlling resource allocation channelled funds more towards curative services than community facilities. Taken together the macro and micro problems led to the dilution of capitation funding and reduced the re-distributive effects of the reforms. This strand of policy foundered in the face of structural and institutional barriers to change.

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  • Hughes, David & Leethongdee, Songkramchai & Osiri, Sunantha, 2010. "Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms," Social Science & Medicine, Elsevier, vol. 70(3), pages 447-454, February.
    • Handle: RePEc:eee:socmed:v:70:y:2010:i:3:p:447-454
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    1. Mills, Anne & Bennett, Sara & Siriwanarangsun, Porntep & Tangcharoensathien, Viroj, 2000. "The response of providers to capitation payment: a case-study from Thailand," Health Policy, Elsevier, vol. 51(3), pages 163-180, April.
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    3. Suraratdecha, Chutima & Saithanu, Somying & Tangcharoensathien, Viroj, 2005. "Is universal coverage a solution for disparities in health care?: Findings from three low-income provinces of Thailand," Health Policy, Elsevier, vol. 73(3), pages 272-284, September.
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    Cited by:

    1. Daniel Chukwuemeka Ogbuabor & Obinna Emmanuel Onwujekwe, 2019. "Aligning public financial management system and free healthcare policies: lessons from a free maternal and child healthcare programme in Nigeria," Health Economics Review, Springer, vol. 9(1), pages 1-10, December.
    2. Supon Limwattananon & Sven Neelsen & Owen O'Donnell & Phusit Prakongsai & Viroj Tangcharoensathien & Eddy van Doorslaer, 2013. "Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand," Tinbergen Institute Discussion Papers 13-067/V, Tinbergen Institute.
    3. Li, Cheng & Yu, Xuan & Butler, James R.G. & Yiengprugsawan, Vasoontara & Yu, Min, 2011. "Moving towards universal health insurance in China: Performance, issues and lessons from Thailand," Social Science & Medicine, Elsevier, vol. 73(3), pages 359-366, August.
    4. Thoresen, Stian H. & Fielding, Angela, 2011. "Universal health care in Thailand: Concerns among the health care workforce," Health Policy, Elsevier, vol. 99(1), pages 17-22, January.
    5. Panpiemras, Jirawat & Puttitanun, Thitima & Samphantharak, Krislert & Thampanishvong, Kannika, 2011. "Impact of Universal Health Care Coverage on patient demand for health care services in Thailand," Health Policy, Elsevier, vol. 103(2), pages 228-235.
    6. Limwattananon, Supon & Neelsen, Sven & O'Donnell, Owen & Prakongsai, Phusit & Tangcharoensathien, Viroj & van Doorslaer, Eddy & Vongmongkol, Vuthiphan, 2015. "Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand," Journal of Public Economics, Elsevier, vol. 121(C), pages 79-94.

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