Achieving Universal Health Coverage in Thailand: Fiscal Space and Policy Sustainability
Viroj Tangcharoensathien, Walaiporn Patcharanarumol, Woranan Witthayapipopsakul
BMJ Global Health · 2019 · DOI: 10.1136/bmjgh-2019-001467
Countries: Thailand
What Was Studied
This paper examines how Thailand achieved and sustained universal health coverage (UHC) since 2002, focusing on the fiscal policies, political economy, and institutional arrangements that made the Universal Coverage Scheme (UCS) possible and financially sustainable over nearly two decades.
What They Found
Thailand's UCS succeeded through several key factors: (1) general tax financing rather than contributory premiums, which ensured coverage of the informal sector; (2) a closed-ended capitation payment system that controlled costs; (3) strong political commitment across government changes; (4) strategic purchasing through the National Health Security Office; (5) total health expenditure remained at 3.5-4.5% of GDP, demonstrating fiscal sustainability. Out-of-pocket spending fell from 33% to 11% of total health expenditure.
What This Means for Nepal
Nepal's Social Health Insurance scheme currently uses contributory premiums, which creates barriers for the large informal sector (over 80% of workers). Thailand's success with tax-financed UHC at a similar income level suggests Nepal could consider shifting to a tax-based model. The capitation payment system and strong purchasing agency (NHSO) are institutional innovations Nepal could adapt. However, Thailand had stronger fiscal capacity and administrative infrastructure — Nepal would need to build these concurrently.
Contextualisation
Thailand achieved UHC in 2002 with a GDP per capita similar to Nepal's current level. Their experience with the Universal Coverage Scheme — funded through general taxation rather than contributory insurance — offers a directly relevant model for Nepal's Social Health Insurance programme.