318th Meeting - Tuesday, December 8, 2009
Universal Health Care in
Present: Edward Rose, Caroline Ford, Bodil Blokker, Bruce Kennedy, Louis Gabaude, Helene Lepiray, Joel Akins, Patrice Victon, John Cadet, Edward van Tuyll. An audience of 10.
Background on Presenter:
This research was presented by Joseph Harris, a PhD candidate in Sociology from the University of Wisconsin-Madison. Joseph has a background in public policy, having worked with the World Bank, UNDP, and Grameen Foundation and having received a Master's degree in Public Affairs from the Woodrow Wilson School of Public and International Affairs at Princeton University.
A number of middle income countries, including
were anything but expected. What accounts for these shifting state obligations towards health care in newly industrial countries? How have these commitments played out in practice?
In 2001, a new program called the "30 baht to cure all diseases" program consolidated two of the programs - the Low Income Health Card and the Voluntary Health Card - and extended coverage to an additional 30% of the population that had previously been excluded. While my work was interested in the overall historical development of these programs, the major focus of my research explored the development and implementation of the major reform in 2001, which was also called the Universal Coverage (UC) program by technocrats within the Ministry of Public Health.
While the media and many scholars typically credit Thaksin Shinawatra's Thai Rak Thai with the reform, my work examined the role of other actors in the policy's development, including international organizations, local NGOs, and academics. My historical research also examined fissures within the medical profession itself.
The ideas for universal health care in
Universal Health Care policy.
The second part of my research explores how
the Social Security scheme and now include such high-tech treatments as HIV/AIDS medication, cancer drugs, dialysis, and methadone replacement therapy. The reform also had major consequences in terms of strengthening the health care system as a whole.
However, the reform caused a number of tensions as well, among them consternation in the medical profession and long wait times at participating secondary and tertiary health care facilities. The new scheme also brought attention to the fact that different kinds of benefits
are available among the different government health insurance programs as well as differences between public and private providers.
In terms of cost, the scheme's budget has more than doubled since it started in 2001. Since it was under-budgeted initially, this has put its budget more in line with what some health economists thought to be a reasonable amount. Currently, while some participating hospitals face problems balancing their books since the scheme's introduction, enough money exists in the system as a whole to prevent the system from collapsing. Economists are continuing to make adjustments to the budget formulas to ensure appropriate levels of admissions and referrals at participating hospitals. The reform is a work in progress.
In terms of sustainability, most health economists agree that the Civil Service Medical Benefit Scheme, not the UC program, is the biggest threat to the financial sustainability of the country's health care system today. At a budget of 60,000 million baht, that program covers less than 10% of the population. The UC program, by contrast, covers nearly 80% of the
population but has a budget that is just under double the amount of the civil service program. In many ways, the fee-for-service structure of the civil service program is similar to the structure of the private health insurance system in the
proves politically feasible).
Conventional accounts of universal health care development in
historical work explore local social movements in other cases in which states in middle income countries recently made expansive commitments to health care.