Pannarunothai Supasit, Patmasiriwat Direk, Srithamrongsawat Samrit
Faculty of Medicine, Centre for Health Equity Monitoring, Naresuan University, Phitsanulok 65000, Thailand.
Health Policy. 2004 Apr;68(1):17-30. doi: 10.1016/S0168-8510(03)00024-1.
Inequality in health between rich and poor in Thailand was well documented; millions of informal workers and their families lacked health insurance; and the poor paid more proportionately in income for health care. The universal coverage is conceived as one of the means to redress the situation. But the term 'universal coverage' may mean differently among different groups of stakeholders. This paper, based on empirical research of health policy reform, collected perceptions and ideas from stakeholders and discusses the ways and strategies that universal coverage might take shape in Thailand. Two sources of information were taken: one from the questionnaire survey (according to the Delphi technique, two rounds of survey were taken), another an in-depth interview. Obtained information for policy formulation included how best, as conceived by stakeholders, to implement the universal coverage, sources of finance, fiscal implication for Thai government, ways to prevent higher demand for unnecessary services, and involvement of local government. Recent policy move in Thailand (the so-called 30 baht for all diseases) emerged in 2001 generated hot debate nationwide. The programme is currently in its early phase and is likely to evolve overtime--i.e. whether or not this programme will be financed by certain types of taxes or from annual government expense still unclear; and budget allocation among different health providers still unsettled. Anyhow this programme may be interpreted as a policy shift away from the pro-market based toward a government-supported egalitarianism.
泰国贫富之间的健康不平等状况有充分记录；数百万非正规工人及其家庭缺乏医疗保险；穷人在医疗保健方面的收入支出比例更高。全民覆盖被视为纠正这种状况的手段之一。但“全民覆盖”一词在不同利益相关群体中可能有不同含义。本文基于对卫生政策改革的实证研究，收集了利益相关者的看法和观点，并讨论了全民覆盖在泰国可能形成的方式和策略。采用了两种信息来源：一种来自问卷调查（根据德尔菲技术进行了两轮调查），另一种是深入访谈。为政策制定获取的信息包括利益相关者认为实施全民覆盖的最佳方式、资金来源、对泰国政府的财政影响、防止对不必要服务的更高需求的方法以及地方政府的参与情况。泰国最近在2001年出台的政策举措（所谓的“所有疾病30铢”）在全国引发了激烈辩论。该计划目前处于早期阶段，可能会随着时间的推移而演变——即该计划是否将由某些类型的税收或政府年度支出提供资金仍不清楚；不同医疗服务提供者之间的预算分配也尚未确定。无论如何，这一计划可被解释为从亲市场转向政府支持的平等主义的政策转变。
