International Health Policy Program, Ministry of Public Health, Tivanon Road, Muang District, Nonthaburi Province 11000, Thailand.
National Health Security Office, Nonthaburi, Thailand.
Bull World Health Organ. 2020 Feb 1;98(2):140-145. doi: 10.2471/BLT.19.239343. Epub 2019 Nov 18.
The challenge of implementing contributory health insurance among populations in the informal sector was a barrier to achieving universal health coverage (UHC) in Thailand.
UHC was a political manifesto of the 2001 election campaign. A contributory system was not a feasible option to honour the political commitment. Given Thailand's fiscal capacity and the moderate amount of additional resources required, the government legislated to use general taxation as the sole source of financing for the universal coverage scheme.
Before 2001, four public health insurance schemes covered only 70% (44.5 million) of the 63.5 million population. The health ministry received the budget and provided medical welfare services for low-income households and publicly subsidized voluntary insurance for the informal sector. The budgets for supply-side financing of these schemes were based on historical figures which were inadequate to respond to health needs. The finance ministry used its discretionary power in budget allocation decisions.
Tax became the sole source of financing the universal coverage scheme. Transparency, multistakeholder engagement and use of evidence informed budgetary negotiations. Adequate funding for UHC was achieved, providing access to services and financial protection for vulnerable populations. Out-of-pocket expenditure, medical impoverishment and catastrophic health spending among households decreased between 2000 and 2015.
Domestic government health expenditure, strong political commitment and historical precedence of the tax-financed medical welfare scheme were key to achieving UHC in Thailand. Using evidence secures adequate resources, promotes transparency and limits discretionary decision-making in budget allocation.
在非正规部门的人群中实施缴费型医疗保险面临挑战，这是泰国实现全民健康覆盖（UHC）的障碍。
UHC 是 2001 年竞选活动的政治宣言。缴费制度不是兑现政治承诺的可行选择。考虑到泰国的财政能力和所需的额外资源数量适中，政府立法规定，将一般税收作为全民覆盖计划的唯一资金来源。
在 2001 年之前，有四个公共健康保险计划仅覆盖了 6350 万人口中的 70%（4450 万）。卫生部收到预算并为低收入家庭提供医疗福利服务，并为非正规部门提供公共补贴的自愿保险。这些计划的供应方融资预算是基于历史数据的，不足以满足健康需求。财政部在预算分配决策中行使其酌处权。
税收成为全民覆盖计划的唯一资金来源。透明度、多方利益相关者参与和使用证据为预算谈判提供了信息。为 UHC 提供了充足的资金，为弱势群体提供了服务和财务保障。2000 年至 2015 年间，家庭自付支出、医疗致贫和灾难性卫生支出有所减少。
国内政府卫生支出、强有力的政治承诺和税收资助的医疗福利计划的历史先例是泰国实现 UHC 的关键。使用证据可以确保充足的资源，提高透明度，并限制预算分配中的酌处决策。
