Defining the Benefit Package of Thailand Universal Coverage Scheme: From Pragmatism to Sophistication

Document Type : Editorial

Authors

1 International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand

2 National Health Security Office, Bangkok, Thailand

Abstract

Benefit package is crucial for implementing universal health coverage (UHC). This editorial analyses how the benefit package of the Thai Universal Coverage Scheme (UC Scheme) evolved from an implicit comprehensive package which covered all conditions and interventions (with a few exceptions), to additional explicit positive lists. In 2002 when the Thai UC Scheme was launched; the comprehensive benefit package, including medicines in the national essential list of medicines, formerly offered by the previous schemes were pragmatically adopted. Later, when capacities of producing evidence on health technology assessment (HTA) increased, rigorous assessment of cost effectiveness is mandatorily required for inclusion of new interventions into the Thai UC Scheme benefit package. This contributed to evidence-informed policy decisions. To prevent emptied promises, whichever policy choices are made about the benefit package, either using a negative or a positive list, developing country governments need to make quality health services available and accessible by the entire population. Political decision on benefit package should be informed by evidence on cost effectiveness, equity dimension and health system capacity to deliver equitable services. Low- and middle-income countries need to strengthen HTA capacity to generate evidence and inform policies.

Keywords

Main Subjects


  1. Hayati R, Bastani P, Kabir MJ, Kavosi Z, Sobhani G. Scoping literature review on the basic health benefit package and its determinant criteria. Global Health. 2018;14(1):26. doi:10.1186/s12992-018-0345-x
  2. Kieslich K, Bump JB, Norheim OF, Tantivess S, Littlejohns P. Accounting for technical, ethical, and political factors in priority setting. Health Syst Reform. 2016;2(1):51-60. doi:10.1080/23288604.2016.1124169
  3. Glassman A, Giedion U, Sakuma Y, Smith PC. Defining a health benefits package: what are the necessary processes? Health Syst Reform. 2016;2(1):39-50. doi:10.1080/23288604.2016.1124171
  4. Paris V. Health benefits plans in OECD countries. Inter-American Development Bank; 2015.
  5. Tangcharoensathien V, Prakongsai P, Limwattananon S, Patcharanarumol W, Jongudomsuk P. From targeting to universality: lessons from the health system in Thailand. In: Townsend P, ed. Building Decent Societies: Rethinking the Role of Social Security in Development. London: Palgrave Macmillan; 2009:310-322.
  6. National Statistical Office, 2017. National Health and Welfare Survey 2017. https://bit.ly/2EEONiC.  Accessed September 20, 2019.
  7. The World Bank. World Development Indicators. https://data.worldbank.org/data-catalog/world-development-indicators.  Published 2019. Accessed September 13, 2019.
  8. Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Mills A. Health systems development in Thailand: a solid platform for successful implementation of universal health coverage. Lancet. 2018;391(10126):1205-1223. doi:10.1016/s0140-6736(18)30198-3
  9. Tejapira K. The irony of democratization and the decline of royal hegemony in Thailand. Southeast Asian Stud. 2016;5(2):219-237. doi:10.20495/seas.5.2_219
  10. Tangcharoensathien V, Pitayarangsarit S, Patcharanarumol W, et al. Promoting universal financial protection: how the Thai universal coverage scheme was designed to ensure equity. Health Res Policy Syst. 2013;11:25. doi:10.1186/1478-4505-11-25
  11. Chaikledkaew U, Kittrongsiri K. Guidelines for health technology assessment in Thailand (second edition)--the development process. J Med Assoc Thai. 2014;97 Suppl 5:S4-9.
  12. Mohara A, Yamabhai I, Chaisiri K, Tantivess S, Teerawattananon Y. Impact of the introduction of government use licenses on the drug expenditure on seven medicines in Thailand. Value Health. 2012;15(1 Suppl):S95-99. doi:10.1016/j.jval.2011.11.016
  13. Wibulpolprasert S, Chokevivat V, Oh C, Yamabhai I. Government use licenses in Thailand: The power of evidence, civil movement and political leadership. Global Health. 2011;7:32. doi:10.1186/1744-8603-7-32
  14. Suchonwanich N, Wananukul W. Improving access to antidotes and antivenoms, Thailand. Bull World Health Organ. 2018;96(12):853-857. doi:10.2471/blt.18.217075
  15. Sruamsiri R, Wagner AK, Ross-Degnan D, et al. Expanding access to high-cost medicines through the E2 access program in Thailand: effects on utilisation, health outcomes and cost using an interrupted time-series analysis. BMJ Open. 2016;6(3):e008671. doi:10.1136/bmjopen-2015-008671
  16. Chuengsaman P, Kasemsup V. PD first policy: Thailand's response to the challenge of meeting the needs of patients with end-stage renal disease. Semin Nephrol. 2017;37(3):287-295. doi:10.1016/j.semnephrol.2017.02.008
  17. Youngkong S, Baltussen R, Tantivess S, Mohara A, Teerawattananon Y. Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand. Value Health. 2012;15(6):961-970. doi:10.1016/j.jval.2012.06.006
  18. Ginsburg PB. Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment. Health Aff (Millwood). 2012;31(9):1977-1983. doi:10.1377/hlthaff.2012.0350
  19. Velasco-Garrido M, Schreyögg J, Stargardt, Busse R. Identification of health baskets in nine EU countries. Rev Fr Aff Soc. 2006;6:63-88.
  20. Guldbrandsson K, Fossum B. An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena. Health Promot Int. 2009;24(4):434-444. doi:10.1093/heapro/dap033
  21. Musgrove P, Fox-Rushby J. Cost-effectiveness analysis for priority setting. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease Control Priorities in Developing Countries. 2nd ed. New York: Oxford University Press; 2006:271-285.
Volume 9, Issue 4
April 2020
Pages 133-137
  • Receive Date: 19 August 2019
  • Revise Date: 17 October 2019
  • Accept Date: 18 October 2019
  • First Publish Date: 01 April 2020