The adjustment of universal health insurance by health policy, strategic planning and health economics in Thailand

The Thai healthcare system of the 1990s, characterized by fragmentation, duplication and inadequate coverage in the existing public provision, could not achieve the health system goals of efficiency and equity. It did not allow collective financing to harness monopolistic purchasing power to send the right signals to health care providers to increase efficiency. Fee-forservice, the dominant mode of provider payment, exacerbated cost containment problems, as seen by faster health expenditure growth than GDP growth, even during periods of recession. In the absence of effective primary care, most of the poor receive care in hospitals that are expensive, have long waiting lines and offer unsatisfactory services. In 1999, two important Acts were promulgated, i.e., the Public Organization Act and the Decentralization Act. If this movement proves to be a success, there will be many more public independent hospitals. This was followed in 2001 by the introduction of universal health care coverage in Thailand, a development which seemed to open the way for hospitals to operate as providers alongside an active purchaser in the form of the National Health Security Office.The objective of this study was to describe the new health insurance system in Thailand and evaluate progress towards improving equity and efficiency. It took the form of documentary research involving a reviewing of official documents and academic commentary on the developing Thai health insurance system in the 1995 - 2007 period, and particularly after 2001