Deepika Khurana explains five key lessons Asian countries can learn from Thailand’s UHC model.

By Deepika Khurana

The most ambitious healthcare reform ever undertaken in a developing country, Thailand’s Universal Health Coverage (UHC) scheme has led to dramatic improvements in various health parameters, including infant mortality rates and life expectancy. The number of children dying in the first five years of life, for example, reduced to less than 1.2 per cent, while life expectancy increased from 57 and 61 years in 1964 to 72 and 79 years in 2018 for men and women, respectively.

Here’s looking at five key lessons Asian countries can learn from Thailand’s UHC model:

1. Start with political commitment

Although Thailand had made attempts to introduce UHC, in bits and pieces, for almost three decades, it was only in 2001 that things truly changed.
With the election of a new government that was committed to implementing UHC in letter and spirit, Thailand proved to the world that with a well-researched system and political commitment, healthcare for all is achievable.

It’s commendable for a developing Asian country to provide free equitable access to healthcare services, medicines and full-financial protection to its citizens. Earlier, before the implementation of the universal healthcare, Thailand had four different state health insurance schemes for its population but despite that, about one-quarter of people remained uninsured and many of them had policies that granted incomplete protection. As a result, the country was in shackles of healthcare crisis.

2. Put the systems in place

Several factors worked in favour of Thailand’s UHC; the most important one is, arguably, the extensive geographical reach with the functional primary healthcare system. Successive governments invested in the health workforce and infrastructure to ensure long-term sustainability. Besides, the policymakers also came up with noteworthy amendments, such as shutting down or consolidating hospitals that were allocated government budgets but were unable to attend to more patients due to quality concerns.
The Thai policymakers adopted a very pragmatic approach. For example, knowing that physicians and nurses were in short supply, they hired young women with high school diplomas and provided them with necessary training and certification to gradually augment the health workforce.

3. Use the right strategy

The most feature factor of Thailand’s UHC was that it ensured citizens a comprehensive health package, without any co-payment, resulting in a substantial reduction in household spending on healthcare. The Thai model is commendable for being locally initiated and financed, making it independent of donor resources.

The government chalked out financing and gatekeeping arrangements that tied patients to medical homes in the vicinity and provided fixed annual payments for physicians to cover outpatient care. This aided in curbing the cost escalation, besides improving the quality of care for patients, especially in remote areas. Moreover, for the ease of monitoring, they leveraged technology extensively. The national civil registration database forms the backbone of all health schemes in the country, ensuring that a beneficiary cannot enrol in two schemes at the same time.

4. Dare to innovate

Thailand’s innovative policy that dealt with the production of generic medication for the universal coverage program contributed immensely to the success of the UHC model. Designed by the reformers and the Government Pharmaceutical Organisation, this policy allowed them to produce generic versions of patented medication under the World Trade Organization (WTO) law at reasonable prices.

As a low middle-income country, Thailand’s innovation in healthcare is an inspiration for both, developed and developing countries, seeking to improve the health outcomes of their citizens at a controlled cost.

5. Make it co-exist

Thailand’s UHC has seen its share of detractors too. Medical associations and beneficiaries of existing programmes for civil servants and employees of large, tax-paying businesses initially perceived the new healthcare reform as a threat. They feared that their own benefits would be diluted by a single-payer programme. However, over the years, the new healthcare programme managed to find its place, alongside separate programmes for civil servants and other tax-paying employees. Thailand has proved to the world that they do not have to join the ranks of the world’s wealthiest nations to provide citizens with easy and equitable access to healthcare. In fact, Thailand is now serving as an advisory and technical partner to Kenya in its bid to implement UHC. Such partnerships enable valuable knowledge transfer to other countries, helping them to make healthcare more accessible and affordable.