What Thailand can teach the world about universal healthcare
While countries all over the world are moving toward universal healthcare, for many it remains just a goal. But a handful of them have rolled out universal health coverage schemes, and there’s plenty to learn from these nations. Consider Thailand, where leaders successfully implemented sweeping healthcare reform without breaking the bank.
In 2000, about one-quarter of people in Thailand were uninsured, and many other people had policies that granted incomplete protection. As a result, the country was in a healthcare crisis. More than 17,000 children younger than five died that year, about two-thirds of them from easily preventable infectious diseases. And about 20% of the poorest Thai homes fell into poverty from out-of-pocket healthcare spending.
In 2001, Thailand introduced the Universal Coverage Scheme (UCS). It’s described as “one of the most ambitious healthcare reforms ever undertaken in a developing country” in the book Millions Saved: New Cases of Proven Success in Global Health. The UCS, which spread to all provinces the following year, provides outpatient, inpatient and emergency care, available to all according to need. By 2011, the program covered 48 million Thais, or 98% of the population.
Thailand’s UCS was implemented in every province by January 2002, but this level of comprehensive care had taken decades to develop. Since the 1970s, free medical care had been available to some people in poverty, but the country had a range of health insurance schemes that left many without coverage. Developing infrastructure – hospitals, clinics and trained staff – to support universal coverage took years.
According to Dr Sara Bennett, associate professor at Johns Hopkins Bloomberg School of Public Health, quality is the most challenging aspect of universal healthcare in developing countries. Government-funded healthcare is often free, but it can be geographically inaccessible, limited to few facilities and administered by poorly trained staff. In addition, what works in urban areas might not be suited to rural contexts and vice versa.
When Thailand established solid health infrastructure, universal healthcare “totally changed the relationship between patients and doctors”, Wibulpolprasert says. Before, patients paid a fee to their doctors when they visited the hospital. After 2001, the government paid hospitals, including salaries for staff, and financially incentivized medical professionals to serve unpopular rural areas.
The lessons in Thailand: a well researched system with a dedicated leadership can improve health, and in an affordable way. As of 2011, the country’s health scheme cost just $80 per person annually, primarily funded by general income tax; it effectively reduced infant mortality, decreased worker sick days and lightened families’ financial burden for healthcare.
Meanwhile, in the US, securing agreement from political leadership is one of the most contentious issues over universal healthcare. The Patient Protection and Affordable Health Care Act, also known as Obamacare, was signed into law in 2010, yet is still embroiled in political controversy. However, the plan is paying off: more people than ever are insured and out-of-pocket spending has dramatically declined among those insured.
Around the world, many low- and middle-income countries are also moving toward universal care. “They are covering more people, who are paying less out of pocket and have access to a broader array of services,” Bennett says. “Many countries are making significant strides towards this, including the poorest.”
Paying for universal healthcare remains a challenge. In South Korea, for instance, care is funded by compulsory health insurance from all citizens and covers about 97% of the population. However, the country’s health system is in growing deficit.
In Thailand, affordability is not currently an issue, though the cost of the program as a proportion of general income tax is rising yearly. Still, the UCS continues to have wide support from the country’s government, health workers and wider population.
“The challenge is to make it more efficient, to get more for less money, particularly with the introduction of new technology and new drugs,” Wibulpolprasert says.
According to Carolyn Hart, Washington office director at health consultancy John Snow Inc, a multisectoral approach is key to global healthcare. “We are looking at the need to develop channels at all price points including free, subsidised and pay as you go, which could be insurance,” she says.
“How can [countries] afford not to invest in the health of their people?” she adds. “Poor health holds you back so badly.”
Source: The Guardian. DateL May 24, 2016