User fees and targeting the poor
Thailand had used this user fees model since 1945. This financial model has a potential
to raise revenue into health care system. In Thailand, revenues collected from all sources
accounted for 10-25% in health center, 25 - 40 % in public hospitals before UC era.
However, patients might go bankrupt according to paying medical bills, or it could be
financial barrier for people to access to care. Therefore poor people should have financial
safety net. Thailand had a long experience on using mean test in the MWS that it was
difficult and consumed a lot of resource to targeting the poor due to dynamic of poverty
status of household and under-reporting by households especially non-financial assets.
The Bureau of Policy Planning of the MoPH evaluated that validity of providing the
entitlement for medical welfare for the poor in 1998 was only 35%. Panel data survey in
4 provinces from 1997 to 2003, which was conducted by Prof. Townsend showed a high
social mobility. Only one forth of population remained in the same income class during
study period. 72% of the household in poorest quintile moved upward, and a lot of
households in higher income quintiles moved downward at the same time (Siamwala and
Jitsuchon, 2007).
In conclusion, this financial model is not a mean to universal coverage. However, if there
is limitation of government budget. First priority should be expansion of the coverage of
health care infrastructure to provide public health and prevention services. Regarding
curative services, user fee model with appropriate measures to decrease financial