While the annual capitation rate eventually approved tended to be lower than
the amount requested, the budget allocated to support the scheme increased
steadily over the 10-year period. Although the total number of UCS members
remained constant at around 47 million, the UCS budget rose from 1,202.4 baht
(US$ 35.40) per capita in 2002 to 2,693.5 baht (US$ 78.80) per capita in 2011 (see
Table 2). This was a 71% real term increase, mostly driven by increased utilization
and rising labour and material costs of providing medical and health services.
Resources were found to fund the rate rise, even in 2009 when GDP fell by 2%
and all ministries had to make spending cuts.
A central administrative database capable of providing robust evidence on
health-service utilization put the NHSO in a strong position to negotiate with the
Budget Bureau. Introducing new service items into the benefits package, and
thereby deepening financial risk protection, was another strategy used by the
NHSO to secure a higher capitation rate. A crucial factor in the first few years was
Prime Minister Thaksin’s recognition that the scheme was underfinanced and his
commitment to increasing the capitation rate.