Harmonization of public health insurance schemes
Harmonization of the three public health insurance schemes remains an issue of
intense debate in Thai society 10 years after the inception of the UCS. The lack of
equity between the three schemes continues to raise questions about whether
entitlement to universal health care means entitlement to health care of a similar
standard for all Thai people. Recent studies have found inequities in access to
essential care offered by the different health insurance schemes, including differences
in benefits packages, payment methods and payment rates, and the
provision of expensive drugs and high-cost procedures.
The architects of the UCS envisaged achieving universal coverage through the
creation of a single fund, a reform proposal that was not supported by the other
two schemes. The Social Security Office was worried that its substantial SSS reserves
would be used to subsidize the UCS, while the Ministry of Finance, responsible for
the CSMBS, argued that generous medical welfare benefits were needed to compensate
low-paid civil servants. Additionally, the most reputable tertiary hospitals
enjoying income from providing services to civil servants predicted erosion in the
quality of care if the CSMBS was combined with the UCS.