health strategies and agree on performance requirements for the service units.
This reduced role conflict, but still left PHOs in the complicated position of maintaining
relations with the MOPH and NHSO, when both might claim jurisdiction
over aspects of the management of local health systems.
There is a widespread perception that clarification of, and agreement about
the roles and responsibilities of purchasers and providers is needed. The unclear
boundary in the first 10 years of the UCS exacerbated tensions between the
MOPH and NHSO. Financing is still not fully aligned with purchasing responsibility.
Purchasing in an emerging economy like Thailand cannot simply mean buying
existing services. Because not all necessary services are provided in all provinces,
there is a need to develop new services and ensure that all necessary services
can be equitably accessed by UCS members through referral, mobile services
or outsourcing to other competent providers. Between 2002 and 2010 the MOPH
was not successful in securing new capital investment funds from the Budget
Bureau and the NHSO financed a capital replacement programme. There were
conflicts when the MOPH had to use the replacement budget for new capital
projects, and in any event this was not sufficient for major construction projects