The proponents of the co-payment raised concerns about the potential
moral hazard arising from overutilization of free treatments and argued
that a charge would help increase system efficiency by limiting pressure on
overburdened service units. However, the annual revenues generated from the
co-payment were only around 2 billion baht, while the costs of administration and
collecting revenues were thought to be substantial (there was no explicit
assessment of administrative costs at the time). The recent push to restore the
co-payment probably reflects a political wish to reclaim the “30 baht” slogan,
as there is no clear evidence to support such a policy on increased cost from
moral hazard.
Despite considerable political turbulence, the UCS continued to thrive,
partly because the leadership of the National Health Security Office (NHSO) — the
institution set up in early 2003 to administer and manage the UCS — was relatively
stable. Dr Sanguan Nittayaramphong, a senior policy-maker in the MOPH,
played a pivotal role. In the early days he functioned as the bridge between the
MOPH “intellectuals” and the politicians, notably Deputy Minister Dr Surapong
Suebwonglee with whom he had a close relationship and shared similar
experiences, as both had worked in rural district hospitals. Dr Sanguan’s contact
with TRT initially carried some personal cost because the UCS was not universally
supported in MOPH circles. He led the team that designed the UCS and in 2003
he became the NHSO’s first Secretary General, a position he held until his death
in late 2007. His successor, Dr Winai Sawasdiworn, was promoted from Deputy
Secretary General and had been involved in UCS since its inception.