The UCS also included clinic-based preventive and health-promotion services
provided in health centres. As the CSMBS and SSS did not include these in their
benefi ts packages, the UCS fi lled the gap by including these services for the
whole Thai population within its annual budget (see Table 2). In 2011 the NHSO
spent 1.27 trillion baht (US$ 4.2 billion) of which less than 11% went to clinical
preventive and health promotion services, and nothing went to primary
prevention and health promotion outside the clinical setting. The latter were
supported by the MOPH regular budget and the Thai Health Promotion
Foundation (ThaiHealth), an independent quasi-public body established by law
in 2001. ThaiHealth is chaired by the Prime Minister, is fi nanced by 2% “sin taxes”
collected from producers and importers of alcohol and tobacco, and generates
annual revenue of about 3 billion baht (US$ 100 million).
The initial benefi ts package that was part of the roll-out across the nation in
2001-2002 was guided by historical precedents, based on what other health
insurance schemes were covering. However, subsequent inclusion or exclusion
of an intervention was guided by a health technology assessment, including
cost-effectiveness analysis, budget impact assessment, equity and ethical
considerations and supply-side capacity to scale up. Box 5 describes the
decision-making process. Added to this mix of criteria were demand-side factors
related to changing population expectations for health care. Inclusion of dialysis
for persons with chronic renal failure, for example, remains controversial as it costs
more than four times GNI per capita for a single quality of life year (QALY) gained
and will consume a huge part of the UCS budget over the long term.