T he UCS has made measureable progress towards achieving its overarching
goal of an equitable entitlement to health care among all Thais and
establishing the three defining features of the scheme. But like all
national health system reforms, the UCS faces stresses and strains that will demand
continued attention and further reforms during the next decade and beyond.
A 2011 World Bank report32 on the public sector in Thailand highlights three key
health-system challenges: (1) inequalities in utilization and spending across the
three insurance schemes; (2) mounting cost pressures; and (3) fragmentation of
financing and unresolved issues concerning the respective roles of central and
local governments. While these issues apply to the whole of the health system,
they are all relevant to the UCS and the scheme will need to be part of solutions
to address them.
Many of the existing and future challenges for the UCS relate to the three
unfinished agendas described in Chapter 6: the purchaser-provider split,
strategic purchasing and the equitable distribution of financial and human
resources, and harmonizing the three health insurance schemes. This chapter first
highlights a complex set of institutional and managerial issues that are inherent in
all three agendas. This is followed by a discussion of what some experts believe
to be the most pressing challenges in the decade ahead: managing the growth
of the UCS in the light of fiscal sustainability, an ageing population, technological
inflation, vested interests among some groups of health professionals and rising
consumer expectations.