The policy of charging for drugs and medical services in public health facilities
was established in the Thai health systems in 1945. An informal exemption mechanism
for the poor, at the discretion of the health worker, was implemented along with
user charges. Informal exemption has gradually evolved into a systematic meantesting
scheme based on household income. A Low Income Card was issued every
three years since 1981 for households below a defined poverty line.
Government employees and retirees and their dependents including parents,
spouse and not more than three children (less than 20 years old) are generously provided
with medical care coverage. An employer liability Workmen’s Compensation
Scheme for work related illness, injury and death compensation was the foundation
for the recent development of tripartite Social Insurance for formal sector private
employees for non-work related illnesses, maternity, disability and death compensation.
Finally, a voluntary community based health insurance scheme has now
developed into a publicly subsidized voluntary Health Card Scheme. Voluntary
private insurance has long existed in Thailand, providing coverage to the better-off
groups.
Various social and health protection schemes developed at different paces
resulting in variations in terms of benefit packages, provider payment methods,
financing sources, level of government subsidy, efficiency and quality of care. However,
by 1996, 30 percent of the population were still uninsured (1) (the number of
uninsured varies due to different estimation methods). Current policy discussions
focus on efficiency improvement, reduction of inequity within the insured population,
and the extension of insurance coverage to the entire population.
This chapter provides an overview of insurance systems in Thailand, describing
its principle, objective, trends of coverage, key characteristics and weaknesses.
Characteristics of the uninsured will be highlighted. Based on these analyses,
recommendation on reform was proposed to achieve greater efficiency, equity and
universal coverage.