Recently there has been increasing interest in using the term “commissioning”
to address the negative connotations associated with the term “purchasing”. In
Thailand there is a widely shared view that health-care professionals do not sell
services to a purchaser; they are “professionals” acting in the best interests of
their patients. Commissioning also implies close cooperation between purchaser
and provider, and might open the way for a more collaborative, non-adversarial
version of purchasing, better aligned to Thai culture.
A problem which has persisted since the UCS was launched has been the tension
between different organizations, interest groups and stakeholders. Many of the
policy adjustments made as the UCS was implemented have involved power
swings between the MOPH and NHSO, or between organizations at different levels
such as the PHOs and CUPs, and central intervention has sometimes been needed
to control the behaviour of particular actors. However, by 2010 there were signs
of positive developments in this area, with some local government organizations
beginning to play a bigger role, and more scope for community involvement in