타일랜드 공공의료제도의 특성과 변화: 탁신정부의 전국민의료보장제도 성립 전후 비교
The Nature and Changing Aspects of Thailand’s Public Health Care Institutions: A Comparison before and after the Establishment of Thaksin’s Universal Health Coverage Scheme
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In 2001 election, Thaksin Shinawatra and his newborn Thai Rak Thai Party (TRT) made a campaign promise with a slogan called “30 baht cures all diseases.” The coverage was finally extended nationwide with an enactment of the National Health Security Act in November 2002. Under the Universal Health Coverage Scheme (UCS), all Thai citizens became eligible for government-sponsored health service regardless of their income level, age, and place of residence. A comprehensive health care system is rare to find in Southeast Asia or any parts of the world, for such a scheme requires a strong financial commitment by the state and entails material interests of almost all people in the society. The health care institutions built under political contexts of a given country reveal a significant degree of influence that can either induce a specific path of development or restrict future political choices in regard to the pace and direction of policy change. In this sense, this paper first focuses on the enduring nature of the health care state in Thailand and then tries to provide explanations on the logic and working order of the public health care institutions before and after the Thaksin’s reform. As the provider, the Thai State has built health facilities and taken charge of the education and discipline of health workers. The number of public health facilities far outruns that of private facilities and health education is almost carried out by public universities. As the owner of hospitals and employer of doctors, the state has controlled over the occupational autonomy and collective influence of the professional health workforce. In addition, as the representatives of medical consumers, the state has directly taken responsibility for the welfare of its people by gradually expanding the benefit coverage to population. Thaksin and TRT made a transformation of the modern health care system in Thailand that has evolved over a century. However, the extent and scope of change was determined within the boundary of existing health infrastructures. The health reform was outlined in a direction that the state provided health services via contract with a hospital and an independent state organization checked the spending of health resources. Thaksin government successfully merged resources from four different health insurance schemes into the UCS to remove overlaps in coverage and guarantee a broader allocation of health resources to all segments of society.
Abstract
In 2001 election, Thaksin Shinawatra and his newborn Thai Rak Thai Party (TRT) made a campaign promise with a slogan called “30 baht cures all diseases.” The coverage was finally extended nationwide with an enactment of the National Health Security Act in November 2002. Under the Universal Health Coverage Scheme (UCS), all Thai citizens became eligible for government-sponsored health service regardless of their income level, age, and place of residence. A comprehensive health care system is rare to find in Southeast Asia or any parts of the world, for such a scheme requires a strong financial commitment by the state and entails material interests of almost all people in the society. The health care institutions built under political contexts of a given country reveal a significant degree of influence that can either induce a specific path of development or restrict future political choices in regard to the pace and direction of policy change. In this sense, this paper first focuses on the enduring nature of the health care state in Thailand and then tries to provide explanations on the logic and working order of the public health care institutions before and after the Thaksin’s reform. As the provider, the Thai State has built health facilities and taken charge of the education and discipline of health workers. The number of public health facilities far outruns that of private facilities and health education is almost carried out by public universities. As the owner of hospitals and employer of doctors, the state has controlled over the occupational autonomy and collective influence of the professional health workforce. In addition, as the representatives of medical consumers, the state has directly taken responsibility for the welfare of its people by gradually expanding the benefit coverage to population. Thaksin and TRT made a transformation of the modern health care system in Thailand that has evolved over a century. However, the extent and scope of change was determined within the boundary of existing health infrastructures. The health reform was outlined in a direction that the state provided health services via contract with a hospital and an independent state organization checked the spending of health resources. Thaksin government successfully merged resources from four different health insurance schemes into the UCS to remove overlaps in coverage and guarantee a broader allocation of health resources to all segments of society.
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