Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms

David Hughes, Songkramchai Leethongdee and Sunantha Osiri

Social Science & Medicine, 2010, vol. 70, issue 3, 447-454

Abstract: Thailand's universal coverage health care policy has been presented as a knowledge-based reform involving substantial pre-planning, including expert economic analysis of the financing mechanism. This paper describes the new financing system introduced from 2001 in which the Ministry of Public Health allocated monies to local Contracted Units for Primary Care (CUPs) on the basis of population. It discusses the policy intention to use capitation funding to change incentive structures and engineer a transfer of professional staff from over-served urban areas to under-served rural areas. The paper utilises qualitative data from national policy makers and health service staff in three north-eastern provinces to tell the story of the reforms. We found that over time government moved away from the original capitation funding model as the result of (a) a macro-allocation problem arising from system disturbance and professional opposition, and (b) a micro-allocation problem that emerged when local budgets were not shared equitably. In many CUPs, the hospital directors controlling resource allocation channelled funds more towards curative services than community facilities. Taken together the macro and micro problems led to the dilution of capitation funding and reduced the re-distributive effects of the reforms. This strand of policy foundered in the face of structural and institutional barriers to change.

Keywords: Universal; coverage; Economic; incentives; Health; care; reforms; Thailand; 30; baht; Scheme; Policy; implementation (search for similar items in EconPapers)
Date: 2010
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (6)

Downloads: (external link)
http://www.sciencedirect.com/science/article/pii/S0277-9536(09)00721-7
Full text for ScienceDirect subscribers only

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:eee:socmed:v:70:y:2010:i:3:p:447-454

Ordering information: This journal article can be ordered from
http://www.elsevier.com/wps/find/supportfaq.cws_home/regional
http://www.elsevier. ... _01_ooc_1&version=01

Access Statistics for this article

Social Science & Medicine is currently edited by Ichiro (I.) Kawachi and S.V. (S.V.) Subramanian

More articles in Social Science & Medicine from Elsevier
Bibliographic data for series maintained by Catherine Liu ().