Title: Re-evaluating "Pro-Poor": A Model for Monitoring the Universal Coverage Scheme in Thailand
Author: Ben Harkins
Year: 2009
Keywords: N/A
Theme: Social Welfare
Advisor(s): Jiruth Sriratanaban
The full thesis available here.
Abstract: Thailand has a per capita GDP of approximately $6,600 (PPP). Although Thailand faced challenges stemming from the Asian economic crisis during the implementation of the universal health coverage (gold card) system, it has managed to maintain its universal health coverage plan for the Thai population since 2001. However, the current universal health coverage system comprises three state-provided health insurance schemes, each with unequal benefits. This historical inequality in healthcare within Thailand has led to efforts to establish a universal health coverage system and monitor and evaluate the quality of treatment for the poor, ensuring that all Thais receive comprehensive healthcare services. The primary objective of this thesis is to create a conceptual model for monitoring the performance of the universal health coverage system, analyzing data from questionnaires, interviews, and observations of direct stakeholders, examining public health databases, and studying the theoretical framework using development and social science concepts rather than focusing solely on quantitative economic analysis. A study of universal health insurance systems reveals that indicators of the effectiveness of programs for the poor should go beyond mere quantitative economic measures. While the study highlights that stakeholders prioritize financial burden reduction, they also acknowledge the overwork of program staff, inadequate funding, and issues with the quality of patient care. Furthermore, economic evaluations focus on the successful transfer of the financial burden away from the poor, neglecting the significant burden placed on public hospitals and healthcare workers. Additionally, there are no suitable economic indicators for assessing the value of receiving quality services and care. The research suggests the need for more comprehensive and conceptually advanced performance indicators for monitoring and evaluation, leading to standardized and high-quality assessments that can effectively identify and address problems within the program. The Nation of Thailand, which had a GDP per capita of approximately $6,600 (PPP) at the time and was still struggling to recover from the crippling effects of the Asian Financial Crisis, was able to implement a universal coverage program for its citizens with a fairly comprehensive benefits package in 2001. However, the current system for universal health coverage in Thailand is a patchwork of 3 separate and unequal public health insurance schemes. Given the equality in the Thai health system that preceded the Universal Coverage Scheme, monitoring of the program for pro-poor qualities is a critical aspect of ensuring that the Scheme meets its goal of providing universal access to high-quality healthcare for all. The primary objective of this research was to construct a conceptual model for pro-poor monitoring of the Universal Coverage Scheme based upon survey of frontline stakeholders, key informant interview, participant observation, review of health system data, and a theoretical framework based on development and sociological concepts rather than the more heavily emphasized quantitative health economic analytics. The results of the research appear to show that pro-poor monitoring indicators should be expanded beyond quantitative economic measures. Although the research did indicate that UC Scheme stakeholders are concerned about economic impacts and characteristics, it also revealed their strong concerns with heavy staff workloads, underfunding of services, and quality of care provided. While the health economic evaluations of the Scheme have accentuated the successful shift of the financial burden of care from the poor, they have been less revealing about the fact that much of that burden has fallen on public health facilities and their staff. In addition, there are no econometric indicators appropriate for determining the value of receiving high quality care when medically necessary. The results appear to indicate that additional metrics should be included in the monitoring model to help address these issues.