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Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms / David, Hughes
Social Science & Medicine, Volume: 70, Issue: 3, Pages: 447 - 454
Swansea University Author: David, Hughes
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The Thai universal coverage health care policy is regarded as a knowledge-based reform involving substantial pre-planning, including expert economic analysis of the financing mechanism. This paper describes the financing system introduced from 2001 which allocated monies to local Contracted Units fo...
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The Thai universal coverage health care policy is regarded as a knowledge-based reform involving substantial pre-planning, including expert economic analysis of the financing mechanism. This paper describes the financing system introduced from 2001 which allocated monies to local Contracted Units for Primary Care (CUPs) on the basis of population. It discusses the policy of using 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 employs 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 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 directed funds more towards curative services than community facilities. Taken together the macro and micro problems resulted in 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.
a. The author made a substantial contribution either to all aspects of the study and (b) took the lead in writing the paper.Journal IF, 2.733; 5-Year IF 3.688 (Thomson 5 year total cites rated 1 of 36 Social Science biomedical (total cites), Google Scholar citations 10. Includes online appendix on SS&M website of 14K words. Based on project from last RAE period funded jointly by British Academy and Leverhulme Trust Study Abroad Fellowship. First presented at Toronto Health Economics Network, and versions also presented at ISA Conference Montreal 2008 and at Ministry seminar (HISRO) in Thailand, 2008. Featured in impact case study showing that study had influenced Thai government health policy.
Thailand, universal coverage healthcare, reform, economic incentives, political economy
College of Human and Health Sciences