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

David Hughes, Songkramchai Leethongdee, Sunantha Osiri

Social Science & Medicine, Volume: 70, Issue: 3, Pages: 447 - 454

Swansea University Author: David Hughes

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DOI (Published version): 10.1016/j.socscimed.2009.10.031

Abstract

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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Published in: Social Science & Medicine
ISSN: 0277-9536
Published: 2010
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URI: https://cronfa.swan.ac.uk/Record/cronfa6725
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spelling 2015-05-11T09:32:45.6538169 v2 6725 2012-01-23 Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms f1fbd458e3c75d8b597c0ac8036f2b88 David Hughes David Hughes true false 2012-01-23 FGMHL 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. Journal Article Social Science & Medicine 70 3 447 454 0277-9536 Thailand, universal coverage healthcare, reform, economic incentives, political economy 31 12 2010 2010-12-31 10.1016/j.socscimed.2009.10.031 http://www.sciencedirect.com/science/article/pii/S0277953609007217 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. COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2015-05-11T09:32:45.6538169 2012-01-23T12:12:33.1770000 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health David Hughes 1 Songkramchai Leethongdee 2 Sunantha Osiri 3
title Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms
spellingShingle Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms
David Hughes
title_short Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms
title_full Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms
title_fullStr Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms
title_full_unstemmed Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms
title_sort Using economic levers to change behaviour: The case of Thailand's universal coverage health care reforms
author_id_str_mv f1fbd458e3c75d8b597c0ac8036f2b88
author_id_fullname_str_mv f1fbd458e3c75d8b597c0ac8036f2b88_***_David Hughes
author David Hughes
author2 David Hughes
Songkramchai Leethongdee
Sunantha Osiri
format Journal article
container_title Social Science & Medicine
container_volume 70
container_issue 3
container_start_page 447
publishDate 2010
institution Swansea University
issn 0277-9536
doi_str_mv 10.1016/j.socscimed.2009.10.031
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
url http://www.sciencedirect.com/science/article/pii/S0277953609007217
document_store_str 0
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description 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.
published_date 2010-12-31T03:08:16Z
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score 11.016235

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