CONTINUOUS DEVELOPMENT BUILT ON A STRONG FOUNDATION

No matter where they are or what station in life they hold, all Thais can be assured that they will be cared for in times of illness or injury. This health security has a long history of evolution for more than three decades and emerged as the National Health Security Act of 2002. However, looking back during the past 30 years, only one-third of Thais was covered by some form of health insurance. The remaining two-thirds had to pay out-of-pocket for health services. For the lower-income households, just one catastrophic illness or injury could force them into bankruptcy.

The first health insurance system began around 1972 with the creation of a Worker Compensation Scheme (WCS). The fund covered the costs of care for workers who had work-related injury or illness. A short-coming of this fund was that it only applied to worksites with at least 20 employees and, initially, the fund only covered worksites in Bangkok. However, by 1988, the fund was expanded to cover every province. After the Compensation Fund Act was passed in 1994, the fund was administered by the Office of the Compensation Fund under the Social Security Office of the Ministry of Labor. Another fund for formal sector employees was the Social Security Act which was passed in 1990. The Social Security Scheme (SSS) provided compensation for those Thais who incurred injury, illness, or death, regardless of whether the condition was work-related or not. Social security provided support for delivery, child care subsidy, old age, and unemployment. By 2002, social security was also provided through participating worksites of any size. For government civil servants, the health insurance was managed separately. Initially, each government agency managed their health insurance within each ministry which set aside a portion of its regular budget for this purpose. In 1980, this system was consolidated under the Royal Decree on the Disbursement of Civil Servants Medical Benefit Scheme (CSMBS) and administered under the ComptrollerGeneral’s Department of the Ministry of Finance.

Thus, over time, Thais who were working in the formal sector had health insurance coverage of some form or another. However, persons outside the formal employment system, including children and the elderly, and did not have a relative who was a government civil servant, did not have health insurance (unless they bought it in the private sector). Accordingly, the Ministry of Public Health (MOPH) began to address this gap in coverage in 1975 through a project entitled “Medical Welfare Scheme.” This project was set up to subsidize medical care for the indigent patients who did not have welfare cards. However, offering this benefit to a patient depended on the discretion of the attending health staff. By 1994, a ‘medical welfare card’ was issued to those deemed qualified to receive subsidized medical care, including the poor, children under 12 years, the elderly, the disabled, veterans and their families, and Buddhist monks/novices. With the 2002 National Health Security Act, the Universal Coverage Scheme (UC scheme) was successfully implemented to cover all Thais throughout the nation who were not covered by CSMBS and SSS. This meant that Thailand has achieved universal health coverage (UHC) since 2002.