สถาบันวิจัยระบบสาธารณสุข

Thailand achieved universal health insurance coverage for the entire Thai population in 2002. However, the health insurance system does not cover all people who live in the country because the National Health Security Act 2002 indicates only “Thai citizenship” for eligibility under the scheme. This has made it impossible for people with citizenship problems to get basic health care. It also caused financial problems for health care providers that have to provide essential care for the people and disease control in many areas. For five years (four health ministers), there were many attempts to push forward the provision of basic health care for people with citizenship problems. This policy was complicated, and concerned with national security. The lack of understanding of the institution concerned and the society at large are the main obstructions. In 2010, the National Health Security Office (NHSO) employed the Moving Mountains Triangle Theory which comprises three strategies: (1) knowledge generation; (2) social movement; and (3) political engagement to push forward the policy. On March 23, 2010, the Cabinet approved this policy and assigned the Ministry of Public Health (MoPH) to operate the scheme instead of NHSO. Although the policy has been approved, some important issues need to be considered. For instance, how well can MoPH manage when supporting systems are lacking? The budgets may not be enough because the capitation budget was calculated by sharing risks with a population of 47 million under the universal coverage (UC) scheme. The benefit packages also may not equal those under the UC scheme. Thus, these aspects are challenging issues for everyone who works on this project.