The National Health Security Act was enacted in 2002, with very strong support and influence from civil society. The National Health Security Act has since then been one of the most important social tools for health systems reform in Thailand. Private health insurance organizations play no role in this reform, and remain only as a supplemental option for high income groups.
Since October 2001, the Universal Coverage Scheme (or UCS or “30 Baht Scheme”) has combined the previous Medical Welfare Scheme and the Voluntary Health Card Scheme to further expand coverage to an additional 18 million people. The UHC scheme aims to provide “universal access to essential health care and reducing catastrophic illnesses from out-of pocket payments by establishing a tax-based financing system and paying providers on a capitation basis.” This scheme covers 74.6 percent of the population as of 2007 estimates. The benefits package is a comprehensive package of care, including both curative and preventive care. The scheme is financed solely from general tax revenue. Public hospitals are the main providers, covering more than 95 percent of the insured. About 60 private hospitals joined the system and register around 4 percent of the beneficiaries.
The Baht 30 copayment was abolished by the next government in November 2006, and the system is now totally free of charge. Since October 2003, the government has also embarked on universal access to antiretroviral drugs (ARVs). Through May 2007, more than 90,000 patients had been registered in the system.
Currently, different methods of financing are applied for the various public health insurance schemes in Thailand. The Compulsory Social Security Scheme (SSS) is financed by contribution from employees, employers, and central government contributions. However, the Civil Servant Medical Benefit Scheme (CSMBS) and the Universal Coverage Scheme (UCS) are financed from general tax revenues.
The UCS is financed through general tax revenues paid to local contracting units on the basis of population size. The target population for the scheme is largely in the informal, agricultural sector and does do not have access to consistent cash income for any kind of regular premium payment, therefore making premium collection difficult.