The challenge
About 30% of Thais had no health insurance, and medical bills pushed families into poverty.
The case
In 2002 Thailand extended tax-funded health coverage to the roughly 30% of the population who had no insurance, charging a 30-baht co-payment per visit. Funding was paid to district health networks per registered person, with a strong focus on primary care in rural areas. Coverage became near-universal, and studies found sharp falls in catastrophic health spending and medical impoverishment, at a cost that remained modest as a share of GDP. A counterfactual estimate cited in The Lancet found the scheme cut the number of households impoverished by health payments in 2008 by 37,628, or 37.4%.
Why it worked
Years of building rural clinics and training health workers came first, so the new coverage had services to pay for. Strong in-country evidence and costing units helped officials make the case and control costs.
Sources
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