Applied Health Economics and Health Policy

, Volume 13, Issue 2, pp 157–166 | Cite as

Funding, Coverage, and Access Under Thailand’s Universal Health Insurance Program: An Update After Ten Years

  • Kannika DamrongplasitEmail author
  • Glenn Melnick
Original Research Article



In 2001, Thailand implemented a universal coverage program by expanding government-funded health coverage to uninsured citizens and limited their out-of-pocket payments to 30 Baht per encounter and, in 2006, eliminated out-of-pocket payments entirely. Prior research covering the early years of the program showed that the program effectively expanded coverage while a more recent paper of the early effects of the program found that improved access from the program led to a reduction in infant mortality.


We expand and update previous analyses of the effects of the 30 Baht program on access and out-of-pocket payments.

Data and Methods

We analyze national survey and governmental budgeting data through 2011 to examine trends in health care financing, coverage and access, including out-of-pocket payments.


By 2011, only 1.64 % of the population remained uninsured in Thailand (down from 2.61 % in 2009). While government funding increased 75 % between 2005 and 2010, budgetary requests by health care providers exceeded approved amounts in many years. The 30 Baht program beneficiaries paid zero out-of-pocket payments for both outpatient and inpatient care. Inpatient and outpatient contact rates across all insurance categories fell slightly over time.


Overall, the statistical results suggest that the program is continuing to achieve its goals after 10 years of operation. Insurance coverage is now virtually universal, access has been more or less maintained, government funding has continued to grow, though at rates below requested levels and 30 Baht patients are still guaranteed access to care with limited or no out-of-pocket costs. Important issues going forward are the ability of the government to sustain continued funding increases while minimizing cost sharing.


Inpatient Care Health Insurance Coverage Contact Rate Universal Health Insurance Coverage Informal Payment 
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No external funding was received for the conduct of this study and/or preparation of this manuscript. Both authors have no conflicts of interest to declare.

Author contributions

Kannika Damrongplasit was the main researcher of this study. Her responsibilities included obtaining the data, conducting empirical analysis, interpreting the results as well as writing up the manuscript. Professor Glenn Melnick helped with the study concept and design, as well as writing up the manuscript. Revision of the manuscript was done by both authors. Kannika Damrongplasit is the guarantor for the overall content of the manuscript.


  1. 1.
    James CD, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I, et al. To retain or remove user fees? Appl Health Econ Health Policy. 2006;5(3):137–53.CrossRefPubMedGoogle Scholar
  2. 2.
    Cheng L, Xuan Y, James B, Vasoontara Y, Min Y. Moving towards universal health insurance in China: performance, issues and lessons from Thailand. Soc Sci Med. 2011;73(3):359–66.CrossRefGoogle Scholar
  3. 3.
    Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid SM, Mukti AG, Akkhavong K, et al. Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet. 2011;377(9768):863–73.CrossRefPubMedGoogle Scholar
  4. 4.
    Lewis M. Informal payments and the financing of health care in developing and transition countries. Health Aff. 2007;26(4):984–97.CrossRefGoogle Scholar
  5. 5.
    Barber S, Bonnet F, Bekedam H. Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia. Health Policy Plan. 2004;19(4):199–208.CrossRefPubMedGoogle Scholar
  6. 6.
    Killingsworth JR, Hossain N, Hedrick-Wong Y, Thomas SD, Rahman A, Begum T. Unofficial fees in Bangladesh: price, equity, and institutional issues. Health Policy Plan. 1999;14(2):152–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Stepurko T, Pavlova M, Gryga I, Groot W. Empirical studies on informal patient payments for health care services: a systematic and critical review of research methods and instruments. BMC Health Serv Res. 2010;10:273.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Chereches RM, Ungureanu MI, Sandu P, Rus IA. Defining informal payments in healthcare: a systematic review. Health Policy. 2013;110(2–3):105–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Falkingham J, Akkazieva B, Baschieri A. Trends in out-of-pocket payments for health care in Kyrgyzstan, 2001–2007. Health Policy Plan. 2010;25(5):427–36.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Baji P, Pavlova M, Gulacsi L, Zsofia HC, Groot W. Informal payments for healthcare services and short-term effects of the introduction of visit fee on these payments in Hungary. Int J Health Plan Manag. 2012;27(1):63–79.CrossRefGoogle Scholar
  11. 11.
    Rechel B, Ahmedov M, Akkazieva B, Katsaga A, Khodjamurodov G, Mckee M. Lessons from two decades of health reform in central Asia. Health Policy Plan. 2012;27(4):281–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Damrongplasit K, Melnick GA. Early results from Thailand’s 30 Baht health reform: something to smile about. Health Aff. 2009;28(3):w457–66.CrossRefGoogle Scholar
  13. 13.
    Limpiyakorn K, Unsook R. Civil servant medical benefit scheme. In: Soonthrontham S, editor. Thai health insurance. Bangkok: National Health Security Office; 2012. p. 122.Google Scholar
  14. 14.
    Social Security Office, Thailand. Social Security Annual Report 2011. Bangkok: Social Security Office; 2011.Google Scholar
  15. 15.
    Gruber J, Hendren N, Townsend R. The great equalizer: health care access and infant mortality in Thailand. Am Econ J Appl Econ. 2014;6(1):91–107.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    National Health Security Office, Thailand. Annual handbook for Universal health coverage. Bangkok: National Health Security Office; 2012. pp. 29–37.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Faculty of EconomicsChulalongkorn UniversityBangkokThailand
  2. 2.Price School of Public PolicyUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.RAND CorporationSanta MonicaUSA

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