In 2001, Thailand introduced the Universal Coverage
of
Health
Care
Policy
(UC)
very
rapidly after the new government came
to
power.
The
policy
aims
to
entitle
all
citizens
to health care and includes health system reforms
to
achieve
equity,
efficiency,
and
accountability. The overall question this thesis
asks
is how
did this
policy
come
about,
and how likely is it that the policy will
achieve
its
goals?
Literature suggests that understanding the
policy process
is
as
important
as
assessing
the
content of particular policies when
judging
policy outcomes.
By
using
an analytical
framework to explore four elements: context, actors, process,
and content,
this thesis
aims to generate general understanding of
the
UC
policy
process,
and
to
use
this
analysis to assess implementation. It
starts
by
addressing
how
and why
universal
coverage, which had long been discussed in
Thailand,
got
on
to the
policy
agenda
in
2001, and then explores how the policy was
formulated
nationally.
It
goes
on
to look
at
implementation in one province, examining
the inter-relationships
between
provincial,
district and community facilities. Data were
gathered
from key informant interviews,
document and media analysis, and group
discussion
with villagers.
The analysis suggests that Thailand's democratization,
created
new
actors
in health
policymaking processes which had long
been
under
control
of bureaucrats
and
professionals. The 1997 Constitution encouraged a more pluralistic
political
system.
Universal access to health was advocated
by
a group of non-government
organizations
who pushed to get UC through legislation and announced
their
campaign
a
few
months
before the 2001 election. NGO interest was paralleled
by
a
political
party
campaign,
announced in 2000 by the Thai-Rak Thai Party,
and
implemented
as
UC
when
the
Party
came to power. UC was picked up
because it
was seen as
legitimate, feasible
under
the
existing infrastructure and government
budget,
and
also
congruent
with
the
reform
intention of the political party. Once it became the
government
in 2001,
an
important
factor in early policy formulation was
the
extent
to
which national
research
provided
evidence to support the policy.
The
research community
was
tightly-knit
and
concentrated in medical-related professions.
One
member
of
this
policy
community
played an important role as a policy entrepreneur.
This
policy
community
continued
to
support evidence for debates in policy-making
during both
policy
formulation
and
implementation. The implementation process
was
a top-down
process;
however, there
were some spaces for street level bureaucrats to
adapt
decisions to fit their
context.
Implementation started through the extension
of
insurance
coverage
in four
phases
under the execution of the Ministry of
Public Health. Private
providers
were
only
minimally involved in these formulation and
implementation
phases.
The
UC
policy
in
2001-2 was characterised by clear policy goals,
limited
participation,
strong
institutional
capacity, and very rapid implementation
-
all
factors
which anticipated
success
of
the
policy. However, the complex technical features
of
the
policy
and
the
big
change
in
system reform were a brake on success.
One
of
the implementation
problems
was
the
mobilization of human resources, especially where
bureaucrats
were
resistant
to
change.
It seems that the implementation of the
UC
policy
in
Thailand
reflected
both
managerial
as well as political problems. Given the findings
of
this
study,
policy
monitoring
should
pay attention to political as well as technical assessment
