Universal health coverage in Thailand: ideas for reform and policy struggling
Universal health coverage in Thailand: ideas for reform and policy struggling
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DOI：
10.1016/s0168-8510(03)00024-1
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发表时间：
2004-04-01
期刊：
影响因子：
3.3
通讯作者：
Srithamrongsawat, S
中科院分区：
文献类型：
--
作者：
Pannarunothai, S;Patmasiriwat, D;Srithamrongsawat, S
泰国富人和穷人之间的健康不平等得到了很好的记录；数百万非正式工人及其家人没有医疗保险；穷人支付的医疗保健收入比例更高。全民覆盖被认为是纠正这种情况的手段之一。但“全民覆盖”一词在不同的利益相关者群体中可能有不同的含义。本文在对卫生政策改革进行实证研究的基础上，收集了利益相关者的看法和想法，并探讨了泰国可能形成全民覆盖的途径和策略。两个资料来源：一个来自问卷调查(根据德尔菲法，进行了两轮调查)，另一个是深度访谈。为制定政策获得的信息包括利益攸关方设想的如何最好地实施全民覆盖、资金来源、对泰国政府的财政影响、防止对不必要服务的更高需求的方法以及地方政府的参与。泰国最近在2001年出台的政策举措(所谓的针对所有疾病的30泰铢)在全国范围内引发了激烈的辩论。该计划目前处于早期阶段，很可能会随着时间的推移而发展--即：这项计划是否将由某些类型的税收或年度政府支出提供资金仍不清楚；不同医疗服务提供者之间的预算分配仍未确定。无论如何，这一计划可能被解读为一种政策转变，从亲市场转向政府支持的平等主义。(C)2003爱思唯尔爱尔兰有限公司。保留所有权利。
Inequality in health between rich and poor in Thailand was well documented; millions of informal workers and their families lacked health insurance; and the poor paid more proportionately in income for health care. The universal coverage is conceived as one of the means to redress the situation. But the term 'universal coverage' may mean differently among different groups of stakeholders. This paper, based on empirical research of health policy reform, collected perceptions and ideas from stakeholders and discusses the ways and strategies that universal coverage might take shape in Thailand. Two sources of information were taken: one from the questionnaire survey (according to the Delphi technique, two rounds of survey were taken), another an in-depth interview. Obtained information for policy formulation included how best, as conceived by stakeholders, to implement the universal coverage, sources of finance, fiscal implication for Thai government, ways to prevent higher demand for unnecessary services, and involvement of local government. Recent policy move in Thailand (the so-called 30 baht for all diseases) emerged in 2001 generated hot debate nationwide. The programme is currently in its early phase and is likely to evolve overtime-i.e. whether or not this programme will be financed by certain types of taxes or from annual government expense still unclear; and budget allocation among different health providers still unsettled. Anyhow this programme may be interpreted as a policy shift away from the pro-market based toward a government-supported egalitarianism. (C) 2003 Elsevier Ireland Ltd. All rights reserved.