1. Healthcare Financing in Thailand: an update in 2007
Updated by
International Health Policy Program (IHPP)
Ministry of Public Health,
Thailand

2. Outline presentation
I. Background information on burden of disease and health care finance
IA. Burden of Disease in 2004 & national health expenditure, 1994 – 2005
IB. Healthcare financing performance
Fairness in financial contribution – EQUITAP results
Incidence of catastrophic and impoverishment from OOPs
Equity in utilization & benefit incidence analysis (BIA)
II. Ongoing major works
IIA. Universal offer of VCT
IIB. Major program review of cervical cancer control
IIC. Review of DCP2 and its application in chronic diseases management
IID. Annual hospital report
III. Future challenges: Renal replacement therapy, financial sustainability, and potential moral hazards, etc.
Honourable Ministers, Ladies and Gentlemen,
I wish to share the Thai lessons on Universal Coverage and the role of SHI in financing and systems design of UC Scheme, its achievement and future challenges

3. IA. Background information: BOD and financing healthcare

4. Profile: top 10 mortality, Thailand 2004 Total deaths 390,285
Top 10 deaths share 63% of total national deaths

5. Profile: top 10 YLL, Thailand 2004 Total YLL 6.07 million years
Top 10 YLL shares 63 % of total national YLL

6. Profile: top 10 YLD, Thailand 2004 Total YLD 3.1 million years
Top 10 YLD shares 71% of total national YLD

7. Profile: top 10 DALY loss, Thailand 2004 Total DALY loss 9
Profile: top 10 DALY loss, Thailand Total DALY loss 9.17 million years
Top 10 DALY shares 52% of total national DALY loss

8. DALY loss by age group and gender, Thailand 2004

9. DALYs per 1,000 population, ranked 22 categories

10. Top 15 risk factors, men Thailand 2004

11. Top 15 risk factors, women, Thailand 2004

12. Total Health Expenditure, NHA 1994 – 2005
The total health expenditure (THE) of Thailand in 1994 was 127,655 million baht at current price including capital formation. The total health expenditure of Thailand had gradually increased during 1995 to 1997 and had sharply decreased in 1998 due to the economic crisis in However, the THE in 2000 to 2005 had slightly increased to 248, million baht (current year price) in Ratio of THE to GDP was 3.5 percent in 1994 and reached to 4 percent in 1997, the year which Thailand faced the economic crisis, after that period the ratios had decreased continuously to 3.3 percent in the year 2001.After UC implementation the ratios increased and reached to 3.7 % in 2002 then it was rather stable at 3.5 % GDP until 2005.

13. Real term growth GDP versus THE, 1994-200513 13

14. THE, Baht per capita NHA 1994-2005 current and constant price (2003)14 14

15. Trend of financing sources NHA 1994-2005
Public financing source comprises of the Ministry of Public Health, other ministries that provide healthcare services, the Civil Servant Medical Benefit Scheme, Universal coverage, local government expenditure, Social Security Scheme and Workmen Compensation Fund. Share of public funding sources was 45 percent of THE in However, public sources of finance gradually increased and became dominant portion, 64 percent of THE in It was due to high average per capita growth rate of 9.7 percent which was greater than that of the non-government sources of finance, 2.2 percent growth per year.

16. Trends of financing agents, NHA1994-2005
This slid show trend of health financing sources focus on the major source of financing both central government and household
In 1994 were central government (Ministry of Public Health and other related ministries) and household direct payment for healthcare, which accounted for 30.5 and 44.5 percent of THE respectively. Nevertheless, the share of each of the two main sources had become nearly one third of the total health expenditure in 2001.
After 2001 central government played the major role of spending on health until 2005 around 40% while as household decrease share till 27.6 % at 2005.

17. Expenditure by financing agent NHA2005
in 2005.Gener Gov exclude social insurance accounted for 55.7 %, of this the central government provides 52.2 %, while local government provided 3.2%. the social security provides 8%.
The non government funding swished from major part in 1944 at 55.3% to minor part in 2005 at 36.1% of total health expenditure. In 2005 Out of pocket payment played the major role in private sector at 27.6 % of THE while as the other private insurance, including with private insurance, private social insurance, Non profit and cooperation, represented 8.4 % of total health expenditure.

18. Expenditure by public financing agents, NHA2005
Within the public expenditure, the health spending for health insurance accounted for 60% of THE, of which the UC contributed 27 %, CSMBS contributed 19% and social security contributed 12 % of total public expenditure on health.

19. Expenditure by healthcare Function NHA200519 19

20. CSMBS total expenditure and growth 1988-2006
million of employees/pensioners
Source: Comptroller General Department, Ministry of Finance (various years) 20 20

21. IB. performance of UC scheme

22. Why general-tax-financed UC Scheme?
Contributory UC Scheme was not in the policy agenda during 2001 general election,
Feasible to apply general tax, additional budget requirement was in fiscal capacity
Not feasible to collect premium
Urgency to nation-wide scale up immediately, political obligations to the constituency
Subsequent studies indicate the Concentration Index of various sources of healthcare finance – Thailand 2002 (O’Donnell et al 2005)
CI weight NHA
Direct tax
Indirect tax
Social insurance
Private insurance
Direct payments
Total Health Financing
General Tax
Note:
CI, an index of the distribution of payments, ranges (-1 to 1), a positive (negative) value indicates the rich (poor) contributes a larger share than the poor (rich), a value of zero is everyone pays the same irrespective of ability to pay
Based on macro financing using the National Health Account, and micro-level household survey by NSO SES; empirical evidence indicates the total health financing in Thailand is quite progressive, the CI equals to almost 0.6. Direct tax is the most progressive source, with the largest CI of Indirect tax and social insurance contribution are similar less progressive than direct tax, CI equals to 0.57.
We also estimate that the general tax which today finances UC scheme is progressive, This means the rich pay more than the poor. The UC Scheme achieve the societal objective that health payment according to capacity to pay.
General tax was applied for UC scheme not only the progressivity, it is not possible, technically, at this moment, to collect premium contribution from the informal rural sector. Enforcement is too difficult. There is no choice that Thai UC applies general tax, instead of contributory scheme like SHI.

23. Contribution of Social Health Insurance (SHI) to UC Scheme system design
SHI as a predecessor of UC
Contract model contractual arrangement with competitive public and private provider contractors
Contract is feasible in the context of comprehensive geographical coverage of MOPH healthcare infrastructure
Closed-ended provider payment method
Among a few developing countries, Thailand pioneers capitation payment method
Additional pay for A&E, high cost care, based on fee schedule
Purchaser Provide split
Social Security Office and National Health Security Office as purchasers – design packages and payment methods
MOPH, other public and private medical institutions as major providers
Comprehensive coverage
Comprehensive service package, OP, IP, Prevention, Promotion
Neither deductibles nor co payment at point of services, UC scheme has nominal pay of US$ 0.75 per visit or admission
SHI is the predecessor of systems design of UC Scheme: especially capitation contract model. Among a few developing countries, Thailand pioneers capitation contract model and proves a decent quality of services with very well cost containment.
Also separate role of purchasers and providers. SHI and UC Scheme provide a comprehensive coverage. Literally there is neither deductibles nor co payment at point of services.

24. Advanced characteristics of the UC Scheme
UC scheme further modified the systems design: notably Primary Care Network as the service contractor, unlike SHI applies 100 bed hospital as main contractor. UC beneficiaries have limited choice to registered primary care network but they are ensured with referral to tertiary care. Ambulatory care applies capitation while admission services apply global budget and DRG system, this is to prevent under-admission in inclusive capitation of SHI.
While SHI has a separate package of dental and maternity, UC Scheme integrates them into curative package to avoid different payment method and high administrative cost
UC scheme covers every members, while SHI cover the workers only.

25. Capitation rate and components Baht per capita, approved fig
Capitation rate and components Baht per capita, approved fig , plan fig. 2008

26. Discrepancy: proposed & approved capitation rateFY
The approved capitation rate is below the proposed figures that IHPP calculated based on utilization from national household survey conducted by NSO, and the unit cost of OP and IP services. The discrepancy is a result of the government fiscal constraint.
The Scheme is therefore under-funded for the last 4-5 years.
IHPP calculates capitation rate based on actual utilization rate and unit cost. Due to fiscal constraint, it results in discrepancy

27. Household health expenditure as % of household income by income deciles prior to UC ( ) and after UC
Source: NSO SES (various years)

28. Distribution of households with health expenditures > 10% total consumption by consumption expenditure quintiles
Source: NSO’s SES (various years)

29. Catastrophic health payments in Thailand, 1996-2002
% non food expenditure on health
1996
1998
2000
2002
0 to 0.5%
31.9
33.2
34.5
41.2
0.5 to 10%
51.3
51.5
50.8
48.1
10 to 25%
11.9
10.9
11.0
7.6
25 to 50%
3.5
3.6
3.1
2.5
More than 50%
1.4
0.8
0.7
0.5
Total
100.0
Source: National Statistic Office, Household Socio-economic Survey, various years.

30. Pre-post UC incidence of catastrophic expenditure Households with health payment > 10% of total consumption expenditures
All households
LIC/VHC
UC–E/-P
Year 2000
Quintile 1
4.0%
2.7%
Quintile 5
5.6%
7.1%
All Quintiles
5.4%
4.7%
Year 2002
1.7%
5.0%
6.1%
3.3%
3.2%
Year 2004
1.6%
4.3%
5.2%
2.8%
2.6%
Year 2006
0.9%
3.0%
2.0%
1.9%
Source: NSO’s SES (various years)

31. Impact of UC: Catastrophic illnesses, impoverishment Limwattananon et al 2005
Dataset: NSO SES 2000 (24,747 households), 2002 (34,785) and 2004 (34,843).
Finding
The incidence of catastrophic health expenditure (>10% of total HH consumption) reduced
From 5.4% in pre-UC 2000
to % in post-UC
An increase in the poverty headcounts due to OOP payments dropped
From 2.1% in pre-UC
to % in post-UC.
Conclusions
Reduction in the catastrophe and impoverishment due to OOP health payments is evident after the UC reform which provides comprehensive coverage of health care with a very small nominal fee.
Catastrophic illness is measured by more than 10% of total household consumption. Our Pre – Post UC assessment indicates the incidence of catastrophic illnesses reduced from 5.4% to 3.3% and 2.2% respectively.
Not only the reduction in the incidence of catastrophic illnesses, the additional number of people fell under the national poverty line after the OOP, also reduced from 2.1% to 0.8% and 0.5% respectively.
This is a positive message, that UC helps achieve two major societal goals, namely minimize catastrophic events to the households and the impoverishment from medical payment.

32. Healthcare Catastrophe vs. OOP Payments & Income data as of 2000
An interesting finding from EQUITAP project in Asia-Pacific region is that the low-income country with higher share of health payment from household’ OOP tends to face catastrophic health expenditure.
Source: van Doorslaer et al. (2005)

33. Utilization by UC members source: NSO HWS2001, 2003, 2004, 2005 and 2006
In view of under funding, utilization among UC members increased significantly compare pre UC 2001 to post UC 2003 and 2004.
Primary care unit and district hospitals are the major providers especially for ambulatory care. A good message emerges. There was a major shift of utilization from tertiary provincial hospital to Primary care unit and District hospital both outpatient and inpatient.

34. Total Ambulatory Visits (millions/yr) (HWS 2001, 03, 04, 05, 06)
SSS
LIC/VHC & UC-E/-P
CSMBS

35. Average Ambulatory Visits (per member/yr) (HWS 2003, 04, 05, 06)
SSS
UC-E/-P
CSMBS

36. Insurance Use for OP Visit (% compliance) (HWS 2003, 04, 05, 06)
SSS
UC-E/-P
CSMBS

37. Total Hospital Admissions (millions/yr) (HWS 2001, 03, 04, 05, 06)
SSS
LIC/VHC & UC-E/-P
CSMBS

38. Average Hospital Admissions (per member/yr) (HWS 2001, 03, 04, 05, 06)
SSS
LIC/VHS & UC-E/-P
CSMBS

39. Insurance Use for IP admission (% compliance) (HWS 2003, 04, 05, 06)
SSS
UC-E/-P
CSMBS

40. Type of health facilities Provincial and regional hospitals
The distribution of ambulatory service use among different income quintiles in 2001 and 2003, by types of health facilities
2003
2001
Concentration indices of ambulatory service use among different types of health facilities in 2001 & 2003
Type of health facilities
2001
2003
Health centers
Community hospitals
Provincial and regional hospitals
Private hospitals
0.4313
0.3484

41. Selected concentration curves of ambulatory service use among different types of health facilities in 2003
This slide demonstrates concentration curves of ambulatory service use in some health facility types in Findings of this study are similar to other studies which ambulatory service use of primary and secondary care levels at health centers and community hospitals is pro-poor; while ambulatory service use of tertiary care level such as university hospitals is pro-rich.

42. The distribution of hospitalization among different socio-economic groups in 2001 and 2003, by types of health facilities
2001
2003
Concentration indices of hospitalization among different types of health facilities in 2001 & 2003
Types of health facilities
2001
2003
Community hospitals
Provincial and regional hospitals
Private hospitals
0.3199
0.3094
Overall hospitalization

43. Selected concentration curves of hospitalization among different types of health facilities in 2003
This slide demonstrates concentration curves of hospitalization in some types of health facilities in Hospitalization of community hospitals and provincial / regional hospitals was pro-poor, while that of university and private hospitals was pro-rich.

44. Who benefits from public subsidies Limwattananon et al 2005
Benefit Incidence Analysis: compare pre-UC 2001 and post-UC 2004 using NSO HWS2001, 2004
OP care
Post UC 2004, the pro-poor subsidy was very pronounced at District Health System (DHS)
Concentration Index = and for Health Centre and District Hospital respectively.
Less progressive at provincial hospitals (PH)
CI =
IP care
More progressive in favour of the poor at DH
CI = in 2001 and in 2004.
Weaker progressive in favour of the poor at PH
CI = in 2001 and in 2004
Conclusions
The pro-poor subsidy were strongest for DHS.
Lessons indicates DHS plays key role in fostering the pro-poor nature of public subsidy.
Close to client services, better accessed
Benefit Incidence Analysis was used to assess how public subsidies were distributed across household quintiles. CI ranges from minus 1 to plus one. The higher the minus, the higher subsidies go to the poor.
Subsidies is more pro-poor at DHS than at the Provincial Hospital, for both ambulatory and admission services
DHS plays an important strategic hub (so called close to client services) in fostering pro-poor nature of public subsidies; DHS is better accessed by the majority poor who resided in rural areas.

45. Percent distribution of net government health subsidies among different income quintiles in 2001 and 2003
Note:
Overall net government health subsidies in 2001 were approximately 58,733 million Baht, and in 2003 were 80,678 million Baht (in 2001-value)
The concentration index of government health subsidies in 2001 was and in 2003 was

46. Concluding remarks 1 Enabling factors for achieving UC
Strong political supports
Health systems capacity and its resilience to rapid nation-wide program scale-up in 6 months
Lessons from predecessors
SHI capitation contract model
CSMBS “no go” fee for service, due to cost escalation and inefficiencies
Voluntary Health Card Scheme – adverse selection and non-viable financially
Linking evidence to policy decision
Integral relationship among researchers – reformists – politicians
Pragmatism
Limited chance to achieve UC by contributory scheme, especially among informal sector, not feasible for contribution collection and enforcement
Learning from SHI, UC takes further advanced steps,
Well thought systems design towards efficiency, cost containment, ensure referral, advocates of primary care contractor
I like to conclude key enabling factors which help achieve UC, not only strong political supports, capacity to generate evidence, and translate evidence into systems design and the systems capacity and resilience to implement program are very important.
SHI informs us to adopt capitation contract model. Capitation helps long term cost containment and financially affordable. It sends a proper message towards efficiency while accreditation and quality monitoring are important tools.
CSMBS tells us a “no go” direction of fee for services reimbursement model. It sends a wrong signal towards inefficiency.
It is not possible to achieve UC through voluntary health card scheme due to adverse selection and financial non-viability. Voluntary health insurance is a temporary step towards UC, it helps build up capacity in insurance management; an important social asset.
Not only lessons learned from SHI, reformist and system designers also take a more advance steps than SHI.

47. Concluding remarks 2
UC Schemes covers the poor, half belongs to Q1 and Q2
However, the Scheme faced chronic under-funding, capitation was below than the proposed figures based on cost and utilization
Significant increase in utilization more on OP than IP
In view of under-funding and increased utilization  danger of poor quality of services and serious hospital financial constraints
Empirical evidence indicates
Pro-poor budget subsidy, DHS is a major hub of fostering the pro-poor nature of financing healthcare
Policy msg.  invest more in DHS
(further) reduction in the incidence of catastrophic illnesses
(further) reduction of impoverishment from medical bills
UC scheme covers the poor, but under-funded than it should be. There is a danger of poor services and serious hospital fiscal constraint.
Good news that UC Scheme benefits more to the poor, through the functioning of DHS, it reduces incidence of catastrophic illnesses and impoverishment thereof.
Studies on long term projection with technical supports from ILO indicates that by 2020, the THE would be 3.88% of GDP, and is within the fiscal capacity of the government
The Prime Minister recently, decides to finance UC scheme totally by excise tax from tobacco and alcohol in FY2007 onwards.

48. IIA. Ongoing major work: Universal offer of VCT

49. The potential VCT uptake with zero price
10.4%
32.6%
Current price
11.7%
39.7%
Current price

50. Predicted Demand for VCT by Regions
Gen. Pop. SW
MSM
IDU

51. IIB. Ongoing major work: Major program review of cervical cancer control

52. National Coverage of Cervical Cancer Screening (Household Survey -2006)
Source: NSO’s Sexual and Reproductive Health Survey (2006)

53. Reported Achievement by Set Targets (2005)
Source: NHSO (2006)

54. Work Components

55. IIC. Review of disease control priorities (DCP-2) and its application to the 10th National Health Development Plan

56. Objectives of the study on DCP-2 and the 10th National Health Development Plan
To review patterns of burden of disease and risk behavior of Thais in 1999 and 2004
To review cost-effective medical treatments and public health interventions suggested by DCP-2 in accordance to BOD of Thailand
To explore similarity and dissimilarity of current practice for disease control and prevention on top-ten priority of disease burden in Thailand, compared to suggestions from the DCP-2
To estimate the magnitude of government investment in disease prevention and reduction in health risk behavior, health promotion, screening and early detection of disease in high priorities, compared to investment in curative interventions
To provide policy recommendations on improving efficiency and efficacy of public investment in health promotion, disease prevention, curative interventions, and economic gains from more investing in health
To develop plan and framework for investing in health and estimate the medium term expenditure framework (MTEF), compared to government health budgets

57. Estimate budget requirements for health investment in
Scope of the study
Review burden of disease (BOD)
and risk behavior of Thais in 1999 and 2004
Select top-ten burden of disease contributing to
highest DALY loss in 2004 as the scope of the study
Review recommendations for effective medical treatments and public health interventions
in DCP-2, compared to current practice and clinical guideline practices in Thailand
Estimate public resources required for investment in health promotion,
disease prevention, and public health program in reducing risk factors and
behavior of each disease, compared to curative program and other sectors
Provide policy recommendations for improving efficiency in health investment in
health promotion, disease prevention, screening, curative and reducing risk behavior
Estimate budget requirements for health investment in
the 10th National Health Development Plan
and present research findings for public hearing of all stakeholders

58. IID. Sustainable Development of Healthcare System Performance in Thailand

59. Objectives
To review previous studies of Thai healthcare performance and current approaches from international perspectives
Based on process of consultation and consensus agreement among major stakeholders in Thailand, to develop and conceptualize the Thai healthcare system performance framework
To build up institutional capacity and foster networking with all stakeholders and technical partners for a long term national capacity in healthcare performance assessment
To assess and produce a public report on Thai healthcare performance in for FY2007 (pilot phase in 4 Provinces)
To develop strategy and policy approach to catalyze improvement in the performance in the positive ways

60. Conceptual Framework of Healthcare System Performance
Review:
Concept;
Domain;
Indicators;
Information system
Review Existing:
Data source;
Thai conceptual Framework:
Goals; domain; Indicators; data
Gap?: Data (available; quality)
Information system;
Develop
Measure
Level:
Hospital and CUP
Report:
Level (province, region)
Indicators
Benchmarking
Analyze,
Synthesis
Revised
Improvement:
Personnel; IT;
Management
Survey?
Users:
Public
Central government
Local government
Healthcare planner
Hospital manger
Health insurer
Academia
Now comes to achievements of UC Scheme

61. III. Future challenges
Now comes to achievements of UC Scheme

62. Prevalence Hypertension: 23% male, 21% female
From the national health exam survey (NHES), the prevalence of hypertension was 23% among men, and 21% among women.
Among men who were found hypertensive, only 23% were diagnosed by health care personnel; while a vast majority, 77% were not diagnosed. Among the diagnosed, 5% failed to treat, the treatment coverage of hypertension was only 17%. Among those treated with anti-hypertensive drugs, only 6% were well controlled.
The situation is better among women, the treatment coverage was higher, 31% and effectiveness of the treatment is also higher, 12%.
Prevalence Hypertension: 23% male, 21% female
All samples are hypertensive, >140/90 mmHg,

63. Prevalence DM: 6% male, 7% female All samples have FBS, >126 mg/dl
Compared with hypertension, the treatment coverage of diabetes (DM) was better, 49% among women, and 33% among men. But the effectiveness of treatment is still unsatisfactory, 15% among women and 9% among men were well controlled of their blood sugar.
Prevalence DM: 6% male, 7% female
All samples have FBS, >126 mg/dl

64. Death from Diabetes
Diabetes
death
Death rate
Poorest Richest

65. Death from Ischemic Heart Disease
Death rate
IHD
death
Poorest Richest

67. CEA and CUA societal perspectives PD and HD at NPV 2005

68. Budget impact analysis 2 scenarios: universal versus limited access to RRT at the lowest cost estimate (250,000 Baht / case/ year)
2005
(year 1)
2009
(year 5)
2014
(year 10)
2019
(year 15)
Universal access to RRT (million Baht)
3,994
18,058
32,255
43,804
As % of UC budget
5.5
18.4
23.7
23.6
As % of THE
1.7
5.9
7.7
RRT for KT eligible (mil Baht)
1,981
8,944
15,966
21,625
2.7
9.1
11.7
0.9
2.9
3.8
UC budget (million Baht)
73,136
98,074
135,987
185,248
Total health expenditure
(million Baht)
230,836
303,931
417,522
572,659

69. Future Challenges (1) Most of the crude ground works had achieved
PHC focus and reorientation, pro-poor achievement, extensive financial protection of the poor, very minimum catastrophic incidence, BUT
Need to increase value for money
Maintain decent quality of care and continued advancement in medical progress
Evidence based and learning organization for
MOF (CSMBS) SSO and NHSO
BOB, MOF Fiscal Policy Office, NESDB
Harmonization across 3 public insurance scheme
Adequate and sustainable financing of the pro poor UC scheme
There are many future challenges, I wish to highlight IHPP and its partners involvement in the policy formulation on the extension of Renal Replacement Therapy, RRT is the only one service not covered by UC Scheme while SHI and CSMBS fully covers.
Cost effectiveness study by IHPP indicates that PD and HD was far too expensive, more than 10,000 USD per life saved, while ART spent 590 USD. RRT is 4 times of GNI per capita for one life year saved, and 18 times as expensive as ART.
However, Kidney Failure is catastrophic for the household. There is an ethical problem of not extending RRT while patients under SHI and CSMBS are fully covered. IHPP and WHO HQ is conducting further policy analysis in this particular issue

70. Future Challenges (2)
Focus more on effective coverage of increasing trend of chronic conditions and effective prevention of injuries
Renal Replacement Therapy for chronic kidney disease patients is not covered by UC Scheme (while SHI and CSMBS cover fully)
Results in catastrophic health expenditure by households
Need serious informed policy decision and long term financial implications
Cost per life year saved (Teerawatananon et al 2005)
Peritoneal dialysis 10,170 US$
Hemodialysis 10,490 US$
Cost per life year saved (Lertiendumrong et al 2005)
Antiretroviral Therapy US$
GNI
US$ 2,540 per capita (2004 WDR)
Cost per life year saved for RRT
4 times of GNI per capita,
18 times as expensive as the current national ART program.
Ethical dimension of not extend RRT to UC members
There are many future challenges, I wish to highlight IHPP and its partners involvement in the policy formulation on the extension of Renal Replacement Therapy, RRT is the only one service not covered by UC Scheme while SHI and CSMBS fully covers.
Cost effectiveness study by IHPP indicates that PD and HD was far too expensive, more than 10,000 USD per life saved, while ART spent 590 USD. RRT is 4 times of GNI per capita for one life year saved, and 18 times as expensive as ART.
However, Kidney Failure is catastrophic for the household. There is an ethical problem of not extending RRT while patients under SHI and CSMBS are fully covered. IHPP and WHO HQ is conducting further policy analysis in this particular issue

71. Acknowledgments National partners International partners
National Health Security Office (NHSO) and other partners who initiate, design and steer the UC scheme
HSRI for supports on NHA development since day one until institutionalized
HISRO, HISO for their technical and financial supports
Ministry of Public Health (MOPH) major healthcare providers and steer the implementation of UC scheme.
National Statistical Office (NSO) for national household surveys
Thailand Research Fund (TRF) for institutional grants to IHPP
International partners
World Bank and MOPH partnership on Country Development Partnership in Health Sector
ILO for peer reviews of capitation rate 2002, and long term financing forecast
WHO and Harvard for studies on ethical dimension of RRT extension to UC members
EU funded Equity in financing, health utilization and public subsidies in Asia Pacific (EQUITAP)
Finally, I wish to acknowledge the following international and national partners for their contributions