Comparative Analysis on Management and Health Benefit Package between People with Citizenship Problem Scheme and Universal Coverage Scheme in Thailand 2020

Abstract

The National Health Security Act 2002 provides health coverage to only “Thai citizens”. The new universal coverage scheme (UCS) in 2002 deprived people with citizenship problem (mainly stateless minority around 700,000) of the previous coverage under the low income card scheme. In the past five years, many attempts from stakeholders were carried out to solve this issue. Eventually, the people with citizenship problem scheme (PCPS) was approved by the cabinet in 2010 to provide essential health care for people with citizenship problems. The aim of this study was to compare differences in management of and benefit packages between the PCPS and the UCS in 2020. We applied a descriptive study to review and analyze related documents as of 1^st January 2020. Results indicated that more than 600,000 children and students of stateless minorities withheld by the cabinet resolution since 2016 were waiting for the approval of identity to get health benefit. The budget for PCPS did not cover 7 additional items as the UCS’s budget, including the no-fault compensation to the users and providers of health care. Only three public hospitals provided health care to the PCPS beneficiaries in Bangkok. In addition, there were 33 different benefits between the PCPS and the UCS. The UCS covered 21 more health interventions and services than the PCPS. The similar 12 benefit items had different management. Three items in the health benefit package had different reimbursement rates. The UCS had 9 special management programs more than the PCPS. Moreover, the PCPS reimbursed 227 items of equipment and prosthesis while the UCS reimbursed 316. The policy recommendations include increasing the budget for specific service gaps and items of reimbursable prosthesis and no-fault compensation in health care, increasing provider networks in Bangkok, and improving management capacity. Further studies on access, efficiency and quality of care of the PCPS were recommended.