Disease prevention and health promotion always crucial for cost cutting: TDRI

One important reason why the capitation budget system has been adopted in the implementation of the Universal Coverage Scheme (UCS) is it is believed to provide incentive for healthcare providers to pay more attention to promoting good health of the people and preventing them from developing preventable health problems. 

The reason is disease prevention and health promotion are altogether considered a key mechanism for primary care units to keep their healthcare costs as low as possible so that they have enough money for paying their other costs. 

That is an important common suggestion by those health economists researching into and evaluating the National Health Security Office’s (NHSO) operating of the UCS and attempts to streamline the healthcare scheme, which has been heard from time to time over the past 19 years.

Marking the 19th anniversary of the NHSO, Thailand Development Research Institute (TDRI), for one, has stressed the need for the NHSO to continue focusing on preventing chronic diseases and injuries from accidents.

And while being regarded as two major challenges facing the NHSO’s management of the UCS’ annual budget, both costs of chronic diseases associated with population aging and costs of treating the people injured in accidents can actually be curtailed, said Worawan Chandoevwit, an advisor on social security at the TDRI.

Thailand's elderly population is growing rapidly, according to various studies including ones by the TDRI.

The country is already considered an "ageing" society, meaning 10% of the population is aged 60 and over, since 2005. It is transitioning to an "aged" society, with those aged 60 and over set to account for 20% of the population this year.

Thailand's trajectory sees it becoming a "super-aged" society in 2031, where those aged 60 and over make up 28% of the population.

These demographics present great challenges for policymakers and demand an urgency in planning.

The NHSO will likely have more money left for funding an inclusion of more healthcare benefits into the UCS’s core benefit package if it can successfully lower these costs with the help of disease prevention and health promotion, which actually concern not only the NHSO but also several other partners, said  Dr. Worawan.


Together with these partners, the NHSO is encouraged to adopt a proactive working approach when working to promote good health and prevent chronic diseases, she said.

From an economist’s perspective, he said, first of all strong determination by most members of the public to have better health is required and it will play a crucial role in the NHSO’s effort to succeed in promoting good health and preventing diseases. 

A recent survey by the National Statistical Office of Thailand has found that what most Thai people now value over other things, even good income, is good health, he said, adding that this clearly demonstrates a positive impact of the UCS on the attitude of the people about their health and their happiness and satisfaction towards their lives.

Secondly, a slight rise in the state’s healthcare spending which has in return brought down the household spending on healthcare by about five times the increase is the evidence that the UCS is a cost-effective mechanism for improving the public health, she said.

“Many people now have more money left for paying their other household expenses, thanks to the UCS,” she said.

Before the UCS came in 2002, the healthcare spending accounted for about 35% of all household expenses, while 17 years later the household healthcare spending has decreased by 25% to only about 10% of all household expenses, during which the state’s healthcare spending rose by only between 5% and 6%, she said.

Speaking of healthcare expenditures, she said, in her point of view it is not really accurate to base the calculation of the country’s ideal healthcare budget mainly on the nation’s Gross Domestic Product (GDP).

“Before COVID-19 it might be alright to compare healthcare costs under the UCS with GDP,” she said.

However, now that Thailand still has to live with COVID-19, which has severely damaged the economy and caused costs of healthcare under the UCS as well as the country’s entire healthcare system to surge, it may no longer be practical to keep calculating the healthcare budget for the UCS based on GDP, she said.

In terms of social disparities, she said, disparities in the country’s healthcare system have been reduced considerably especially when compared with other systems including the education system during the past years of the UCS’ operations, she said.

Despite this achievement, the remaining disparities in healthcare benefits and expenses among all existing healthcare schemes still need to be eliminated to improve equality in the people’s healthcare rights no matter which scheme they are in, she said.

“Hopefully, in the next 10 to 20 years from now patients will no longer be asked under which healthcare scheme they are registered before they will be given care by doctors,” she said.

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