Narrative Review on Universal Health Coverage in Thailand and China from the Lens of Social Determinants of Health Theory
DOI:
https://doi.org/10.59096/osir.v17i2.268730Keywords:
universal health coverage, social determinants of health theory, Thailand, ChinaAbstract
This article through the literature review method briefly compares universal health coverage (UHC) in Thailand and China, highlighting their strategies and challenges in achieving UHC through the lens of social determinants of health: a) health financing design and sustainability, b) accessibility of healthcare resources, and c) participatory and responsive governance. While Thailand mainly utilizes a tax-based approach, China employs a health insurance model. Both countries have achieved high insurance coverage. However, some challenges exist. The unmet need for health services due to long waiting times has been a key concern in Thailand, whereas financial hardship from receiving care was a critical concern in the case of China. Thailand has created a mechanism to allow a wide range of stakeholders to participate in the UHC design to ensure responsive governance. In contrast, China has not yet formed comprehensive legal grounds for participatory and responsive governance on UHC. Their experiences and encountered obstacles can offer valuable lessons on how middle-income nations can advance towards UHC, highlighting the critical need for ongoing improvements in health systems to tackle the existing and new health challenges due to the change in population demographics and the continuing increase of population healthcare demand.
References
Holmes D. Margaret Chan: committed to universal health coverage. Lancet. 2012 Sep 8;380(9845):879. doi:10.1016/S0140-6736(12)61493–7.
Van Hees SG, O’Fallon T, Hofker M, Dekker M, Polack S, Banks LM, et al. Leaving no one behind? Social inclusion of health insurance in low-and middle-income countries: a systematic review. Int J Equity Health. 2019;18(1):134. doi:10.1186/s12939-019-1040-0.
Tangcharoensathien V, Thammatach-Aree J, Witthayapipopsakul W, Viriyathorn S, Kulthanmanusorn A, Patcharanarumol W. Political economy of Thailand’s tax-financed universal coverage scheme. Bull World Health Organ. 2020 Feb 1;98(2):140–5. doi:10.2471/BLT.19.239343.
Tao W, Zeng Z, Dang H, Li P, Chuong L, Yue D, et al. Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China. BMJ Global Health. 2020 Mar 19;5(3):e002087. doi:10.1136/bmjgh-2019-002087.
Tangcharoensathien V, Patcharanarumol W, Kulthanmanusorn A, Saengruang N, Kosiyaporn H. The political economy of UHC reform in Thailand: lessons for low- and middle-income countries. Health Syst Reform. 2019;5(3):195–208. doi:10.1080/23288604.2019.1630595.
Fang H, Eggleston K, Hanson K, Wu M. Enhancing financial protection under China’s social health insurance to achieve universal health coverage. BMJ. 2019 Jun 21;365:l2378. doi:10.1136/bmj.l2378.
Xinhua. National Health Insurance Bureau: China’s basic health insurance participation rate has stabilized at around 95% in recent years [Internet]. Beijing: State Council of the People’s Republic of China; 2023 May 18 [cited 2024 Mar 14]. <https://www.gov.cn/lianbo/bumen/202305/content_6874798.htm>. Chinese.
Tangcharoensathien V, Patcharanarumol W, Prakongsai P, Jongudomsuk P, Srithamrongsawat S, Thammathataree J. Thailand health financing review 2010 [Internet]. Nonthaburi: International of Health Policy Program, Ministry of Public Health; 2010 May 31 [cited 2024 April 2]. 43 p. <http://dx.doi.org/10.2139/ssrn.1623260>
Suphanchaimat R, Kosiyaporn H, Limwattanayingyong A. Migrant policies in Thailand in light of the universal health coverage: evolution and remaining challenges. OSIR. 2019 Jun 28;12(2):68–74. doi:10.59096/osir.v12i2.262971.
Chen G, Liu GG, Xu F. The impact of the urban resident basic medical insurance on health services utilization in China. Pharmacoeconomics. 2014 Mar;32(3):277–92. doi:10.1007/s40273-013-0097-7.
Huang F, Gan L. The impacts of China’s urban employee basic medical insurance on healthcare expenditures and health outcomes. Health Economics. 2017 Feb;26(2):149–63. doi:10.1002/hec.3281.
Shan L, Wu Q, Liu C, Li Y, Cui Y, Liang Z, et al. Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China. BMJ Open. 2017 Jun 2;7(5):e014425. doi:10.1136/bmjopen-2016-014425.
Beijing Municipal Medical Insurance Bureau. Beijing residents’ health service guide [Internet]. Beijing: People’s Government of Beijing Municipality; 2024 Mar 6 [cited 2024 Jun 15]. <https://www.beijing.gov.cn/fuwu/bmfw/sy/jrts/202403/t20240306_3581600.html>. Chinese.
Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet. 2019 Sep 28;394(10204):1192–204. doi:10.1016/S0140-6736(19)32136-1.
Deng DS, Zhao YJ. The construction logic and development path of national medical insurance in China. Qiusuo. 2013;(12):242–4. doi:10.16059/j.cnki.cn43-1008/c.2013.12.091. Chinese.
He AJ. Scaling-up through piloting: dual-track provider payment reforms in China’s health system. Health Policy Plan. 2023 Feb 13;38(2):218-227. doi:10.1093/heapol/czac080.
Li L. Pioneering a Chinese style healthcare coverage system: the Sanming healthcare reform. Chinese Social Security Review. 2024 Mar 15;8(2):12–23. <https://www.caoss.org.cn/upload/news/20240413/1dd44873eae54864af19aa6d4d4934c0.pdf>. Chinese.
Rong X, Yin J, Duan S, Sun Q, Babar ZU. The effects of pricing policy on the prices and supply of low-cost medicines in Shandong, China: evidence from an interrupted time series analysis. BMC Public Health. 2020 Apr 29;20(1):588. doi:10.1186/s12889-020-08746-x.
Fu R, Chen Q, Lin Y, Lin Z, Zheng Z, Hu Z. Short-term and long-term effects of Sanming healthcare system reform on drug-related expenditures for rural patients with cancer in public hospitals: an interrupted time series analysis using segmented regression model in China. BMJ Open. 2023 Jan 5;13(1):e065586. doi:10.1136/bmjopen-2022-065586.
Tangcharoensathien V, Limwattananon S, Patcharanarumol W, Thammatacharee J, Jongudomsuk P, Sirilak S. Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing. Health Policy and Planning. 2015 Nov;30(9):1152–61. doi:10.1093/heapol/czu120.
Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Mills A. Health systems development in Thailand: a solid platform for successful implementation of universal health coverage. Lancet. 2018 Mar 24;391(10126):1205–23. doi:10.1016/S0140-6736(18)30198-3.
Vongmongkol V, Viriyathorn S, Wanwong Y, Wangbanjongkun W, Tangcharoensathien V. Annual prevalence of unmet healthcare need in Thailand: evidence from national household surveys between 2011 and 2019. International Int J Equity Health. 2021 Nov 12;20(1):244. doi:10.1186/s12939-021-01578-0.
Coronini-Cronberg S, Laohasiriwong W, Gericke CA. Health care utilisation under the 30-Baht Scheme among the urban poor in Mitrapap slum, Khon Kaen, Thailand: a cross-sectional study. Int J Equity Health. 2007 Sep 21;6:11. doi:10.1186/1475-9276-6-11.
Wu J, Yang Y, Sun T, He S. Inequalities in unmet health care needs under universal health insurance coverage in China. Health Econ Rev. 2024 Jan 2;14(1):2. doi:10.1186/s13561-023-00473-4.
Zhou S, Huang T, Li A, Wang Z. Does universal health insurance coverage reduce unmet healthcare needs in China? Evidence from the National Health Service Survey. Int J Equity Health. 2021 Jan 21;20(1):43. doi:10.1186/s12939-021-01385-7.
Vongmongkol V, Viriyathorn S, Wanwong Y, Wangbanjongkun W, Tangcharoensathien V. Annual prevalence of unmet healthcare need in Thailand: evidence from national household surveys between 2011 and 2019. Int J Equity Health. 2021 Nov 12;20(1):244. doi:10.1186/s12939-021-01578-0.
Thammatacharee N, Tisayaticom K, Suphanchaimat R, Limwattananon S, Putthasri W, Netsaengtip R, et al. Prevalence and profiles of unmet healthcare need in Thailand. BMC Public Health. 2012 Oct 30;12:923. doi:10.1186/1471-2458-12-923.
Limwattananon S, Neelsen S, O’Donnell O, Prakongsai P, Tangcharoensathien V, Van Doorslaer E, et al. Universal coverage with supply-side reform: The impact on medical expenditure risk and utilization in Thailand. Journal of Public Economics. 2015 Jan;121:79–94. doi:10.1016/j.jpubeco.2014.11.012.
Tangcharoensathien V, Tisayaticom K, Suphanchaimat R, Vongmongkol V, Viriyathorn S, Limwattananon S. Financial risk protection of Thailand’s universal health coverage: results from series of national household surveys between 1996 and 2015. Int J Equity Health. 2020;19(1):163. doi:10.1186/s12939-020-01273.
Gao Q, Prina M, Wu YT, Mayston R. Unmet healthcare needs among middle-aged and older adults in China. Age Ageing. 2022 Jan 6;51(1): afab235. doi:10.1093/ageing/afab235.
Zhang R, Li J, Du X, Ma T, Zhang L, Zhang Q, et al. What has driven the spatial spillover of China’s out-of-pocket payments? BMC Health Serv Res. 2019 Aug 30;19(1):610. doi:10.1186/ s12913-019-4451-0.
Murray CJ, Frenk J. A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78(6):717–31.
Marshall AI, Kantamaturapoj K, Kiewnin K, Chotchoungchatchai S, Patcharanarumol W, Tangcharoensathien V. Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand. BMJ Glob Health. 2021 Feb;6(2):e004117. doi:10.1136/bmjgh-2020-004117.
Legal Daily. Healthcare legislation urgently needs acceleration [Internet]. Guangdong: Standing Committee of the Guangdong Provincial People’s Congress; 2023 Nov 7 [cited 2024 Apr 1]. <https://www.gdpc.gov.cn/gdrdw/rdlz/rdyj/content/post_191785.html>. Chinese.
Tang YJ. Study on the system of public participation in medical care. Journal of Nanjing Medical University (Social Sciences) 2015 Jun;(3):191–5. doi:10.7655/NYDXBSS20150306. Chinese.
Lei SQ. Multiple deliberative policy argument: a case study of the new medical reform. Chinese Public Administration. 2016;(8):121–5. doi:0.3782/j.issn.1006-0863.2016.08.19. Chinese.
Li H. Public participation in the policy formation process: A case study of medical policy reform in China. Journal of East China University of Political Science and Law. 2014;(3):96–105. Chinese.
Wei Y, He J. Research on public participation of healthcare reform. Medicine and Philosophy. 2012 Jan; 33(1A):53–5. Chinese.
Sripathy A, Marti J, Patel H, Sheikh JI, Darzi AW. Health professional education and Universal Health Coverage: A summary of challenges and selected case studies. Health Aff (Millwood). 2017;36(11):1928–36. doi:10.1377/hlthaff.2017.0517.
Tejativaddhana P, Briggs D, Fraser J, Minichiello V, Cruickshank M. Identifying challenges and barriers in the delivery of primary healthcare at the district level: a study in one Thai province. Int J Health Plann Manage. 2013;28(1):16–34. doi:10.1002/hpm.2118.
Leerapan B, Teekasap P, Urwannachotima N, Jaichuen W, Chiangchaisakulthai K, Udomaksorn K, et al. System dynamics modelling of health workforce planning to address future challenges of Thailand’s Universal Health Coverage. Hum Resour Health. 2021;19(1):31. doi:10.1186/s12960-021-00572-5.
Lakha F, Suriyawongpaisul P, Sangrajrang S, Leerapan B, Coker R. Breast cancer in Thailand: policy and health system challenges to universal healthcare. Health Policy Plan. 2020 Nov;35(9):1159–67. doi:10.1093/heapol/czaa063.
Tao W, Zeng Z, Dang H, Lu B, Chuong L, Yue D, et al. Towards universal health coverage: lessons from 10 years of healthcare reform in China. BMJ Glob Health. 2020 Mar 19;5(3):e002086. doi:10.1136/bmjgh-2019-002086.
Xiao N, Long Q, Tang X, Tang S. A community-based approach to non-communicable chronic disease management within a context of advancing universal health coverage in China: progress and challenges. BMC Public Health. 2014;14 Suppl 2(Suppl 2):S2. doi:10.1186/1471-2458-14-S2-S2.
Tao W, Zeng Z, Dang H, Li P, Chuong L, Yue D, et al. Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China. BMJ Glob Health. 2020 Mar 19;5(3):e002087. doi:10.1136/bmjgh-2019-002087.
Yip W, Fu H, Jian W, Liu J, Pan J, Xu D, et al. Universal health coverage in China part 2: addressing challenges and recommendations. Lancet Public Health. 023 Dec;8(12):e1035–42. doi:10.1016/S2468-2667(23)00255-4.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
