Abstract for: Dynamics of Healthcare Utilization under the Civil Servant Medical Benefit Scheme of Thailandís Universal Health Coverage
Unexpected heath systems problems have emerged during the first decade of Thailand's Universal Health Coverage (UHC). Healthcare expenditures of the Civil Servant Medical Benefit Scheme (CSBMS), one of the three major publicly-funded health insurance schemes under the UHC, have been rapidly and disproportionately increasing. The epidemiological transition to non-communicable diseases, rapidly aging populations, and the limited range of available facilities providing chronic care and elderly care for the beneficiaries also led to the compromised healthcare quality and efficiency. Using system dynamics approach to explore the behavioral change of stakeholders over the period of 20 years, the current structure of Thailandís healthcare delivery systems and the complex relationships among the factors related to suboptimal quality and inefficiency were revealed. Policy options on comprehensive strategies to strengthen healthcare delivery systems for the CSMBS beneficiaries were developed. While strategies for budget controlling such as healthcare utilization management show a limited success, early implementations of integrated primary care services to effectively and timely deal with the progress of chronic illnesses appears to be a promising fundamental solution. These lessons learned from Thailand could benefit the policymakers of healthcare reforms in low- and middle-income countries during the epidemiological transition and the population aging.