Keeping universal healthcare strong

For 23 years, Thailand’s universal healthcare scheme, better known as the “gold card’, has protected millions from financial ruin, a remarkable achievement that has earned worldwide praise. Yet, the system is not perfect.

- AMANEE HAMU. THONGCHAI NAPIM MANATCHAYA CHUYINGSAKULTIP KULLAPORN UNNANON

Klong Toey's most impoverished residents claim that a private facility meant to care for them under the government's 30-baht healthcare plan INSTEAD exposes them to discrimination and gross neglect, in this file photo dated April 7, 2013. PATIPAT JANTHONG

(PATIPAT JANTHONG)

Since 2002, the gold card has been more than public health. It symbolises the effort to build a fair and accessible healthcare system for everyone. For a country marked with stark inequality, it is a crucial lifeline that ensures illness does not drive families into debt, bankruptcy, or preventable death.

The National Health Security Office (NHSO) runs the scheme. First known as the “30-baht system’, it has won global recognition for universal coverage and gained praise for its reach, quality of care, and better overall public health outcomes, as well as its ability to manage budgets for service providers.

But the hurdles are hurdles that will undermine this healthcare system.

Thailand is ageing fast. Chronic illnesses are on the rise, while new pandemics such as Covid-19 can bring healthcare systems down to their knees. In terms of policies, the health care system must deal with uncertainties — government policies keep shifting, and the cost of medical technology climbs higher every year.

That said, despite its success, the NHSO cannot afford to be complacent. It needs to tighten how it manages services and money — and do so openly. Efficiency and integrity are vital. They build public trust and justify any calls for expansion and future funding.

To see how well the system is coping, the TDRI research team looked at the NHSO through the lens of “3Es”: Execution, Evidence, and Efficiency. In plain terms, we asked: Are plans put into action? Are decisions guided by solid data? And are resources — money, staff, and time — used wisely?