Overview
Over more than two decades, Thailand’s Universal Health Coverage (UHC) system has played a pivotal role in promoting equity and reducing the financial burden of healthcare for the population. Nonetheless, Thailand continues to face structural challenges, including low effective coverage of services for noncommunicable diseases (NCDs), persistent disparities in access among vulnerable groups, and overcrowding in large hospitals. In response, the government and the National Health Security Office (NHSO) piloted the “One ID Card for Universal Access to Healthcare” policy to reduce access barriers, expand the role of innovative service units, and streamline reimbursement processes. Phase 3 of the policy expanded implementation to six health regions and Bangkok, covering 45 provinces, necessitating a comprehensive evaluation of system-level mechanisms, local contexts, and long-term impacts.
This study aims to assess governance mechanisms, the operational performance of public and private providers, the integration of health information systems, changes in care-seeking behaviors, and trends in budgeting and health system resilience. It employs a convergent mixed-methods design, combining qualitative data from regional and provincial policymakers, public facilities, and innovative service units with quantitative surveys of the general population and vulnerable urban groups. It also utilizes national datasets such as the 43-file reimbursement database and the innovative service system to capture both empirical evidence and contextual nuances across diverse settings.
Findings indicate that the policy has improved access to services through innovative units without clear evidence of increased patient congestion in large hospitals, contrary to initial concerns. However, several system-level limitations remain, including fragmented health and reimbursement data systems, gaps in personal health records (PHRs), weak monitoring and oversight at the regional and provincial levels amid decentralization, and communication gaps affecting both the public and frontline health workers. Urban contexts—particularly Bangkok—present additional complexities and dynamics distinct from earlier pilot areas. The evaluation highlights the policy’s potential to strengthen the health system’s adaptive capacity and crisis preparedness, provided that supportive mechanisms around data, financing, and multisectoral collaboration are further developed. The insights generated hold significant value for evidence-informed policymaking, the design of monitoring frameworks, and strategic investments in primary care and service innovation to enhance efficiency, equity, and sustainability in Thailand’s UHC system over the long term.
