Efficiency or equity: value judgments in coverage decisions in Thailand

Sripen Tantivess · Román Pérez Velasco · Jomkwan Yothasamut · Adun Mohara · Hatai Limprayoonyong · Yot Teerawattananon

31 citations0/0 files storedJournal of Health Organization and Management

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Healthcare Systems and Reforms Health Systems, Economic Evaluations, Quality of Life Healthcare Systems and Practices

Abstract

PURPOSE: The purpose of this paper is to analyse the roles of social values in the reform of coverage decisions for Thailand's Universal Health Coverage (UC) plan in 2009 and 2010. DESIGN/METHODOLOGY/APPROACH: Qualitative techniques, including document review and personal communication, were employed for data collection and triangulation. All relevant data and information regarding the reform and three case study interventions were interpreted and analysed according to the thematic elements in the conceptual framework. FINDINGS: Social values determined changes in the UC plan in two steps: the development of coverage decision guidelines and the introduction of such guidelines in benefit package formulation. The former was guided by process values, while the latter was shaped by different content ideals of stakeholders and policymakers. Analysis of the three interventions suggests that in allocating its resources to subsidise particular services, the UC authority took into account not only cost-effectiveness, but also budget impacts, equity and solidarity. These social values competed with each other and, in many instances, the prioritisation of benefit candidates was not led solely by evidence, but also by value judgments, even though transparency was recognised as an ultimate goal of reform. RESEARCH LIMITATIONS/IMPLICATIONS: The study findings indicate room for improvement and for future research--the current conceptual framework is inadequate to capture all the crucial elements which influence health prioritisation, as well as their interactions with social values. ORIGINALITY/VALUE: The paper fills a gap in literature as it enhances understanding of the effects of social value judgments in real-life health prioritisation.

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2004Case Study Research 1994Reforming the health sector in developing countries: the central role of policy analysis 2004National Institute for Clinical Excellence and its value judgments 2002Implementing public policy 2008Priority setting in health care: Lessons from the experiences of eight countries 2003Expanding access to priority health interventions: a framework for understanding the constraints to scaling‐up 2002BEST PRACTICE IN UNDERTAKING AND REPORTING HEALTH TECHNOLOGY ASSESSMENTS 2007Universal Coverage In The Land Of Smiles: Lessons From Thailand’s 30 Baht Health Reforms

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