As her condition worsened, Nattaya was forced to quit her job and became bedridden. This not only caused physical pain but also deteriorated her mental health, leading her to lose her sense of autonomy and self-worth. When physical therapy provided no relief, knee replacement surgery became the only medical option.

In 2023, Nattaya walked out of Bang Pa-in Hospital with healthy legs and a bill showing "0". The complex surgery and artificial joint, estimated to cost between 96,000 and 146,000 baht (approximately 79-120 million VND), were fully covered by the Universal Coverage Scheme (UCS). Just two months later, she returned to work, regaining her independence. Nattaya's story exemplifies the effectiveness of Thailand's public healthcare system, where the right to good health is no longer a privilege of the elite, according to Bangkok Health Service.

Nattaya is just one of over 6 million Thais facing musculoskeletal conditions, according to 2021 statistics. With 50% of the population over 65 suffering from these ailments, the demand for medical intervention is immense. Doctor Jaturong Bamrungchaowakasem, the orthopedic specialist who treated her, stated that a standard knee replacement surgery costs up to 100,000 baht, not including 46,000 baht for an artificial joint with a 15-year lifespan. Without government intervention, this financial burden could push a middle-class household into poverty. Studies from the World Bank (WB) also indicate that, thanks to the UCS, the percentage of Thai households impoverished by healthcare costs has sharply declined from 2,7% in 2000 to below 0,5% in the recent decade.

Nattaya Phusudsawang at the hospital in 2023. *Photo: NHSO*

Established in 2002, the UCS became the heart of Thailand's healthcare system. Initially, the UCS operated with a co-payment method, known as "30 baht for all diseases", where patients paid only 30 baht per visit. In the early 2010s, the government introduced the use of national identification cards instead of yellow cards for UCS beneficiaries accessing medical services. Since 2006, this fee has been waived in many cases, making most medical services free or heavily subsidized for Thai citizens.

The core purpose of the UCS is to ensure that all citizens have access to essential medical care without financial burden, covering a comprehensive package of health services from outpatient and inpatient care, preventive services like vaccinations, maternal care, and emergency services, to the treatment of chronic diseases and complex surgeries such as knee replacement.

The program is primarily funded through general government taxes, with a significant portion of the annual budget allocated for its maintenance. In 2024, the Thai government allocated approximately 223 billion baht (over 6 billion USD) to this fund. To manage cash flow, the National Health Security Office (NHSO) applies a capitation mechanism. Instead of paying for each service individually, hospitals receive a fixed budget, about 3,472 baht per person per year, to cover all treatment costs for residents in their managed area.

The operational mechanism of the UCS is ensured by an efficient reimbursement system, managed by the NHSO. Hospitals provide free or low-cost services to UCS patients, then submit electronic reimbursement requests to the NHSO and receive payment within two weeks.

After more than two decades of stable operation, in 2024, the UCS system entered a new revolution, transitioning from the philosophy of "treat all diseases" to "treat anywhere", according to Doctor Jadej Thammatacharee, Secretary General of NHSO. Previously, UCS patients were required to seek examination and treatment at their registered medical facility (often a hospital in their hometown) and needed a complex referral if they wished to be examined elsewhere.

The new objective is to allow people to access medical services using only their national identification card at any healthcare facility nationwide. The development of digital technology has laid the foundation for this, enabling the connection of health data across the country. This not only helps the NHSO track and reimburse costs for healthcare providers anywhere but also allows medical teams to continuously access patient records, reducing treatment duplication. A pilot program in 12 provinces was launched last year and is expanding nationwide.

However, the exploding demand for medical examination and treatment has led to chronic overcrowding in public healthcare facilities, with patients queuing from early morning and surgical waiting times extending for months. More severely, the capitation mechanism has become a double-edged sword for tertiary hospitals. Because actual treatment costs for complex cases often exceed the allocated quota, hundreds of public hospitals are facing budget deficits and the risk of accumulating debt.

The immense workload and modest remuneration in the public sector are also eroding the healthcare workforce. Burnout is causing many skilled doctors and nurses to leave the public system for private hospitals with higher incomes. This "brain drain" creates significant staffing gaps, especially in rural areas, leading to an alarming disparity in treatment quality across geographical regions.

To safeguard the system from potential collapse, policymakers are implementing governance reforms. The NHSO is leveraging its unique position, representing nearly 50 million beneficiaries, to negotiate drug and medical supply prices down to record lows, saving billions of baht annually for reinvestment. Simultaneously, a preventive healthcare strategy is being enhanced through a network of village volunteers to manage chronic diseases directly within communities, preventing severe complications that require costly hospitalization.

Digital technology is also being mobilized as a key solution to alleviate overload. The "treat anywhere" policy, combined with a telemedicine system, allows people to receive medication for common ailments at network pharmacies or private clinics. This crowd-dispersal strategy not only reduces pressure on large hospitals but also optimizes resources, ensuring that budgets are focused on critical cases that truly require specialized intervention.

Binh Minh (According to NHSO, WHO, Bangkok Health Service)