In April 2001, Thailand became one of the first middle or low income countries to introduce universal healthcare coverage to the population. The system covers all previously uninsured people and those from the lowest income groups--more than 30% of the population.1 The system aims to provide the same quality of service as those covered by other forms of insurance--for example, healthcare cover as an employee benefit.

Praised by the World Health Organization, the success of the system will be watched closely as a possible model for other countries. Under this scheme dubbed the "30 baht health plan," people buy a gold card that entitles the holder to medical care and treatment for a single fee of 30 baht (about 40 pence). This covers most care, but excludes more advanced treatment such as kidney dialysis and antiretroviral drugs.

The system is financed jointly from government revenue, out of pocket payments, and contributions by workers and employers to a social fund. Healthcare providers, usually individual hospitals, receive payment through a capitation system. For each person registered, the provider receives an annual allowance of 1200 baht (£18; $28; a24) a year. Also, resource strapped hospitals can draw from a contingency fund of $122m.2

The problems with the scheme include equity. To get a gold card you must present official identification documents or a house certificate, which may prevent the poorest, and often the most in need from receiving it. Thailand also has over 2 million illegal immigrants, who are not entitled to any health care.3 Many hill tribe people, originally refugees from neighbouring Burma and Laos, who have lived in Thailand for many generations, have not been able to get the necessary registration documents.

The scheme also has an inherent urban bias; emphasis on hospital curative medicine means rural people must come into the cities for care and incur the extra cost and time demands. Curative primary health care, which would particularly benefit these people and be cheaper than hospital care, needs to be developed.

The funding of the scheme--hospitals cover the bulk of their care from a government subsidy--means that delays in payments to the hospital can leave the hospital under-resourced and, in turn, jeopardise patient care. Many hospitals have been unable to cope if they overspend, and many large hospitals around the country have been forced to cut back on staff and close beds amidst fears of bankruptcy.4

Complaints of substandard treatment are increasing. Patients may be referred to numerous different institutions as each refuses to take them. Further criticism lies in the sustainability of the system without substantial rises in tax.

The government asserts that although the system has teething problems, it is still being developed and will begin to evolve and expand over future years.5 Despite the problems, this is hopefully a progressive step towards quality health care for even the poorest people in Thailand.