n South African Medical Journal - Health financing lessons from Thailand for South Africa on the path towards universal health coverage : guest editorial

Volume 106, Issue 6
  • ISSN : 0256-9574
  • E-ISSN: 2078-5135



Five years after the release of its Green Paper on National Health Insurance (NHI), 4 years after the institution of NHI pilot sites and following the recent release of the White Paper on NHI, South Africa (SA) needs to move beyond the phase 1 plans , policy making and health system strengthening activities to phase 2 - putting into place the legal and institutional frameworks and systems for implementation of its universal health coverage (UHC) system. In doing so, SA can draw on considerable practical lessons from other countries' reforms in managing UHC with favourable equity outcomes over the past decade. We outline some potentially significant lessons from the Thai health financing system for SA. Thailand has received widespread international recognition as one of several middle-income countries that have made enormous progress in building a UHC system and in achieving 'good health at low cost'. Although its per capita GDP is below that of SA, Thailand has not only massively improved health outcomes (e.g. infant mortality 9.8/1 000) but made great improvements in social security objectives (>99% population coverage, high level of financial risk and impoverishment protection). It has low out-of-pocket payments and health-related catastrophic expenditure has fallen from 2.7% to 0.49%, but there is some room for improvement for urban poor populations.

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