Developing nations watch Thailand's bold healthcare plan

As a vote-grabbing election pledge, it had a familiar ring: affordable health- care for all. And what worked for former President Bill Clinton in 1992 also proved a winner last year for Thaksin Shinawatra, Thailand's telecom tycoon-turned-populist politician. For Thai voters fed up with rising healthcare costs, the promise that any hospital visit – including surgery – would cost only 30 baht (75 cents) hit the spot.

Prime Minister Thaksin has kept his word, launching an ambitious plan to provide subsidized care and medicine to millions of underinsured Thais. His National Health Insurance Bill is expected to clear parliament shortly. Meanwhile, authorities have already issued 45 million saffron-colored cards that entitle the holder to a 30-baht treatment by a local healthcare provider.

While this puts him ahead of Mr. Clinton, whose healthcare bill never cleared the Senate, Mr. Thaksin has yet to convince everyone that his plan is working, or that it will outlast its architect. Doctors warn of falling standards and cash shortfalls in state hospitals. Economists predict that Thaksin will need to raise taxes to pay for his generosity, and say that this and other pledges are forcing Thailand into debt.

At stake is more than just Thaksin's chance of reelection. Thailand's bold experiment with universal health coverage, an expensive privilege enjoyed by a minority of countries, could prove a model for other developing nations, who are watching closely. Should Thailand succeed in introducing comprehensive healthcare without breaking the bank, other nations may follow, rather than accept the US model of private insurance.

"Thailand is moving towards universal coverage much quicker than other similar countries in the region," says Bjorn Melgaard, country representative for the World Health Organization (WHO).

Proponents of universal coverage argue that Thailand and other developing countries can improve productivity and play economic catch-up by investing early in public health, rather than waiting for growth.

They point to a WHO commission chaired last year by Harvard economist Jeffery Sachs that yielded detailed projections of economic returns – and lives saved – from healthcare spending in poor countries.

Experts also say that while Thailand needs progressive taxes to fund its reforms, more targeted spending can help soften the blow. Thailand has plenty of well-equipped hospitals and trained doctors – at least in urban areas – but it lacks a countrywide network of family doctors to handle routine care. Since the 30-baht plan was launched, city hospitals have complained of a flood of out-of-town patients who want to skip local practitioners – who can provide routine care at lower costs – and head straight to the country's best, and highest-paid, specialists.

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