タイにおける「30バーツ医療制度」の政策決定過程 : 社会保障アジェンダをめぐる「対立」と「同盟」に関するアクター分析
スポンサーリンク
概要
- 論文の詳細を見る
Many publications on East Asian welfare systems have appeared in the past five years. These studies cover issues of comparative welfare regimes, comparative institutional arrangements, policy implementation and so on. On the other hand, the studies on Southeast Asian welfare systems have just started off recently. This paper examines the policy-making process of the "30 baht universal healthcare scheme" launched in order to give more priority to primary care units (PCU) by the Thai Government since April 2001. Under the "30 baht universal healthcare scheme", a patient pays only 30 baht for a hospital visit and the rest is subsidized by the government and budgets are mainly allocated to community hospitals (contracting units for primary care: CUP) at a fixed per-capita rate based on the number of patients registered at each hospital (CUP). A strategic policy coalition between bureaucrats and politicians was observed in the process of policy formation. Previous experience and investment in health care by the Ministry of Public Health (MOPH) was essential for implementation of the 30 baht scheme. This paper notes that the "30 baht universal healthcare scheme" is a product of institutional rearrangement of Thailand's medical care resources initiated by a coalition between "community health-oriented bureaucrats (mo chonnabot)" in MOPH and "populistic" Thai Rak Thai Party led by Prime Minister Thaksin Shinawatra. The "30 baht universal healthcare scheme" has fundamentally changed the allocation system of medical care resources among the three different levels of hospitals, that is, community hospitals (rongphayaban chumchon), provincial hospitals (rongphayaban thua pai) and regional hospitals (rongphayaban sun). The older system, with support of "advanced medicine-oriented bureaucrats", another historically stronger faction of the MOPH, made it possible for large hospitals in charge of providing more advanced care and treatment to enjoy higher funding. In the legislative process of the National Health Security Bill, the "advanced medicine-oriented bureaucrats" faction lobbied against the bill. But the bill was passed almost unanimously by parliament in November 2002.