The politics of change in Thailand’s health system

Abstract

Thailand became internationally recognised by its astonishing achievement in rapidly establishing Universal Health Coverage (UHC) nationwide in less than a year once a newly elected government came to power in 2001. Most previous studies on the political and policy aspects of Thailand’s UHC, or the Universal Coverage Scheme (UCS), often focused on how this policy came about. Using the Policy Feedback Theory (PFT), however, this thesis examines how UCS, once created in 2002, changes the nature of the political landscapes surrounding its health system and explores how feedback effects generated from such changes, in turn, affect the policy durability over time until the end of 2018. The three political landscapes that this thesis considers are (1) governance configurations, (2) power distribution among groups, and (3) meaning of welfare citizenship. Semi-structured interviews with forty-two key stakeholders were conducted in 2017 to supplement evidence from the reviews of publicly available documents. Content and thematic data analyses were conducted, and process tracing was further employed to address alternative causal explanations and to draw reliable causal inferences. The findings demonstrate that UCS substantially changed the politics surrounding the Thai health system in myriad ways, albeit in different degrees. Although UCS plays a significant role that changes the political landscapes during 2002-18, the thesis argues that UCS is not the only cause affecting such changes. Instead, the political landscapes prior to 2002 that gave rise to UCS are still in operation and also have direct and indirect consequences affecting politics surrounding the health system during 2002-18. Changes in the three political landscapes reciprocally produce various policy feedbacks, both self-reinforcing and self-undermining effects, that either stabilise or erode the durability of UCS. The thesis further argues that the critical factor that made the goals and principles of UCS durable during 2002-18, and beyond, is the interplay between self-reinforcing effects arisen from socio-political, fiscal and administrative feedback mechanisms that are explicitly more influential and prominent than that of self-undermining effects. UCS has generated numerous ‘increasing returns’ and proven itself with its self-reinforcing effects, despite politically seen as populist in its early years, to become ‘locked-in’ and costly for any government to reverse course and to alter its rights-based orientation.

Date of Award	1 May 2020
Original language	English
Awarding Institution	King's College London
Supervisor	Tomas Maltby (Supervisor) & Brian Salter (Supervisor)