**3.2 Thailand health insurance Scheme**

Thailand is a middle-income country in South-East Asia, with a population of 69 million and a GDP per capita of \$7,792. About 56% of its population is in rural area [51]. Thailand's health financing is worthy of consideration because of its long history of challenges similar to Nigeria, and its eventual rapid success which has become a global reference [53, 54]. The quest of Thailand toward achieving UHC began as early as 1975. After several trials with several health insurance mechanisms, Thailand achieved UHC in 2002 after commencing its Universal Coverage Scheme (UCS) the previous year [55]. By 2015, Thailand had been able to provide health coverage for 98% of its population [54]. Before 2001, the formation of different health insurance types to cater for various risk pool resulted in the fragmentation and failure of those schemes. When UCS was introduced, against all the odds, other fragments were collapsed into UCS except the Civil Servant Benefit Scheme (CMBS) and the Social Security Scheme (SSS). CMBS is a tax-funded health insurance that provides coverage for the formal sector, while SSS is a form of SHI for the private sector, covering about 12.3 million people.

Three essential factors contributed to the success of UCS within just a year. First, it is funded exclusively through government tax except at the beginning of the scheme when patients were required to pay 30 Baht (\$0.75) co-payment. Excise tax on alcohol and tobacco were earmarked to fund the scheme [43, 56]. Evidence has proven that tax-funded (especially direct-tax) health insurance is less regressive compared to SHI [45, 57]. Second, contrary to what operates in Nigeria, UCS uses a comprehensive medical package with only very few diseases not covered. This saw improvement in access and equity. Third, there is a purchase-provider split in the payment for health services. Capitations are paid for outpatient service, while DRG is used to pay for inpatient care [57]. Since UCS was introduced, there has been an improvement in health outcomes of the population reflected in Thailand's positive health indices. Moreover, the number of households suffering from catastrophic health spending became insignificant [47, 53]. Thailand's success story will not be complete without pointing out that the resilient political determination, community engagement, evidence-based research, and regular monitoring and evaluation employed by the Thai government were instrumental to achieving the feat [58].
