Coverage Decisions and the Court: A Public Health Perspective on Glucosamine Reimbursement in Thailand

Abstract —Thailand achieves universal health coverage through the introduction of three benefit schemes: the Civil Servant Medical Benefit Scheme (CSMBS), Social Security Scheme, and Universal Coverage Scheme. The primary benefit package of these schemes includes all medicines referenced in the National List of Essential Medicines. However, the CSMBS pays for nonessential drugs (NEDs) for particular conditions.  The CSMBS's cost escalation prompted the Ministry of Finance to tightly control drug expenditure. In 2010, glucosamine—an NED—was prohibited from CSMBS reimbursement. Subsequently, a dispute was lodged at the Administrative Court by two CSMBS beneficiaries. The court ruled that glucosamine reimbursement should be reinstated in the CSMBS scheme based on two grounds: the Royal College of Orthopedic Surgeons of Thailand's clinical practice guidelines and an argument with reference to Article 78(8) of the 2007 Constitution mandating the state to provide appropriate benefits to government and state officials.  Our comments are based on two factors: (1) the integrity of evidence that the Court applied and (2) the ruling with reference to Constitution Article 78(8) as it conflicts with Article 51, which aims to ensure equal rights to health services by all citizens. Because court cases concerning health care coverage in Thailand may expand in the future, we call upon the public to discuss the following issue: whether the court should rule on the inclusion of particular interventions or whether it should focus on the integrity of the coverage decision-making process. Similar lessons can be drawn from the experiences of countries in Latin America and Europe. In any case, all concerned parties including the court should be equipped with a good understanding of the complexity of the country's health systems in either option.