Efforts by countries to attain universal coverage are often hampered by supply constraints that can reduce access to care for those already in the system and, in many Asian and developing countries, by the emergence of informal payment systems that extract under-the-table payments from patients. In 2001, Thailand extended government-financed coverage to all uninsured people with little or no cost sharing. The authors found that Thailand has added nearly fourteen million people to the system and achieved near-universal coverage without compromising access for those with prior coverage; they also found that, to date, no informal payment system has emerged.
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