Experience in Thailand showed that universal coverage can be done using pluralistic approaches. However,it cannot be happen by change or political party agenda. It needs long term plan and continuous effort to go further step by step when windows of opportunities exist at points along the route of policy development.
Health care infrastructure should be the first step before arrangement of health care financing for universal coverage.
There is no single payment mechanism which is the best for every service.
In Thailand there is a trend that the three large scheme move toward to similar payment mechanisms for similar services.
They use fee-for-service method for specific services or equipments i.e. prosthetic heart value, which they would like to promote more usage. On the other hand, they use case mixed method i.e. to control inpatient cost.

Quality improvement program and measurements to improve equity are the next step after achievement of the universal coverage.