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Thailand achieved universal health coverage (UHC) with three public health insurance schemes in 2002. This study examines how political economy factors influenced the evolution of universal health coverage reform in Thailand by applying the political economy framework. This study concluded that while path dependency played an important role in putting pressure on resistance to change, the ability of the reform team to generate and effectively use evidence to guide the policy decision-making process allowed the reform to be placed on a “good path” such that it was able to overcome opposition.