Background: Evidence for the impact of health care spending in the area of maternal, newborn and child health (MCH) in developing countries is limited.

Objectives: To examine the investment and medical care expenses for MCH under Universal Health Coverage (UHC) in Thailand.

Method: A prevention–appraisal–failure (PAF) cost element method was applied. Using a payer perspective, data related to PAF elements of MCH were collected from the Universal Coverage Scheme (UCS) inpatient claim database, UCS liability claims, the health-budget administration and health resource databases of the Ministry of Public Health, and the population census of The National Statistical Office in fiscal years 2007–2011. The main outcome measures included payments and budgets for MCH at a provincial level.

Results: Investment and medical care costs of antenatal care to prevent and manage complications increased from US$7.77 per person per year (PPPY) in 2007 to US$11.69 PPPY in 2011. The payments to support quality-focused activities ranged from US$0.60 to US$1.19 PPPY, whereas failure costs resulting from postpartum complications and UHC liability claims were US$1.92, 2.24, 2.35, 2.48, and 2.56 PPPY. Univariate regression analyses of year-on-year changes in prevention and appraisal costs for providing MCH and changes in the failure costs showed significant negative associations between 3 of 4 pairs of years

Conclusions: Increased year-on-year costs of preventing MCH problems were associated with a reduction in year-on-year costs incurred for correcting problems. Despite increasing trends for all the costs, this finding indicated improvements in allocation of resources to address MCH challenges in Thailand.