The Kingdom of Thailand health system review
Overview
A sustained political commitment to the health of the population since the 1970s has led to significant investments in health infrastructure, in particular primary health care, district and provincial referral hospitals, and improvements in the overall functioning of the health system.
Thailand achieved Universal Health Coverage in 2002. Since then public expenditure on health significantly increased from 63% in 2002 to 77% of the total health expenditure in 2011, while out-of-pocket expenditure was reduced from 27.2% to 12.4%. Extensive geographical coverage of health-care delivery, a comprehensive benefits package free at point of service, and increased capacity of the Ministry of Public Health facilities are the main factors that have contributed to improved pro-poor utilization, low level of unmet health needs and pro-poor benefit incidence. The dominant close-ended payment system, notably capitation, global budget and Diagnostic Related Groups, has been cost-effective. The National Health Security Office has demonstrated its capacity in managing strategic purchasing.
Thailand is self-reliant in healthcare workforce production with high-quality standards. The healthcare workforce density per 1000 population is slightly above the 2.28 WHO benchmark of doctors, nurses, and midwives. To ensure adequate healthcare workforce serving rural populations, continued efforts of multiple interventions have been applied, such as recruitment of students with a rural background, curriculum reflecting rural health problems, mandatory rural service by all medical graduates since 1972, and financial and non-financial incentives. Quality is ensured through a national licensing examination for all cadres of medical professionals since 2001, licensing by professional councils, and relicensing for professional nurses every five years, requiring a cumulative number of continuing nursing education credits.
Thailand has performed better in terms of maternal and child health as compared with other low- and middle-income countries. However, despite good health at low cost, overall adult mortality rates are not lower than in neighbouring countries and are actually higher than countries in Central America.
Health reforms have been implemented locally since the 2000s. The sin tax-funded Thai Health Promotion Foundation supports health promotion actions; the National Health Commission convenes National Health Assembly as a platform for participatory public policy formulation; and the Healthcare Accreditation Institute supports quality improvement through local ownership, funding and accreditation. Innovative reforms have been facilitated by strong national capacity to generate evidence on health policy and systems, manage changes and oversee effective implementation.
The remaining challenges in the Thailand health sector include: financing and service-provision policies for the elderly; large gaps in urban primary health care; risks of reliance on general taxation in financing health
care during the economic downturn; risks of internal migration of health-care professionals in response to increased demands for health services by international patients following the 2015 Association of Southeast Asian Nations (ASEAN) Economic Community;
and adjustments by the Ministry of Public Health in responding to the dynamics of health-system governance, an increased number of actors and interests.