Volume 3, Number 5: November 2019 | Article
As Thailand is said to be one of the most efficient and successful health care models in Southeast Asia and try to develop itself to be destination for medical tourism globally. Without the aid of a robust and effective public health system, this could not have been done. In 2018, Thailand ranked 27th among 56 countries in healthcare efficiency, according to the Bloomberg Health Care Efficiency Index. However, many experts have been questioned about the ability of the government to keep the public health care system continued. In this essay, we are going to focus on reasons why the future of Thailand’s public health care is in danger.
As experts in health care and public finance have cautioned for years that public health will become a burden that the government is unprepared for subsidizing and has recommended reform. Currently Thailand is covered by three health insurance programs with different benefits. The biggest is the universal health coverage (UHC), known as the thirty-Baht scheme, which encompasses 70 percent of the population and offers universal access to critical health care services at almost no expense for low income people and people without insurance. The expenses account for 40 percent of all public health care spending. The rest of the population, including workers in the private sector, belongs to self-financed social security programs and the tax-funded Civil Servant Medical Benefit Scheme (CSMBS) which covers officials and members of their families. Thai Health Promotion Foundation figures show that public health spending accounted for 13 percent of the state budget in 2014. This amount of spending may not sound troubling, but over the past 12 years public health expenditure has increased by an average of 12 percent a year. (Tdri, 2018) The UCS has also expanded the scope and extent of its services, such as protecting refugees and expanding coverage to cover a wider variety of therapies. (Chan, 2018) The lack of shared data between the schemes makes the state’s measurement of spending on public health inaccurate, making it difficult to manage and control spending. The Thailand Development Research Institute (TDRI) predicts that around 480 billion Baht or more will be spent on public healthcare in 2032. (Tdri, 2018)
The rising in the aging population, longer life expectancy, and the decrease in the working population have put tremendous pressure on the economy and public welfare system in Thailand. The World Bank estimates that by 2040, more than 25 percent of the Thai population of about 17 million people will be 65 years of age or older. (Chan, 2018) Evidence shows that when people grow older, there is a higher chance that people will suffer from non-communicable diseases (NCDs). In accordance with a 2008 Ministry of Public Health survey, total public spending on five major NCDs, including cancer, hypertension, heart disease, stroke and diabetes, was around 25 billion Baht. (Tdri, 2018) Currently, the money that the state spends on treating NCDs is among the top of long lasting disease. This shows that rising in aging population will eventually increase expenditure on public health and the government needs to be prepared for this challenge. TDRI also warned that aging population would drive Thailand’s healthcare spending within 15 years to 1.4 trillion Baht. (Tdri, 2018)
While the UCS is Thailand’s primary health care system, self-financed social security programs and the CSMBS are also available. The CSMBS provides far better benefits, compared to the other two schemes. For instance, in accordance with the Aids Access Foundation, every year in the national universal health care system, 3,426 Baht was set aside per patient, compared with about 14,000 Baht per person allocated in the CSMBS. (Chan, 2018) Another potential issue is the utilization issue. An initial study of the thirty-Baht pilot health insurance program found that when the thirty-Baht scheme was introduced, the lower income group expanded their use of health care services. (Supakankunti, 2019) People may become more careless with regard to caring for themselves and may even be participating in risky activities with the understanding that if they are injured, there is someone to take care of them, without stressing about the medical care cost.
To sum up, although use of the universal coverage system has several advantages, it is clear that the successful public health care in Thailand today faces several challenges. The challenges are growing budget, aging society, unfair budget allocation, and increasing of utilization. Health ministries will play an essential role in developing health care systems and, to some degree, improving the education of staff working there is also important. It is not possible to achieve concrete improvements to health care systems without corresponding adjustments in education of medical staff.
References:
- Tdri. (2018, March 6). Is the future of Thailand’s health care in danger? Retrieved from https://tdri.or.th/en/2018/03/future-thailands-health-care-danger/.
- Chan, A. (2018, November 5). The challenges of Thailand’s public healthcare system. Retrieved from https://www.pacificprime.co.th/blog/the-challenges-of-thailands-public-healthcare-system/.
- Supakankunti, S. (2019, November 9). The Thai Health System in Transition: The Challenge of Mutual Responsibilities. Retrieved from https://www.encyclopedia.com/international/applied-and-social-sciences-magazines/thai-health-system-transition-challenge-mutual-responsibilities.
Interesting article!
Despite the praise on Thailand’s healthcare system, I agree that it is far from perfect. A major problem related to free healthcare is the shortage of health professionals. When looking at the supply side of the healthcare system, there is not enough human resources in rural areas. The issue rises from the lack of incentive and motivation provided by the government. As a result, health professionals such as doctor have to work over the legal working hours. Furthermore, doctors in remote area have not graduated yet. It means that they are not qualified as doctors yet. Thus, lives of patients are at risks.
Moving forward the government must not overlook the issue of the supply side of the healthcare system. The health professionals are the small stakeholders or the minority in the system. However, their voices must also be heard.
I enjoyed reading your article and I think this topic is very interesting since health care systems and the composition of the society are continuously evolving. We have also discussed the Thai healthcare system in one of my other classes, called Economic Development. This article complements what we have discussed there.
Thailand has both public and private hospitals with the latter providing a higher standard of healthcare and hospitals that look like hotels. I think this is also one of the important issues in the Thai healthcare system, since most doctors that graduate prefer working at private facilities due to higher wages, better technologies and facilities. This causes a growing abondonment of doctors working in public hospitals, especially in rural areas.
Because medical education is heavily subsidized by the Thai government, graduated doctors are obliged to work three years in rural areas in order to combat the deficit of professionals. However, after these three years most of them still move to more urban areas and often one of the private hospitals. This is also one of the current issues that affects the quality of healthcare provided in public hospitals.
Furthermore, the medical tourist are an addition to the Thai economy, but these treatments also require professionals that could have worked in one of the public hospitals for instance.
A proposed solution for this problem is that the Thai government obliges private hospitals with public hospitals in one. The income earned from private hospital treatmens could then be used for the operationalization of the public hospitals. This allows for improvement facilities, technologies and wages, which makes working in public hospitals more interesting for healh professionals.
Lastly, some of the issues you discussed are not only applicable to Thailand, but these are global issues, such as the ageing society. It will be interesting to see how the Thai healthcare system will implement changes in order to combat the increasing costs while maintaining medical quality.
I really think the topic you raised about the current Thai healthcare system is very true. Healthcare is a vital sector of every nation and improving the system was often neglected by the Thai government.
Thus, I have a point I would like to add on to your article.
Regardless of the moral hazard and the problem of huge governmental deficit, Thailand’s healthcare system may also be at risk because of inequality. Even though the UHC has existed for decades, we cannot deny that the quality of healthcare for those under the program significantly differs from the quality of healthcare for the privileged. And by quality, I do not mean the facilities but a whole-day wasted at the hospital, ineffective medicines, the about-to-break-down medical tools, insanitariness etc.
The Universal Healthcare has proven to provide the poor with affordable healthcare services, but it is really effective enough?
Whatever the challenges are, the health of its citizens is the backbone of every nation. Eliminating the UHC completely, is out of question. However, the government should really concentrate more on the issue than any other profit maximising regime. The government has to be extra careful in finding a better solution, or else cutting the cost of healthcare would lead to a higher national risk.
I enjoy reading your article. I think that government should concern about this problem as this scheme must use a large amount of money to subsidize the health care system. Therefore, the government should revise the scheme in order to improve and make it efficient as possible. I also agree with the author to the point that this scheme caused unfair budget allocation because it does not provides for everyone in the country. Another point is that when this welfare is distributed to the poor with unlimited use, they might be careless with their health because they feel that someone is responsible for their medical cost. I think this policy is a good policy but government might need to limit the use so people will see the value of the welfare.