OVERVIEW
- Population: 69.8 Million
- Housing: 51.1% Urban, 48.9%Rural
HISTORY
Primary health care in Thailand began long before the 1978 Declaration of the Alma Ata. According to
Asian Biomedicine journal, a stone inscription indicates that King Chaivorman VII, "established over 102 hospitals called Arogayasala (Sanskrit for healing halls) in the northeastern region of the current Thailand and itsvicinity. These Aroyayasalas were staffed with various professionals, namely, doctors, nurses, pharmacists,recorders of statistics, food and drug preparers." Other stone inscriptions reveal that herb gardens provided a source of medicine.
4 Western medicine was slowly incorporated into health care in Thailand, mainly from French and Portuguese influence; they introduced international methods of medicine and Western hospitals. Christian missionaries from also had a role in the development and use of Western medicine in the country.
4
In recent history, Thailand has dedicated itself to improve the health and lives of the Thai people. Between 1960 and 1975, health, education and infrastructure development were a focused of the government, investing in public health initiatives in both rural and urban areas that reduced disparities and improved health for everyone. Life expectancy at birth increased from 63.8 years to 77.6 years between 1975 and 2005.5 Before implementing the Universal Coverage Scheme in 2002, Thailand had four health insurance programs that intended to cover the whole population. The Medical Welfare Scheme (MWS), which was a government subsidy program that intended to expand access to the poorer population in 1975, then it expanded to the elderly population in 1992 and other vulnerable groups in 1994. The Voluntary Health Card Scheme (VHCS) was established for people who were not eligible for the other programs. Each household had the option to purchase insurance coverage for 500 baht a year. The Civil Servant Benefit Scheme (CSMBS) and the Social Security Scheme (SSS) covered individuals in the formal employment sector.6
In 2001, 30% of the population was still uninsured mostly due to operational issues in the MWS and VHCS programs. The MWS had issues with assessing the incomes of those working in the informal employment sector, which gave access to individuals who were not eligible for MWS. The VHCS ran into the problem of adverse selection since it was mainly voluntary. The gaps were filled by integrating the MWS and the VHCS into the Universal Coverage Scheme in 2002.
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HEALTH & HEALTH SYSTEM
Thailand implemented Universal Health Coverage in 2002
6 and, according to an article in
Health Systems in Transition, since then public expenditure on health increased from 63% to 77% of the total health expenditure, while out-of-pocket decreased from 27% to 12%. An analysis shows the successful launch of the Universal Coverage Scheme (UCS) was due to the political commitment, civil society engagement and technical expertise. The UCS is financed by general tax and covers approximately 76% of the population consisting of those not covered by the other two insurance schemes. The benefit package is comprehensive and includes general medical care, rehabilitation services, high cost medical treatment, and emergency care. The scheme has increased healthcare access and reduced incidences of catastrophic health expenditures.The UCS benefits the most vulnerable populations more than any other program. The budget for the UCS is allocated on a capitation basis for outpatient care and uses Diagnosis-Related Groups (DRGs) for inpatient care.
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The Civil Servant Medical Benefit Scheme (CSMBS) covers approximately 9% of the population and includes government employees as well as dependents such as parents, spouse, and up to two children. This scheme is characterized by fee for service for outpatient services and DRG for inpatient services and free choice of public providers. It is also financed by general tax and includes a slightly higher benefits package than the UCS. The Social Security Scheme (SSS) covers 16% of the population consisting of private sector employees without dependents. It is financed by payroll tax including a three part contribution from 1.5% of salary, equally by employer, employee, and government. This scheme is characterized by capitation payment for outpatient and inpatient services. It has a comprehensive benefits package including outpatient services, inpatient services, emergency and high-cost care, however it excludes preventative care and health promotion.8
There are more than 1,000 hospitals in Thailand’s public sector with a relatively good standard of care and is used by the majority of Thai citizens. The downfalls of the public health system are long wait times and outdated equipment. Private hospitals provide high quality care and have attracted higher income Thai citizens as well as attention from all over the world especially from the Middle East and Europe. The best of the private hospitals are in Bangkok and other major cities.
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HEALTH INDICATORS & DEMOGRAPHICS
There is still a significant portion of the population living in rural areas which are affected by health disparities that are being addressed. The year round tropical climate makes it a good environment for viruses and bacteria which create health hazards in Thailand. Cholera and leptospirosis are water-borne diseases that can be contracted in Thailand for example.9
- Fertility Rate: 1.5 live births per woman
- Life Expectancy (Female, Male): 81, 74
- Infant Mortality Rate: 6.7 deaths per 1,000 live births
- Child Mortality Rate: 7.8 per 1,000 live births
- Maternal Mortality Rate: 37 deaths per 100,000 live births
- Thai: 91.5%
- Khmer: 2.3%
- Malay: 2.1%
- Bamar: 1.5%
- Other: 2.6% (Other asian ethnicities, migrants)
- 0-14 years: 16.7%
- 15-24 years: 13.8%
- 25-54 years: 46.1%
- 55-64 years: 12.4%
- 65 years and over: 11%
References
1 The World Bank. (2020). Thailand . Data. https://data.worldbank.org/country/thailand.
2 The World Bank. (2017). Current health expenditure (% of GDP). Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS.
3 Thailand Population (LIVE). Worldometer. (2020). https://www.worldometers.info/world-population/thailand-population/.
4 Charuluxananan, S., & Chentanez, V. (2007). History and evolution of western medicine in Thailand. Asian Biomedicine . https://www.researchgate.net/publication/47386858_History_and_evolution_...'s%20first%20hospital%20was%20built,Hospital%20was%20established%20in%201914.
5 Tangcharoensathien, V., Limwattananon, S., Suphanchaimat, R., Patcharanarumol, W., Sawaengde, K., & Putthasri, W. (2013). (rep.). Health workforce contributions to health system development: a platform for universal health coverage. World Health Organization. Retrieved from https://www.who.int/bulletin/volumes/91/11/13-120774/en/
6 Paek, S. C., Meemon, N., & Wan, T. T. H. (2016). Thailand’s universal coverage scheme and its impact on health-seeking behavior. SpringerPlus, 5(1). https://doi.org/10.1186/s40064-016-3665-4
7 Overview. World Bank. (2020, September). https://www.worldbank.org/en/country/thailand/overview.
8 Jongudomsuk, P., Srithamrongsawat, S., Patcharanarumol, W., Limwattananon, S., Pannarunothai, S., Vapatanavong, P., … Fahamnuaypol, P. (2015). The Kingdom of Thailand Health System Review. Health Systems in Transition, 5(5). https://apps.who.int/iris/bitstream/handle/10665/208216/9789290617136_en....
9 Healthcare in Thailand | Expat Arrivals. Globe Media Limited. https://www.expatarrivals.com/asia-pacific/thailand/healthcare-thailand.
10 Thailand. Thailand - Country Profile - 2019. (2020). https://www.indexmundi.com/thailand/.
11 Misachi, J. (2019, July 18). Largest Ethnic Groups In Thailand. WorldAtlas. https://www.worldatlas.com/articles/largest-ethnic-groups-in-thailand.html.
