Health
The health system offers universal access to health services to all Thai citizens. The system has a network of both public and private providers.
Please click on the following topics to learn more:
- Proportionof Hospitals
- Population VS Medical Staff Ratios
- Health Expenditure
- Health Schemes in Thailand
- Funding Mechanisms
- Challenges
Proportion of Hospitals
In 2006, the Ministry of Public Health (MoPH) owned about two-thirds of all hospitals. The public hospitals strive to attain widespread geographical coverage.
In 2008, the MoPH owned 953 hospitals which cover more than 90% of all districts; and 9,762 health centres, which cover every sub-district[1]. Private hospitals can mostly be found in the
Source: MoPH (2009)
Population VS Medical Staff Ratios
Over the last decade, the number of medical staff has increased.
The figure on the right shows health personnel/population ratios by region.
Clearly, the Bangkok region enjoys the best ratios. The differences are particularly big when comparing the doctor/population ratios: Bangkok has 3.6 times more doctors than the Central region and over 8.1 times more than the Northeast region.
Source: MoPH (2009)
Health Expenditure
The national expenditure on the health system amounted to 3.5% of GDP in 2006. This is less than other countries in the region, such as Laos (3.6%), Cambodia (6.0%) and Vietnam (6.6%)[3]. The financing details of the health system are recorded in the National Health Accounts. Although these provide comprehensive details of the financial aspects of the health system, the most recent recently published date back to 2005.
Source: MoPH (2009)
The figure on the left shows the composition of total health expenditure in 2007: 48% of total expenditure is made by the publicly managed health schemes; central and local government spent about 25%; and private household expenditures amounted to 19% of total health spending.
Health Schemes in Thailand
There are three major publicly managed health schemes: the contributory Social Security Scheme (SSS), and the non-contributory Civil Servants Medical Benefit Scheme (CSMBS) and the Universal Coverage Scheme (UCS). There also exists some minor health schemes for different target groups, but these are very small when compared to these three schemes. UC, which merged separate schemes for the poor such as LIS(Low Income Scheme), MWS(Medical Welfare Scheme), HCS(Health Card Scheme) in 2001, especially is the product of the concerted effort to move towards universal health coverage for all since the 1970s (ILO, 2008, p.11; Sakunphanit, 2010, pp. 74-5).
Funding Mechanisms
Funding mechanisms of health care vary among each scheme as Table 1 below. It should be highlighted that copayment by servicer users exists even under public health care schemes; and that expense per capita of CSMBS is much higher than those of UC and SSS which is attributed mainly to different mechanisms of provider payment.
Table 1: Funding Mechanisms of health care schemes
Scheme | Source of Funding | Co-payment | Per Capita Expense (as of 2008) * 1,000 Baht |
UCS | General tax revenue | Previously Baht 30, now Abolished Copayment only required if Using nonemergency services From unregistered facilities | 2.2 (USD 0.07) |
CSMBS | General tax revenue | Yes, for some inpatient care and for private hospitals | 12.1 (USD 0.37) |
SSS | Tripartite contributions | Maternity and emergency Services beyond budget ceiling | 1.8 (USD 0.05) |
Private health insurance | Out of pocket | Varies by insurance plan | Varies |
Table 2: briefly explains how payment mechanisms are different between schemes.
Schemes | Payment Mechanisms |
UCS | Mainly capitation: risk-adjusted capitation for ambulatory services, DRG under global budget for in-patient |
CSMBS | Fee for service for out-patient services, DRG for in-patient services |
SSS | Mainly risk-adjusted capitation using utilization, chronic diseases and relative weight of DRG |
Private Health Insurance | Fee for services |
Table 3: Characteristics of Public Health Protection Schemes
Characteristics | I. Civil Servants:
CSMBS | II. Private formal sector:
| IV. Rest of the population:
UC | |
---|---|---|---|---|
SSS | WCS | |||
I. Scheme nature | Fringe benefit | Compulsory | Compulsory | Social welfare |
Model | Public reimbursement model | Public contracted model | Public reimbursement model | Public integrated model |
II. Population coverage 2007 | Government employee, pensioners and their dependants (parents, spouse, children) | Formal sector private employee, >1 worker establishments | Formal sector private employee, >1 worker establishments | The rest Thai population, who are not qualified to previous columns. |
Coverage (% of population) | 7% | 15% | Same as SSS | 76% |
III. Benefit Package | ||||
Ambulatory services | Public only | Public & Private | Public & Private | Public & Private |
Inpatient services | Public & Private (emergency only) | Public & Private | Public & Private | Public & Private |
Choice of provider | Free choice | Contracted hospitals or its network with referral line, registration required | Free choice | Contracted hospitals or its network with referral line, registration required |
Cash benefit | No | Yes | Yes | No |
Conditions included | Comprehensive package | Non-work related illness, injuries | Work related illness, injuries | Comprehensive Package1 |
Maternity benefits | Yes | Yes | No | Yes |
Annual physical check-up | Yes | No | No | Yes |
Prevention, Health promotion | No | Health education, immunization | No | Yes2 |
Services not covered | Special nurse | Private bed, special nurse | No | Private bed, special nurse, eye glasses |
IV. Financing | ||||
Source of funds | General tax | Tri-parties 1.06% of payroll each | Employer, 0.2-2% of payroll with experience rating | General tax |
Financing body | Comptroller General Office, MOF | SSO | SSO | NHSO |
Payment mechanism | Fee for service for OP, DRG for IP | Capitation3 | Fee for service | Capitation for OP3, DRG for IP4 |
Copayment | Yes: IP at private hospitals | Maternity, emergency services | Yes if beyond the ceiling of 30,000 Baht | No |
Expenditure per capita in 2006 (Baht) | 8,785 | 1,738 | 211 | 1,659 |
Per capita tax subsidy in 2006 (Baht) | 8,785 plus administrative costs | 579 plus administrative costs | administrative costs | 1,659 plus administrative costs |
1 Personal health prevention & promotion, medical services and dental services. 2 The UC scheme offers prevention and health promotion to the whole population. 3 Some medical and dental services are reimbursed by Fee for service. 4 The UC uses a fixed budget (‘closed end’) and allocates this to providers according to the relative weight of DRGs. |
(Adapted from ILO, 2008, p.12:Table 3)
Challenges
Although the Thai health system offers universal coverage at comparatively high quality, it also faces some serious challenges. First of all, there are some equity problems within the system. The unequal government subsidies that are given to each scheme are the source of this problem. To illustrate this problem, figure 4 above shows the composition of total health expenditure in 2007. The UC scheme accounts for 22% of the total health expenditure, but is providing access to health care to 76% of the population. Compared to the CSMBS scheme, accounting for 19% of the total health expenditure and covering only 7% of the population, it is obvious that the disposable resources for both non-contributory schemes are unbalanced. This is both the result of an austerity policy of the UC scheme, as well as the lack of effective cost control measures within the CSMBS. Also, providers often use the CSMBS to make up for the (relatively) low payments received from the SSS and UC scheme[4]: in other words, the providers use the CSMBS for intra-hospital cross-subsidization. The chronic under-funding of the UC scheme can lead to poor quality for services offered to UC members compared to the beneficiaries of other schemes.
Another problem of equity can be observed in the SSS, where a contribution ceiling of 15,000 Baht (about 450 USD) exists. This means that all wage-amounts above the ceiling are exempted from contributions.
The graph on the left shows that in 2008 of the 9.2[5] million SSS insured, about 1.4 million persons –or 16%- earned more than 15,000 Baht. The contribution ceiling prevents to collect contributions from higher incomes on an equitable basis and decreases potential total revenues. Furthermore, the imposition of a contribution ceiling turned SSS-financing regressive for individual households.
Furthermore, a problem of the Thai health system is the present split into a domestic system, serving predominantly the poor and middle-income households, and an export-oriented system. Due to its comparatively high quality, Thailand is the world’s leading export country of health services, attracting more than one million patients a year (in 2008, this amounted to 615 million dollar[6]). While the export of health provides substantial income to the country, it has enormous detrimental brain-drain-effects on the domestic system; at the same time, the domestic system is not given the required flexibility and resources that would allow for successful competition through improvement of service. Last, not the least, ‘Preparing for an ageing society’ also should be recognized. Surveys show that decreasing total fertility rates and longer life expectancies are contributing to an aging society in Thailand which necessarily will have a negative impact on financial sustainability of health care system (Skunphanit, 2010, p.85).
[2] MoPH (2009)
[3] WHOSIS, total health expenditure as a percentage of GDP
[4] ILO (2009), Health Care reform: financial management, report 4
[5] ILO (2008)
[6] IHPP (2009), Trade in health-related services
* Skunphanit, T. (2010), “Moving Toward Universal Health Coverage : Thailand”, Joint Learning Workshop, Delhi, India, 3-5 February 2010.
* Original paper has not been provided for this page since administrative conditions have not been met.
Social security schemes and programs by branch