HEALTH AND WELLNESS FOR ALL

Thailand 2017 | HEALTH & EDUCATION | REVIEW: HEALTH

A regional leader in health services, Thailand has both a far-reaching public healthcare system and a dynamic and growing private care system.

Decades of private and public investment in Thailand's health have led to vast improvements in the healthcare system. Since the inauguration of a universal healthcare coverage system in 2002, nearly 99% of Thai citizens receive primary care. Thanks to a robust synergy between private medical consortiums and governmental schemes, Thailand continues to make great progress in providing affordable and high-quality healthcare to not only its own people but to the entire region.

Since the implementation of universal healthcare, the Thai population is covered by three major insurance plans. The Universal Coverage Scheme (UCS) covers the majority of the population; the Civil Servant Medical Benefit Scheme (CSMBS) covers civil servants and their dependents; and the Social Health Insurance Scheme (SHIS) covers private-sector employees. According to the latest data from the National Statistic Office of Thailand, the UCS covers 74.4% of the population; the SHIS covers 15.4%; and CSMBS covers 8.6%.
According to the latest analysis by the World Health Organization (WHO), total health expenditures as a proportion of GDP was roughly 4.5% in 2012 and public expenditure accounted for 76% of total health spending, while private expenditure accounted for 24%. Healthcare expenditure as percentage of GDP is expected to be even lower than 4.5%, a figure that is not projected to cause undue strain on the government's budget. Total healthcare expenditure in 2012 was roughly USD16.5 billion. General governmental expenditures accounted for nearly 68.4% of this total, or USD11.3 billion, and out-of-pocket expenditures for health consumers accounted for 11.6% or a little over USD1.9 billion. In the last 10 years, health expenditures have held steady, varying between 10% and 13% of general government expenditures.

Health

According to the Ministry of Public Health, the five biggest causes of death in Thailand are cancers, accidents and poisonings, hypertension and cerebrovascular diseases, heart diseases, and pneumonia and other lung diseases. While there have been declines in the number of deaths from accidents and poisonings as a result of tighter governmental regulations and better education about safe driving, deaths from heart disease, hypertension, and stroke have been on the rise. In an effort to combat this rise, a number of organizations have redoubled their educational efforts.

One such group that focuses on education is the Heart Association of Thailand. In an exclusive interview with TBY, Chumpol Piamsomboon, President of the Heart Association of Thailand, explained that the association's “key responsibility is to focus on prevention through public education jointly with the Heart Foundation of Thailand." Mr. Piamsomboon and his colleagues' efforts are aided by their prestigious association with the royal family; His Majesty King Bhumibol Adulyadej awarded the Heart Association of Thailand Royal Patronage, thereby adding importance and visibility to the group and its mission.

Though certain communicable diseases, notably HIV/AIDS, artemisinin resistant malaria, and tuberculosis, still pose a problem, collaboration between the Ministry of Public Health (MPH) and the US Centers for Disease Control and Prevention has led to the design and implementation of effective disease prevention programs.

Helping Those Most In Need

Within the health system, major emphasis is placed on effectively distributing healthcare to rural areas of Thailand. As such, the healthcare infrastructure is extensive and efficiently serves even the farthest flung areas of the state. According to the WHO, a diffused, geographically oriented system of healthcare allocation composed of sub-districts, districts, and provinces means that Thai citizens have greater access to care than ever before. Approximately 10,347 health centers, each staffed by an average of four personnel, provide a point of access for millions of rural people.

One unintended consequence of focusing heavily on rural channels of health care distribution has been, in some instances, the neglect of urban areas. Large urban populations have heavily taxed the health system in certain cities. The situation has been particularly acute in Bangkok, where an emphasis on hospital construction has lead to an overlooked and overburdened health center infrastructure, according to WHO.

Public Input

In an effort to more effectively and efficiently craft health policy, a number of autonomous health organizations have been founded. One of the most interesting and dynamic of these health initiatives is autonomous governmental agency Thai Health Promotion Agency (ThaiHealth). Founded in 2001, ThaiHealth is dedicated to encouraging a fuller understanding of health within Thai society. Funded by a 2% surcharge on excise taxes from the tobacco and alcohol industry, ThaiHealth is focused on research, advocacy, and awareness for a wide variety of health-related issues relating to both society and the environment. All independent health agencies like ThaiHealth work in tandem with the MOPH. According to the WHO, this cooperative structure helps civil society groups and other public interests participate in crafting Thai health policy, thereby enriching the quality of health policy and health discourse in Thailand.

Obstacles and Opportunities for an Aging Population

As Thailand's population ages, there is evidence that adjustments may be required to continue providing quality healthcare. According to the International Labor Organization, 20% of Thailand's population is projected to be 60 years of age or older by 2035, with the proportion approaching 30% by 2050. According to the WHO, the percentage of the population over 80 tripled from 1970 to 2010, rocketing from 500,000 to 1.7 million. An increasingly large percentage of the population will be faced with severe and elderly-specific ailments, such as restricted cognitive and physical function, an increase in chronic illnesses, and psychosocial stress. Between 2009 and 2020, the number of elderly with severe and profound dependence is expected to double.

This aging population has significant commercial and investment potential in segments dealing with senior-services, nursing, and home-care. For firms positioned to take advantage of this demographic trend, there is the prospective for significant returns on investment. One such firm is CT Asia Robotics, which, according to Business Insider, has seen success manufacturing and distributing a robot, named Dinsow, designed to care for the elderly. Businesses throughout the USD4 billion Thai health industry are redoubling efforts to find ways to better serve Thailand's elderly. In an effort mitigate the impact of an older population on the healthcare system, a variety of campaigns aimed at supporting healthy aging have been devised and implemented.

Private Sector

While public health facilities are predominant in Thailand, private-sector providers are displaying signs of robust growth. According to the WHO, of Thailand's 1,320 hospitals, 75% of them are public, and 79% of all hospital beds in Thailand are in public facilities. Private hospitals are often much smaller in terms of the number of beds, and 69% are estimated to have less than 100 beds. Furthermore, occupancy rates in private hospitals are often lower, approaching 50% compared to nearly 80% for hospitals operated by the MOPH. However, private hospitals make up a more significant portion of medical services and facilities in urban areas.
Though private hospital growth slowed in the years immediately following the establishment of a universal coverage system, things have been speeding up. Thanks to excellent medical facilities and practitioners, Thailand has become a hub for medical tourism in the region, and much of the growth in private hospitals is derived from this source. In an interview with TBY, Dr. Chairat Panthuraamphorn, Managing Director of Samitivej Hospitals, reiterated these findings. “Thailand is renowned for its highest standards of medical facilities and service qualities, more so than any country in the region," Dr. Panthuraamphorn explained. “Patients recognize this, and it is up to us to seize this opportunity to make the most of the growing regional connectivity."

With eight hospital groups currently listed on Thai exchanges, and serious investment projects planned, private health providers in Thailand are poised for even greater growth.

Looking to the Future

As the Thai health industry continues to develop, strides will continue to be made. Public and private enterprises are responding to changes, addressing issues, and leading the way forward in terms of regional health standards. Potentially problematic areas of health, like an aging population and an increase in non-communicable diseases, are being addressed by both public and private initiatives.

Chaiyasith Viriyametakul
CHAIYASITH VIRIYAMETAKUL
CEO, Vibhavadi Medical Centre
The highest demand is in the areas of cardio, cancer, and diabetes. The government needs to focus on subsidies for heart disease prevention and treatment.