Rapid Assessment for Resilient Recovery and ... - GFDRR

Public sector health facilities play a crucial role in the health service system as they
provide health services to the people in all localities with good accessibility and coverage,
particularly in remote areas, while private sector health facilities play a significant role in
urban areas. The Ministry of Public Health (MOPH) is the most important healthcare
provider in the public sector. MOPH’s provincial hospitals achieved national coverage as
early as the 1950s, followed by the achievement of “a district hospital in every district”
coverage by the 1980s, and “health centers/health promotion hospitals in every sub-district
(tambon)” coverage by the 1990s. In addition, MOPH owns and operates 25 large regional
hospitals for advanced tertiary care, and 47 specialized hospitals. Complementing MOPH
health facilities, there are a number of health facilities operated by other public agencies,
including university hospitals, Ministry of Defense hospitals, Bangkok Metropolitan Administration
facilities, as well as those provided by other local administrative organizations.
There are over 800 public hospitals and 9,000 health centers/health promotion hospitals in
the country. Private health facilities also play a significant role in providing health services
in urban areas throughout the country, particularly in areas with good economic status.
There are over 16,800 private clinics without in-patient beds and 340 private hospitals
nationwide. Private hospitals provide around 20 percent of hospital beds in the country.
Achieving almost universal health coverage through three public mandatory insurance
arrangements in 2002 is one of the most significant achievements in the development of
Thailand’s health service system. The Universal Health Coverage (UC) scheme, the Social
Security Scheme (SSS), and the Civil Servant Medical Benefit Scheme (CSMBS) now
cover an estimated 98 percent of the population, with the UC scheme alone covering 75
percent. The cost of the UC and CSMBS is borne by the national budget, while SSS (for
formal sector labor force) is financed by tripartite contributions from employers, employees
and the government. Overall, the universal health coverage policy not only provides equal
opportunities for women and men to receive healthcare services, but it has been very effective
in improving access to health services for the poor. Incidences of catastrophic outof-pocket
health expenditures declined from 5.4 percent in the pre-UC era to 3.3 percent
thereafter. The impact of out-of-pocket expenditures for health on increasing the poverty
headcount has declined from 2.1 percent to 0.8 percent. 102 Overall, utilization of health
centers and district hospital services has doubled after the introduction of the UC scheme.
Thailand has achieved a lot with relatively low levels of spending on health per GDP,
though the government’s share of health spending is constantly rising. Total health spending
(financed from public and private sources) in Thailand was estimated to amount to
around 4 percent of GDP in 2008. This is lower than many regional and middle-income
peers that have made less progress toward universal coverage. Nevertheless, unlike
many other middle-income countries, a high and rising share of total health spending is
financed by the government. In 1995, government financing accounted for 47 percent of
total health spending; by 2008, this had increased to 75 percent. As a result, government
health spending as a share of GDP has nearly doubled, from around 1.5 percent in 1995
to almost 3 percent in 2008. The upside of this trend is the reduced reliance on out-ofpocket
financing, and the benefits that come with that in terms of financial protection and
equity in access. However, these benefits imply a growing fiscal burden. In a context of
102 Limwattananon et al (2005) Presentation to the International Conference on Social Health Insurance in Developing
Countries, December 5-7, 2005, Berlin, Germany.
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