WEALTH

FOCUS
by experts. Typical is Eduardo Banzon, senior health
specialist with the Asian Development Bank, who believes
the country provides a good model for delivering universal
health at low cost.
In over 40 years of commitment, Thailand has markedly
improved life expectancies for males and females, he notes.
“What’s more, infant mortality has dropped sharply from
68 per 1,000 live births in 1970, to below 10 in 2006.”
When compared to countries with similar income
levels, Thailand’s achievements stand out. There has
also been a dramatic decline in under-five mortality
through a reduction of respiratory infections, heart failure,
communicable and parasitic diseases and diarrhea. Child
immunization rates for diphtheria, tetanus and whooping
cough even exceed the rates in some Western European
countries. All of this has been achieved at relatively low cost
in terms of health expenditure per capita and percentage of
GDP devoted to health (6.5% in 2014).
“I think Thailand can be proud of its successes,” says
Suthana Setawanna, the director of healthcare services in
Thailand. “The country has an impressive record of health,
particularly in fighting diseases associated with poverty.
We have achieved a good standard of sustainable medical
coverage for all and in levelling differences between the
rich and poor.”
He continues, “The system has transformed dramatically.
And judging by the surveys, people are quite aware of how
special it is. It typically receives 90% or more satisfaction
rate.”
DENTAL WORK IN THE LAND OF SMILES
In Thailand, improving healthcare has been a priority
ever since 1961, when the National Economic and Social
Development Plan was launched. Based around the notion of a
right to a healthy life, successive five-year plans saw facilities
continually upgraded and expanded into rural areas.
Initiatives such as establishing nurses and midwifery
colleges, combined with hometown placement, limited
the drain of skills to Bangkok. Compulsory placement
programs see young doctors serve up to three years
in remote areas to limit the concentration of professionals
in Bangkok.
It was, however, the election of Prime Minister
Shinawatra in 2001 that finally saw the system become
accessible to all. Under the slogan of “30 baht treats all”
($0.85), the system switched from subsidized healthcare to
a guaranteed access to a set of services, including free
prescription drugs, outpatient care and hospitalization, as
well as expensive services, such as radiotherapy and
surgery. Importantly for a country known as “the land of
smiles,” the system also covers basic dental work.
The 30 baht referred to the co-payment amount that
patients paid for every doctor’s visit or hospital admission,
but financing comes from progressive taxation. Those who
can pay usually opt for higher quality services, or have
private insurance for access to the well-developed private
medical sector.
One consequence has been a decline in out-of-pocket
expenses, which, according to the World Health
Organization, reduced the number of non-poor households
impoverished by ruinous health bills. In 1994, 45% of the
total health expenditure of the country came from
households. By 2010, this had fallen to 15%, lower than the
OECD average of 17.9%. The launch of the scheme in 2002
also changed the lives of the poor as healthcare was
extended to the 18.5 million people previously uninsured,
out of a total population of 62 million.
Yet the Thai system faces challenges. “There are issues
concerning financing, workload and efficiency,” says
Suporn Patcharatakul. A doctor who worked in the public
system before being appointed as vice president of the
Medical Department at Allianz Ayudhya Assurance in 2013,
Patcharatakul speaks at first hand of conditions on the
hospital wards.
“There is mounting frustration amongst medical staff
at the workload they are shouldering, as well as the far
lower pay in the public sector,” he comments. “These always
exist in any system, but the differences in Thailand have
starkly increased over the years.”
Numbers bear him out. As access has improved, people
have used the services more often. Total annual outpatient
visits increased from 111.9 million in 2003 to 153.4 million
in 2010, while admissions increased from 4.3 million to 5.6
million for a population that only increased slightly, which
is placing stress on the system.
Financing is a perennial issue. Costs have risen since
the scheme's inception. With the co-payment scrapped in
2006, the Thailand government is shouldering more of the
costs compared to other middle-income countries. The
government spend on healthcare has trebled since 1995
from 1.5% as a share of GDP.
“Rising costs could threaten the efficiency of the system
in the future, especially if budget cuts come in,” agrees
Setawanna. “However the increasing escalation of costs is
also due an increase in the chronic diseases associated
with an aging population.”
The country now needs to readjust its successful
system, he believes, to help handle costly non-communicable
diseases at the community level rather than in hospitals.
“This, along with disease prevention and better health
promotion, will be important for Thailand to keep its health
system sustainable.”
Allianz • 35