Government Spending and Central-Local Relations in Thailand's Health Sector
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World Bank, Washington, DC
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This paper focuses on efficiency and
equity in the financing of health services, and the evolving
role of central and local government in the health sector.
Thailand has seen significant improvements in health
outcomes and succeeded in expanding the coverage of health
protection schemes over the last decades. While the
achievements of Thailand's health system are
undeniable, this paper highlights three key challenges: (i)
inequalities in utilization and spending under different
health financing schemes and across geographic areas; (ii)
mounting cost pressures; and (iii) fragmentation of
financing and unresolved issues concerning the respective
roles of central and local governments. This paper shows
that although some of the differences in utilization and
spending across schemes can be explained by the age profile
of members, significant variations remain even after
controlling for differences. It documents large variation in
resources and spending across regions, both for the system
as a whole and within the respective health financing
schemes. In addition, the paper highlights pressures to
increase government health spending that are primarily the
result of rising spending in the Universal Coverage (UC) and
Civil Servant Medical Benefit Scheme (CSMBS) schemes. Cost
pressures are likely to persist due to rising incidence of
chronic disease, population aging, continuing pressure from
health workers for greater compensation, demands for
expanded benefits under the respective schemes, and the
rising expectations of patients. Finally, the paper argues
for a more systematic and decisive approach to
decentralization of prevention and promotion functions,
based on more detailed specification of the roles and
responsibilities of central and local government. It also
suggests that the current approach to primary care
decentralization through voluntary transfer of health
centers has limited potential, and that there is a need to
consider local management of networks of providers that
combine both general hospital and primary care services.
Palabras clave
ACCESS TO HEALTH CARE, ACCESS TO HEALTH SERVICES, AGE GROUPS, AGE STRUCTURE, AGED, AGING, AMBULATORY CARE, ANTENATAL CARE, BRAIN, BRAIN DRAIN, BREAST CANCER, BUDGET ALLOCATION, BULLETIN, CAPITA HEALTH EXPENDITURE, CAPITATION, CAPITATION PAYMENT, CARDIOVASCULAR RISK FACTORS, CARE PERFORMANCE, CENTRAL BUDGET, CERVICAL CANCER, CHRONIC CONDITIONS, CHRONIC DISEASE, CHRONIC DISEASES, CITIZEN, CITIZENS, CLINICAL OUTCOMES, CLINICAL PRACTICE, COMMUNICABLE DISEASES, COMMUNITY HOSPITALS, COST OF CARE, CURRENT POPULATION, DECISION MAKING, DEMOCRACY, DEMOGRAPHIC TRANSITION, DEPENDENCY RATIO, DETERMINANTS OF HEALTH, DIABETES, DIAGNOSIS, DISEASE MANAGEMENT, DISEASE PREVENTION, DISPARITIES IN HEALTH, DISSEMINATION, DOCTORS, DRUGS, ECONOMIC GROWTH, ECONOMIC OUTCOMES, ECONOMIES OF SCALE, ELDERLY, ELDERLY POPULATION, EMERGENCY CARE, EMPLOYMENT, EPIDEMIOLOGICAL CHANGES, EPIDEMIOLOGICAL TRANSITION, EPILEPSY, EQUITY IN ACCESS, ESSENTIAL HEALTH SERVICES, EXPENDITURE CONTROL, EXPENDITURES, FAMILY PLANNING, FAMILY PLANNING PROGRAMS, FEE-FOR-SERVICE, FERTILITY RATE, FINANCIAL BARRIERS, FINANCIAL INCENTIVE, FINANCIAL INCENTIVES, FINANCIAL MANAGEMENT, FINANCIAL PROTECTION, GENERAL PRACTITIONERS, GLUCOSE, GOVERNMENT AGENCIES, HEALTH CARE, HEALTH CARE COSTS, HEALTH CARE SYSTEM, HEALTH CARE WORKERS, HEALTH CENTERS, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FINANCING, HEALTH FINANCING REFORM, HEALTH INSURANCE, HEALTH INSURANCE SCHEMES, HEALTH INSURANCE SYSTEM, HEALTH INSURERS, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH POLICY, HEALTH PROFESSIONALS, HEALTH PROMOTION, HEALTH RESEARCH, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE UTILIZATION, HEALTH SERVICES, HEALTH SERVICES RESEARCH, HEALTH SPENDING, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH SYSTEMS, HEALTH WORKERS, HEALTH WORKFORCE, HEALTHCARE INSTITUTIONS, HEALTHCARE SYSTEM, HEART ATTACKS, HOSPITAL ADMISSION, HOSPITAL ADMISSIONS, HOSPITAL BEDS, HOSPITAL SYSTEMS, HOSPITALIZATION, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, HYPERTENSION, ILLNESS, IMMUNIZATION, IMMUNIZATIONS, IMPLICATIONS FOR HEALTH, INCOME, INCOME COUNTRIES, INFANT, INFANT MORTALITY, INFANT MORTALITY RATES, INFERTILITY, INFORMAL SECTOR, INJURIES, INTERNATIONAL COMPARISONS, INTERNATIONAL TRADE, LABOR FORCE, LABOR MARKET, LEVELS OF FERTILITY, LIFE EXPECTANCY, LIFE EXPECTANCY AT BIRTH, LIVE BIRTHS, LOCAL AUTHORITIES, LOCAL GOVERNMENTS, LOW INCOME, MATERNAL MORTALITY, MATERNAL MORTALITY RATIO, MEDICAL BENEFIT, MEDICAL DOCTORS, MEDICAL EDUCATION, MEDICAL STAFF, MINISTRY OF EDUCATION, MORBIDITY, MORTALITY, MYOCARDIAL INFARCTION, NATIONAL HEALTH, NATIONAL HEALTH SYSTEMS, NATIONAL LEVEL, NUMBER OF CHILDREN, NUMBER OF CHILDREN PER WOMAN, NURSE, NURSES, NUTRITION, OUTPATIENT SERVICES, PARTICIPATION IN DECISION, PATIENT, PATIENT PARTICIPATION, PATIENTS, PAYMENTS FOR HEALTH CARE, PHARMACISTS, PHO, POCKET PAYMENTS, POLICY RESPONSE, POPULATION DISTRIBUTION, POPULATION PROJECTIONS, PREVENTIVE HEALTH SERVICES, PRIMARY CARE, PRIMARY HEALTH CARE, PRIVATE HEALTH INSURANCE, PRIVATE HOSPITAL SECTOR, PRIVATE HOSPITALS, PRIVATE INSURANCE, PRIVATE SECTOR, PRIVATE SPENDING, PROGNOSIS, PROGRESS, PROVIDER PAYMENT, PROVINCIAL HOSPITALS, PUBLIC DEMAND, PUBLIC EXPENDITURE, PUBLIC EXPENDITURE ON HEALTH, PUBLIC HEALTH, PUBLIC HEALTH EXPENDITURE, PUBLIC HEALTH SYSTEM, PUBLIC HOSPITAL, PUBLIC HOSPITAL SYSTEMS, PUBLIC HOSPITALS, PUBLIC PROVIDERS, PUBLIC SECTOR, QUALITY OF HEALTH, QUALITY SERVICES, RESEARCH INSTITUTIONS, RESOURCE ALLOCATION, RISK FACTORS, RURAL AREAS, RURAL POPULATION, SEGMENTS OF SOCIETY, SERVICE DELIVERY, SHARE OF HEALTH SPENDING, SOCIAL HEALTH INSURANCE, SOCIAL SECURITY, SURGERY, SURVIVAL RATE, TREATMENT, UNFPA, URBAN AREAS, URBANIZATION, VACCINES, WORKERS, WORLD HEALTH ORGANIZATION, WORLD POPULATION, decentralization