Thailand Public Finance Management Report
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World Bank, Washington, DC
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This discussion paper is one of five
discussion papers for the Thailand public financial
management report. It focuses on efficiency and equity in
the financing of health services, and the evolving role of
central and local government in the health sector. Over the
last few decades, Thailand has seen significant improvements
in health outcomes, reflecting sustained public investment
in both infrastructure and human resources. Thailand has
also succeeded in expanding the coverage of health
protection schemes, culminating in the introduction of the
Universal Coverage (UC) scheme in 2001. These efforts have
broadened access to health services, contributed to greater
and more equitable utilization, and helped reduce the
financial burden and the risk of impoverishment associated
with health care expenses. However, there are fewer data on
broader measures of health system performance, including
dimensions of quality. Overall, available evidence suggests
a mixed picture. For instance, while there has been
improvement in the management of chronic conditions, a
significant number of cases remain undiagnosed or untreated.
Similarly, Thailand has seen recent improvement in 2-year
survival rates from cancer and heart attacks, but still lags
far behind Organization for Economic Co-operation and
Development (OECD) countries. While the achievements of
Thailand's health system are undeniable, this paper
highlights three key challenges: (i) inequalities in
utilization and spending; (ii) mounting cost pressures; and
(iii) fragmentation of financing and unresolved issues
concerning the respective roles of central and local
government. This paper provides evidence of regional
differences in diagnosis and management of chronic disease,
and of survival rates from cancer and heart attacks. These
data do not suggest a strong relationship between the health
system and spending on the one hand, and on quality or
health outcomes on the other. Indeed, efficiency may be a
greater concern, with over-provision now a growing problem
in some parts of the health system. However, more evidence
is needed on these issues. For example, while high levels of
spending and utilization in the Civil Servant Medical
Benefit Scheme (CSMBS) are often noted, it is less clear
whether this is associated with better outcomes (e.g. higher
cancer survival rates or improved health outcomes for the
elderly). The implications of geographic disparities in
spending in the Social Security Scheme (SSS) and the CSMBS
also warrant further attention.
Palabras clave
ACCESS TO HEALTH CARE, ACCESS TO HEALTH SERVICES, AGE GROUPS, AGE STRUCTURE, AGED, AGING, AMBULATORY CARE, ANTENATAL CARE, 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, CITIZEN, CLINICAL OUTCOMES, CLINICAL PRACTICE, COMMUNICABLE DISEASES, COMMUNITY HOSPITALS, COST OF CARE, DECISION MAKING, DEMAND FOR HEALTH, DEMAND FOR HEALTH CARE, DEMAND FOR LONG-TERM CARE, DEMOCRACY, DEMOGRAPHIC TRANSITION, DEPENDENCY RATIO, DETERMINANTS OF HEALTH, DIABETES, DISPARITIES IN HEALTH, DISSEMINATION, DOCTORS, DRUGS, ECONOMIC GROWTH, ECONOMIC OUTCOMES, ELDERLY, ELDERLY PEOPLE, ELDERLY POPULATION, EMPLOYMENT, EPIDEMIOLOGICAL CHANGES, EPIDEMIOLOGICAL TRANSITION, EPILEPSY, EQUITY IN ACCESS, EXPENDITURE CONTROL, EXPENDITURES, FAMILY PLANNING, FEE-FOR-SERVICE, FERTILITY RATE, FINANCE MANAGEMENT, FINANCIAL BARRIERS, FINANCIAL INCENTIVE, FINANCIAL MANAGEMENT, FINANCIAL PROTECTION, GENERAL PRACTITIONERS, GLUCOSE, GOVERNMENT AGENCIES, HEALTH CARE, HEALTH CARE COSTS, HEALTH CARE EXPENDITURE, HEALTH CARE RESOURCES, HEALTH CARE SPENDING, HEALTH CARE SYSTEM, HEALTH CARE UTILIZATION, HEALTH CARE WORKERS, HEALTH CENTERS, HEALTH COSTS, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURE GROWTH, HEALTH EXPERTS, HEALTH FINANCING, HEALTH FINANCING REFORM, HEALTH INSURANCE, HEALTH INSURANCE COVERAGE, 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 RESEARCH, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH WORKERS, HEALTH WORKFORCE, HEALTHCARE INSTITUTIONS, HOSPITAL ADMISSION, HOSPITAL BEDS, HOSPITAL REVENUES, HOSPITAL SYSTEMS, HOSPITALIZATION, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, HYPERTENSION, ILLNESS, IMMUNIZATION, INCENTIVES FOR PROVIDERS, INCOME, INCOME COUNTRIES, INFANT, INFANT MORTALITY, INFANT MORTALITY RATES, INFERTILITY, INFORMAL SECTOR, INJURIES, INTERNATIONAL COMPARISONS, INTERNATIONAL TRADE, INTERVENTION, LABOR FORCE, LABOR MARKET, 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 EQUIPMENT, MEDICAL STAFF, MEDICAL TECHNOLOGY, MINISTRY OF EDUCATION, MORBIDITY, MORTALITY, NATIONAL HEALTH, NATIONAL HEALTH SPENDING, NATIONAL HEALTH SYSTEMS, NURSE, OBESITY, OUTPATIENT SERVICES, PARTICIPATION IN DECISION, PATIENT, PATIENT PARTICIPATION, PATIENTS, PAYMENTS FOR HEALTH CARE, PHARMACISTS, POCKET PAYMENTS, POCKET PAYMENTS BY PATIENTS, POLICY RESPONSE, POPULATION PROJECTIONS, POPULATION SIZE, 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, PROVISION OF SERVICES, PUBLIC DEMAND, PUBLIC EXPENDITURE, PUBLIC EXPENDITURE ON HEALTH, PUBLIC HEALTH, PUBLIC HEALTH SYSTEM, PUBLIC HOSPITAL, PUBLIC HOSPITAL SYSTEMS, PUBLIC PROVIDERS, PUBLIC SECTOR, QUALITY OF HEALTH, RESOURCE ALLOCATION, RISK FACTORS, RURAL AREAS, RURAL POPULATION, SERVICE DELIVERY, SHARE OF HEALTH SPENDING, SOCIAL HEALTH INSURANCE, SOCIAL SECURITY, SOCIAL SERVICES, SURGERY, UNFPA, URBAN AREAS, URBANIZATION, VACCINES, WORKERS, WORLD HEALTH ORGANIZATION, WORLD POPULATION