Thailand Public Finance Management Report : Government Spending and Central-Local Relations in Thailand’s Health Sector

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.

Bibliographic Details

Main Authors:	Lindelow, Magnus, Hawkins, Loraine, Osornprasop, Sutayut
Format:	Report biblioteca
Language:	English en_US
Published:	World Bank, Washington, DC 2011-04
Subjects:	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,
Online Access:	http://documents.worldbank.org/curated/en/136461468117866298/Thailand-Public-finance-management-report http://hdl.handle.net/10986/27401
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