Thailand Public Finance Management Report
Thailand Public Finance Management Report
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.
- World Bank United States
CAPITATION, HEALTH INSURANCE, MEDICAL TECHNOLOGY, AGING, PRIMARY CARE, MEDICAL STAFF, EMPLOYMENT, PUBLIC HOSPITAL, INCOME, HEALTH CARE COSTS, CAPITA HEALTH EXPENDITURE, WORKERS, URBANIZATION, INFORMAL SECTOR, ELDERLY POPULATION, PRIVATE INSURANCE, RISK FACTORS, MEDICAL BENEFIT, SOCIAL SERVICES, PRIVATE SPENDING, SOCIAL HEALTH INSURANCE, HEALTH EXPENDITURE, AGED, PATIENT PARTICIPATION, SERVICE DELIVERY, HEALTH FINANCING REFORM, HEALTH ECONOMICS, LIFE EXPECTANCY AT BIRTH, PRIVATE HOSPITAL SECTOR, CHRONIC CONDITIONS, HEALTH SERVICE, PATIENT, AMBULATORY CARE, COMMUNITY HOSPITALS, NATIONAL HEALTH SYSTEMS, GENERAL PRACTITIONERS, ELDERLY, FEE-FOR-SERVICE, HEALTH SERVICE UTILIZATION, BUDGET ALLOCATION, PUBLIC HOSPITAL SYSTEMS, AGE STRUCTURE, HEALTH PROFESSIONALS, DEMAND FOR LONG-TERM CARE, HOSPITALS, PHARMACISTS, MATERNAL MORTALITY, INCENTIVES FOR PROVIDERS, COMMUNICABLE DISEASES, HEALTH PROMOTION, HOSPITAL BEDS, PROGNOSIS, SURGERY, RURAL POPULATION, WORLD HEALTH ORGANIZATION, ANTENATAL CARE, HOSPITAL REVENUES, GLUCOSE, HEALTH CARE WORKERS, LIFE EXPECTANCY, POPULATION PROJECTIONS, EQUITY IN ACCESS, EPILEPSY, HUMAN DEVELOPMENT, NATIONAL HEALTH SPENDING, HEALTH POLICY, DISSEMINATION, INTERNATIONAL TRADE, PUBLIC PROVIDERS, SHARE OF HEALTH SPENDING, HEALTH CARE, HOSPITALIZATION, PUBLIC HEALTH, FINANCIAL BARRIERS, HEALTH CARE SYSTEM, POLICY RESPONSE, DEPENDENCY RATIO, INTERNATIONAL COMPARISONS, PRIVATE HEALTH INSURANCE, DISPARITIES IN HEALTH, HEALTH INSURERS, MATERNAL MORTALITY RATIO, NATIONAL HEALTH, HOSPITAL SYSTEMS, HOSPITAL ADMISSION, HEALTHCARE INSTITUTIONS, CAPITATION PAYMENT, POPULATION SIZE, HEALTH CARE UTILIZATION, NURSE, PUBLIC EXPENDITURE, CHRONIC DISEASE, INJURIES, POCKET PAYMENTS BY PATIENTS, PROVISION OF SERVICES, INFANT MORTALITY RATES, ECONOMIC GROWTH, BRAIN DRAIN, HEALTH CENTERS, HEALTH SYSTEM, PROVINCIAL HOSPITALS, PROVIDER PAYMENT, CARDIOVASCULAR RISK FACTORS, EPIDEMIOLOGICAL TRANSITION, QUALITY OF HEALTH, HEALTH SERVICES RESEARCH, COST OF CARE, RESOURCE ALLOCATION, WORLD POPULATION, FINANCIAL INCENTIVE, HEALTH OUTCOMES, PUBLIC EXPENDITURE ON HEALTH, DEMAND FOR HEALTH, INTERVENTION, HEALTH ORGANIZATION, BULLETIN, DEMAND FOR HEALTH CARE, CLINICAL PRACTICE, PARTICIPATION IN DECISION, 330, MINISTRY OF EDUCATION, HEALTH INSURANCE SYSTEM, DEMOCRACY, ELDERLY PEOPLE, DEMOGRAPHIC TRANSITION, LIVE BIRTHS, ACCESS TO HEALTH CARE, BREAST CANCER, DETERMINANTS OF HEALTH, PATIENTS, RURAL AREAS, FERTILITY RATE, AGE GROUPS, HEALTH COSTS, HEALTH CARE EXPENDITURE, PROGRESS, LABOR MARKET, DECISION MAKING, HYPERTENSION, MORTALITY, MEDICAL EDUCATION, CERVICAL CANCER, HEALTH CARE RESOURCES, PUBLIC SECTOR, LOW INCOME, HEALTH SECTOR, SOCIAL SECURITY, CENTRAL BUDGET, INFANT, PREVENTIVE HEALTH SERVICES, GOVERNMENT AGENCIES, FINANCIAL MANAGEMENT, EXPENDITURE CONTROL, MEDICAL EQUIPMENT, INFANT MORTALITY, HEALTH INSURANCE COVERAGE, MEDICAL DOCTORS, UNFPA, DIABETES, HEALTH RESEARCH, OUTPATIENT SERVICES, PUBLIC HEALTH SYSTEM, HEALTH WORKFORCE, ECONOMIC OUTCOMES, IMMUNIZATION, FAMILY PLANNING, HEALTH EXPERTS, HEALTH WORKERS, LOCAL GOVERNMENTS, OBESITY, CITIZEN, PRIVATE SECTOR, FINANCIAL PROTECTION, HUMAN RESOURCES, DOCTORS, ILLNESS, EXPENDITURES, INFERTILITY, MORBIDITY, HEALTH INSURANCE SCHEMES, HEALTH FINANCING, CARE PERFORMANCE, HEALTH SYSTEM PERFORMANCE, VACCINES, HEALTH CARE SPENDING, DRUGS, LOCAL AUTHORITIES, INCOME COUNTRIES, PUBLIC DEMAND, CLINICAL OUTCOMES, FINANCE MANAGEMENT, ACCESS TO HEALTH SERVICES, PRIMARY HEALTH CARE, EPIDEMIOLOGICAL CHANGES, HEALTH EXPENDITURE GROWTH, POCKET PAYMENTS, LABOR FORCE, PRIVATE HOSPITALS, URBAN AREAS, PAYMENTS FOR HEALTH CARE
CAPITATION, HEALTH INSURANCE, MEDICAL TECHNOLOGY, AGING, PRIMARY CARE, MEDICAL STAFF, EMPLOYMENT, PUBLIC HOSPITAL, INCOME, HEALTH CARE COSTS, CAPITA HEALTH EXPENDITURE, WORKERS, URBANIZATION, INFORMAL SECTOR, ELDERLY POPULATION, PRIVATE INSURANCE, RISK FACTORS, MEDICAL BENEFIT, SOCIAL SERVICES, PRIVATE SPENDING, SOCIAL HEALTH INSURANCE, HEALTH EXPENDITURE, AGED, PATIENT PARTICIPATION, SERVICE DELIVERY, HEALTH FINANCING REFORM, HEALTH ECONOMICS, LIFE EXPECTANCY AT BIRTH, PRIVATE HOSPITAL SECTOR, CHRONIC CONDITIONS, HEALTH SERVICE, PATIENT, AMBULATORY CARE, COMMUNITY HOSPITALS, NATIONAL HEALTH SYSTEMS, GENERAL PRACTITIONERS, ELDERLY, FEE-FOR-SERVICE, HEALTH SERVICE UTILIZATION, BUDGET ALLOCATION, PUBLIC HOSPITAL SYSTEMS, AGE STRUCTURE, HEALTH PROFESSIONALS, DEMAND FOR LONG-TERM CARE, HOSPITALS, PHARMACISTS, MATERNAL MORTALITY, INCENTIVES FOR PROVIDERS, COMMUNICABLE DISEASES, HEALTH PROMOTION, HOSPITAL BEDS, PROGNOSIS, SURGERY, RURAL POPULATION, WORLD HEALTH ORGANIZATION, ANTENATAL CARE, HOSPITAL REVENUES, GLUCOSE, HEALTH CARE WORKERS, LIFE EXPECTANCY, POPULATION PROJECTIONS, EQUITY IN ACCESS, EPILEPSY, HUMAN DEVELOPMENT, NATIONAL HEALTH SPENDING, HEALTH POLICY, DISSEMINATION, INTERNATIONAL TRADE, PUBLIC PROVIDERS, SHARE OF HEALTH SPENDING, HEALTH CARE, HOSPITALIZATION, PUBLIC HEALTH, FINANCIAL BARRIERS, HEALTH CARE SYSTEM, POLICY RESPONSE, DEPENDENCY RATIO, INTERNATIONAL COMPARISONS, PRIVATE HEALTH INSURANCE, DISPARITIES IN HEALTH, HEALTH INSURERS, MATERNAL MORTALITY RATIO, NATIONAL HEALTH, HOSPITAL SYSTEMS, HOSPITAL ADMISSION, HEALTHCARE INSTITUTIONS, CAPITATION PAYMENT, POPULATION SIZE, HEALTH CARE UTILIZATION, NURSE, PUBLIC EXPENDITURE, CHRONIC DISEASE, INJURIES, POCKET PAYMENTS BY PATIENTS, PROVISION OF SERVICES, INFANT MORTALITY RATES, ECONOMIC GROWTH, BRAIN DRAIN, HEALTH CENTERS, HEALTH SYSTEM, PROVINCIAL HOSPITALS, PROVIDER PAYMENT, CARDIOVASCULAR RISK FACTORS, EPIDEMIOLOGICAL TRANSITION, QUALITY OF HEALTH, HEALTH SERVICES RESEARCH, COST OF CARE, RESOURCE ALLOCATION, WORLD POPULATION, FINANCIAL INCENTIVE, HEALTH OUTCOMES, PUBLIC EXPENDITURE ON HEALTH, DEMAND FOR HEALTH, INTERVENTION, HEALTH ORGANIZATION, BULLETIN, DEMAND FOR HEALTH CARE, CLINICAL PRACTICE, PARTICIPATION IN DECISION, 330, MINISTRY OF EDUCATION, HEALTH INSURANCE SYSTEM, DEMOCRACY, ELDERLY PEOPLE, DEMOGRAPHIC TRANSITION, LIVE BIRTHS, ACCESS TO HEALTH CARE, BREAST CANCER, DETERMINANTS OF HEALTH, PATIENTS, RURAL AREAS, FERTILITY RATE, AGE GROUPS, HEALTH COSTS, HEALTH CARE EXPENDITURE, PROGRESS, LABOR MARKET, DECISION MAKING, HYPERTENSION, MORTALITY, MEDICAL EDUCATION, CERVICAL CANCER, HEALTH CARE RESOURCES, PUBLIC SECTOR, LOW INCOME, HEALTH SECTOR, SOCIAL SECURITY, CENTRAL BUDGET, INFANT, PREVENTIVE HEALTH SERVICES, GOVERNMENT AGENCIES, FINANCIAL MANAGEMENT, EXPENDITURE CONTROL, MEDICAL EQUIPMENT, INFANT MORTALITY, HEALTH INSURANCE COVERAGE, MEDICAL DOCTORS, UNFPA, DIABETES, HEALTH RESEARCH, OUTPATIENT SERVICES, PUBLIC HEALTH SYSTEM, HEALTH WORKFORCE, ECONOMIC OUTCOMES, IMMUNIZATION, FAMILY PLANNING, HEALTH EXPERTS, HEALTH WORKERS, LOCAL GOVERNMENTS, OBESITY, CITIZEN, PRIVATE SECTOR, FINANCIAL PROTECTION, HUMAN RESOURCES, DOCTORS, ILLNESS, EXPENDITURES, INFERTILITY, MORBIDITY, HEALTH INSURANCE SCHEMES, HEALTH FINANCING, CARE PERFORMANCE, HEALTH SYSTEM PERFORMANCE, VACCINES, HEALTH CARE SPENDING, DRUGS, LOCAL AUTHORITIES, INCOME COUNTRIES, PUBLIC DEMAND, CLINICAL OUTCOMES, FINANCE MANAGEMENT, ACCESS TO HEALTH SERVICES, PRIMARY HEALTH CARE, EPIDEMIOLOGICAL CHANGES, HEALTH EXPENDITURE GROWTH, POCKET PAYMENTS, LABOR FORCE, PRIVATE HOSPITALS, URBAN AREAS, PAYMENTS FOR HEALTH CARE
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