Thailand Health Profile Report Health Essay

Health is related to numerous factors. Indispensably, analysis of situation and trend of the Thai health system requires comprehensive consideration on changes in both individual and environmental contexts that influence health, e.g. economy, education, demography, family characteristic and migration, genetics, value and belief, culture, politics and government, environment, infrastructure and technology, as well as health services system itself. This inspires the idea of creating the Thailand Health Profile report, a report that offers information on Thailand’s health system integrally connected with its determinants.

Thailand can be proud to have achieved most of the eight UN Millennium Development Goals (MDGs), in particular the three health-related goals.

In 1970, Thailand had an infant mortality rate of 68 per 1,000 live births, while today it is estimated at 13 per 1,000 live births. According to a 2008 study published in the medical journal Lancet, Thailand enjoyed the highest annual rate of reduction in child mortality among 30 low- and middle-income countries between 1990 and 2006. Thailand Health Profile Report Health Essay.

The maternal mortality ratio has also shown a similar decreasing trend. In addition, Thailand has been successful at curbing new HIV infection rates by 83 per cent since 1991, thanks to the arduous efforts made by governments and NGOs. Such impressive health outcomes did not occur in isolation from its socio-economic development context.

From 1969 to 2009, its gross national income (GNI) grew from US$210 to $3,760 in current figures, or 17 times over 40 years. During the 1970s and 1980s, Thailand invested heavily in highways that connect the isolated and impoverished Northeast and North to Bangkok; electrification throughout the country; as well as expansion of school enrollment for both boys and girls. As a result, the positive spillover effects also benefited the public health sector.

As economic growth accelerated in the mid-1980s and 1990s, the country continued to finance infrastructure projects which brought greater connectivity, wider access to electricity and safe drinking water and clean sanitation, primary and secondary schools, and primary health centres in rural areas across the country.

Four decades ago when Thailand was still a low-income country, it invested early in health care infrastructure that has reached the most remote rural communities. Instead of concentrating resources to urban tertiary hospital development, public health leaders placed more financing to rural areas from 1982 onwards, which has encouraged greater and affordable access to healthcare at the most local levels. Such investments have paid off.

In a study carried out by the London School of Hygiene and Tropical Medicine and released in Bangkok last month, Thailand featured as one of the countries to achieve “good health at low cost”. According to the World Health Organization (WHO), its total health expenditures (THE) is estimated at 4.1 per cent of its GDP or $328 per capita, which is relatively low for the health outcomes achieved.

The extensive network of primary healthcare facilities implemented through district health systems supplemented by some of the excellent research outfits undoubtedly played a crucial role in improving health outcomes especially for the rural population. Thailand Health Profile Report Health Essay.In addition, Thailand has been successful in training nurses and doctors for its health system, innovatively distributing human resources to rural areas by engaging new medical graduates to serve for three years in a rural hospital, and providing additional monetary incentives.

In addition, health volunteers recruited from local communities also play important support, prevention and detection roles, and thereby enhancing community involvement. Thailand’s health achievements are not limited to impressive indicators, but extend to attaining universal health coverage (UHC).Globally, the number of countries that have attained UHC is relatively small, and comprises mostly of OECD countries.

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Within Asian, Brunei, Malaysia, Singapore and Thailand have achieved UHC, with the Philippines, Vietnam, and Indonesia approaching full coverage as they embark on reforms. Yet, according to the International Labour Organization (ILO), only 5 to 10 per cent of people are covered in sub-Saharan Africa and South Asia, while in middle-income countries, coverage rates vary between 20 to 60 per cent.

Annually across the world, about 150 million people suffer financial catastrophe and 100 million are pushed below the poverty line due to regressive payment systems for healthcare and absence of UHC.

In 2002 when Thailand was still a lower-middle income country with a GDP/capita of $1,900, the country achieved UHC. This did not happen overnight but gradually since the 1970s through the creation of three health insurance schemes:

the Civil Servant Medical Benefit Scheme (CSMBS),

Social Security Scheme (SSS)

Subsequently the Universal Coverage (UC) Scheme – formerly referred to as the “Bt30” Scheme.

Achieving a coverage rate of 99 per cent of the population is more than just meeting a national objective; it represents a source of inspiration to other low- and middle-income countries.

As a matter of fact, officials from various health ministries and NGOs from Asia and Africa often request a visit to Thailand’s public health institutions such as the National Health Security Office, International Health and Policy Programme, Health Systems Research Institute and the Ministry of Public Health to “study how Thailand did it”.

As of now, 99 per cent of the Thai population is covered through a comprehensive healthcare package that ranges from health prevention and primary care, to hospitalization due to traffic accidents to renal replacement therapy and access to ART treatment for HIV.

It has been shown that the UC Scheme has contributed significantly to reducing instances of catastrophic healthcare expenditures, especially in impoverished areas of the country.

Based on the recent evaluation of the ten years of the Scheme, the number of impoverished households dropped from 3.4 per cent in 1996 to 0.8-1.3 per cent between 2006 and 2009, thus contributing to poverty reduction, building greater financial stability to vulnerable households and improved long-term livelihood security. In addition, it helps Thailand to attain the principle of the right to health for all. Thailand Health Profile Report Health Essay.

In a country with high income inequality as measured by the Gini Coefficient, access to affordable healthcare is a bridge that helps mitigate many of the socio-economic inequities that still plague this nation.

Thailand has demonstrated that UHC may not be an unattainable dream to be experienced by only the rich countries. Low-income countries such as Ghana and Rwanda have already made much progress towards UHC, and countries such as India and Bangladesh are working towards developing effective UHC systems. The biggest single determinant in this is political commitment.

In a round-table conference in Bangkok in November, 2011, UN Secretary-General Ban Ki-moon declared that no countries rich or small would have “enough” resources to carry out UHC reform but the challenge for every country is how soon they can move into it.

This was echoed at the recent Prince Mahidol Award Conference with the theme of UHC. Attended by participants from 68 countries, none said that UHC is impossible to achieve in their contexts. With the right policies – social, economic and political, it is possible for a low- or middle-income country to embark on the road towards UHC.

Although Thailand has achieved universal coverage, big challenges remain.

These challenges include:

How to include foreign migrant workers into the healthcare system

How to merge the three schemes to reduce inequities in benefit packages

How to ensure sufficient and highly-trained human resources in health to meet current shortages

How to manage Thailand’s transition into a “grey” society in the next decades

What are the evolving financial mechanisms that can be used to better serve the population?

UHC after all is not an endpoint in itself, but a journey that moves us closer to better health for all. Mushtaque Chowdhury and Natalie Phaholyothin are based at the Rockefeller Foundation’s Asia Regional Office in Bangkok. The article reflects the views of the authors, which do not necessarily represent those of the Rockefeller Foundation.

Healthcare in Thailand

Introduction

One of the most popular Asian countries for relocation is Thailand. The country has a rich historical and cultural background.Thailand Health Profile Report Health Essay.  However, there are some concerns that expatriates should be aware of, and one of these is the issue of healthcare.

The healthcare system

Most of the doctors in Thailand are specialists; that is why it may be hard to find a reliable all-round general practitioner to treat you for minor medical problems. As an expatriate, you will have to go to a general hospital, where you will most likely be examined by a doctor who is a specialist in one field or another. Since it may be common to have a number of smaller medical conditions, it may be difficult for a medical specialist to deal with these.

The best way, especially if you are not quite sure of your problem(s), is simply to seek an internist as your first port of call. However, it should be noted that there are still some major hospitals in Thailand that have family doctors or medical practitioners. Most doctors in Thailand do not have one specific place of work.

Thai surgeons and physicians have different working schedules at different hospitals that can be spread over the whole of Bangkok. Because of this, doctors are likely to go from one hospital to another to do their rounds. Additionally, these doctors may also have private clinics. In light of this, they tend to work very long hours. It is not difficult to imagine the problems that this could cause. For example, if you just had surgery and a problem arises, there is the possibility that your surgeon might be performing another surgery in a different hospital, or he may be at his private clinic. This may result in your doctor trying to solve the situation over the phone.

Local Government Policies and Major Measures to Promote

The Thai government began strategic plans since 2004 to promote Thailand as a prime medical tourism destination. Since then, the country has enjoyed a large number of visitors in this category.

The Department of Export Promotion and the Department of Health Service Support reported a rapid growth of 16.48% during 2001-2009 for health services delivery to foreigners: Thailand Health Profile Report Health Essay.

Year

No. of Foreign Patients

Estimate Income

(Million Baht)

2007

1,373,807

106,640

2008

1,380,000

107,419

2009

1,390,000

108,197

Source: The Royal Thai Embassy, Washington

Thailand is now widely acclaimed among the international community as the medical hub in Asia, with significant advantages including the availability of modern equipment and specialties, easy entrance, competitive prices, and great hospitality from service operators and personnel.

The fact that Thailand is a superb tourist destination with serene beaches and mountains, intriguing arts and culture, food, entertainment, and shopping, make Thailand a great medical tourism destination.

The policies and strategies to promote Thailand as a medical hub of Asia

Most healthcare service providers particularly hospitals participate in travel marts, travel fairs, trade fair, exhibitions, seminars, conferences.

Using advertisements in travel magazines in countries with the supporting from the government. With the cooperation from the Ministry of Public Health, Tourism Authority of Thailand (TAT), Ministry of Foreign Affairs, and Department of Export Promotion (DEP) organized these activities for promoting healthcare services to international markets.

Other informative materials are provided such as brochures, booklets, video-cds, paper bags and t-shirt with logos were also used to create awareness of the available healthcare services

Some healthcare service providers build up cooperation with the local institutes, universities, medical schools in other countries to establish collaboration in education, exchange of knowledge and training as well as to promote their alternative healthcare services.

Advertising about medical and nonmedical services in both local and international media are used by healthcare service providers. The advertisement has to be based on Thai laws and regulations about how to advertise healthcare services. Thailand Health Profile Report Health Essay. Media such as magazines, newspaper (both in Thai and English), television etc. are used to target local people and expatriates who work in Thailand.

History of Development

Modern medical system in Thailand dates back over 100 years, during the reigns of King Rama III and King Rama IV when American and British missionaries introduced modern medicine in Thailand. However, the advancement of modern medicine really took a huge step during reign of King Rama V and began to rise steadily from then on.

King Rama V initiated the idea to found Siriraj Hospital to accommodate people’s needs for healthcare. He founded the Royal Medical School that would later lay the foundation of modern medical schools. These initiatives led to establishments of other hospitals in Bangkok and large cities. His Royal Highness Prince Mahidol of Songkhla was one of the driving forces that have given Thai modern medicine its place among that of developed countries.

HRH Princess Mahidol of Songkhla received certificate in Public Health and later graduated M.D. cum laude from Harvard University, USA. He became the pioneer in the Thai modern medicine and has been regarded as the “Father of Thailand’s Modern Medicine.” Even though he passed away at the early age of 38 due to deteriorating health, he has greatly contributed in modern medicine of Thailand.

His Majesty King Bhumibol has granted permission to establish the Prince Mahidol Award as a global award in honor of His Royal Highness Prince Mahidol of Songkhla. The Award is granted to individuals or organizations around the world with outstanding work for humanity in the fields of medicine and public health.

During 1950s, many Thai medical doctors graduated or completed their training abroad, in the United States in particular. In 1970s and 1980s, a large number of Thai doctors continued their studies and trainings in the United States. A large number of medical doctors moved from public hospitals to work in private hospitals.

At the same time, many Thai doctors practicing or having medical licenses abroad moved back to Thailand to and other countries. During this time, private hospitals with international accreditation emerged in work in private hospitals. Thailand Health Profile Report Health Essay. One of the major driving forces behind the advancement of Thai modern medicine is the establishment of the “Thai Red Cross Society.”

During the economic boom of the 1990s in Thailand, as the economic condition improved and personal income level increased, public demand for good quality health care also increased accordingly. Leading private hospitals expanded their capacity to accommodate such demand. According to the Ministry of Public Health of Thailand, the total number of hospitals increased from 422 in 1991 to 491 in 1997, and the number of beds more than doubled, from 14,927 to 38,275 during the same period.

However, when the 1997 financial crisis hit, the domestic market was significantly affected. Personal health expenditures were curtailed as economic condition declined. Private hospitals had to make up for the loss of their domestic patients by shifting their focus outside of Thailand and inviting patients from abroad.

Because of the local currency devaluation, as well as the low labor and other factor costs, the total price of the medical treatment in Thailand was less than half that in the United States, even after adding in the costs of travel and accommodations.

In the face of declining revenue, Bumrungrad Hospital in Bangkok brought in a new management team from outside the country to manage its program for international patients and to lead the hospital out of its financial difficulties. Under this new management, Bumrungrad became the first internationally accredited hospital in Southeast Asia in 2002 and pioneered the medical tourism business. Its 50,000 international patients in 1997 had gone up to 350,000 in 2005. In this sense, the success of medical tourism in Thailand was a typical factor-driven phenomenon, where people traveled to obtain medical services with the lowest cost. Thailand Health Profile Report Health Essay.

Industry Introduction (SWOT Analysis and Development Status)

Thailand is one of the best destinations in Asia for health-conscious tourists. The country has been one of the contemporary pioneers of Medical Tourism in Asia, with more than a million foreign patients annually coming to over 956 public and 309 private hospitals, 7 of which are JCI accredited (as of 2010), and 17 of which are in the pipeline.

The international patients will have access to the rich pool of over 19,000 medical doctors and 100,000 nurses, many of which have undergone trainings in the United States, UK, Germany, Australia, Japan, and other countries.

It is also notable that Thailand has been the leader in holistic treatment approaches, including healthcare, illness prevention, treatments, rehabilitative and restorative care. These approaches have gained greater attention in the western countries.

Thailand has convenient access, beautiful tourist destinations, and superior services. Presently, Thailand is able to offer most comprehensive range of medical treatments to the world due to many Thai-Physicians have been studied and specialty trained as specialist from abroad since 1960.These Physicians moved back to work in Thai private Hospitals and Clinics. So, they are able to freely offer their expertise and specialists to Thai as well as foreigner patients. Thailand Health Profile Report Health Essay.

The most three popular services in medical tourism consist of:

Cosmetic and Plastic Surgery such as

Breast Augmentation (Augmentation Mammoplasty)

Breast Lift (Mastopexy)

Nose Surgery (Rhinoplasty)

Liposuction (Lipoplasty)

Dentistry such as

Dental Bonding

Dental Bridges

Dental Crowns

Dental Filling

Dental Implants

Teeth Whitening

Generalists raging from

Blood Vessel System

Bones

Joint and Tendons

Breast

Cardiology

Diagnostics

General Surgery

SWOT Analysis

Strengths

Thailand has a lot to offer, including safe services that have attracted more than a million foreign travelers per year. Thai hospitals are among the first in Asia to be JCI-accredited. Such superior quality, when coupled with medical advancement and globally accepted conveniences, makes great impressions of excellence in health care and care-giving services, as well as superb health-oriented restorative meals upon foreigners who have undergone treatments in Thailand.

Thailand gets advantage in medical expenses. Thailand Health Profile Report Health Essay. The universities with faculty of medicine play a key role in serving as a specialized medical center with international reputation and have medical research projects which gain acceptance in the international medical circles, for example, Siriraj Hospital, Chulalongkorn Hospital, Thammasat Hospital, varsity hospitals in Chiang Mai campus, Prince of Songkla campus, and Khon Kaen campus

Thailand has world-famous medical institutions which provide the medical fraternity with top-quality health professionals such as Chulalongkorn University, Mahidol University, Thammasat University, Chiang Mai University, Prince of Songkla University, and Khon Kaen University

Thai health and herbal products are produced with high quality standards. Many of the producers are accredited with GMP and supervised by FDA, Ministry of Health. These products have been well accepted by the health conscious consumers around the world.

Thailand offers the most comprehensive range of medical services and facilities that serve even the most demanding needs of foreign patients. The services are supervised by medical doctors with medical licenses in modern medicine, Thai traditional medicine, Thai applied medicine, Chinese medicine, natural medicine, and many more.

Faculty of Medicine Siriraj Hospital, Mahidol University is invited to demonstrate the cardiovascular treatment using balloons and biodegradable polymer stents at the CCT 2010 – Complex Cardiovascular Therapeutics 2010, the largest international event in Asia at Globe, Japan.

Thailand is among one of the world’s top destinations thanks to stunning tourist attractions. Besides, the country provides tourists with the greatest travel convenience due to a wide range of facilities, for example, an international airport deemed as an aviation hub of the region, varied international flight in service, first-class hotels and accommodations on a par with international standards with affordable prices and to name a few. Thailand Health Profile Report Health Essay.

Thai smile and Thai hospitality make health care system in Thailand differ from that in other countries. Leading private hospitals such as Bumrungrad International Hospital offers services worthy of a 5-star hotel along with state-of-the-art medical care and treatment. These high standards of services distinguish Thailand from their competitors.

Thailand offers integrative wellness centers and facilities, including the Thai Destination Spa, Medical Spa, Thai massage, wellness activities, restorative activities, revitalizing activities for the elderly, long-stay health care, and health-oriented food.

Thailand has a good transportation infrastructure to attract foreign patients to get medical treatment in Thailand. Starting operation in June 2006, Suvarnabhumi Airport is now a major hub of transportation in with the rank 5th busiest airport in Asia, having handled 40.5 million passengers in 2009.

Weakness

Lack of Physicians is the weakness of Thailand to grow further in this industry. This problem makes private hospitals compete with not only the government ones but also with other private ones by compete for the specialists in each field. This problem also happens in other medical hubs in Asia like India where the physicians are not enough to offer the medical service.

Thailand is identified as lack of transparency, low corporate governance levels, an inadequate banking sector, insufficient minority shareholder rights, inadequate business legislation and political interference. The extent of bureaucratic red tape in Thailand got worse in recent years. These are the obstacles for health care system development.

The traffic in Bangkok is main obstacle in medical emergencies and unwanted delays are unavoidable. As the capability to deal with emergency procedures is very important, the developments of emergency medicines normally rely on fast access to suitable hospitals. Thailand Health Profile Report Health Essay. Thai health care system is still face with the problem to take the patients to the closest hospitals, especially at the rush hour.

The demand condition is a barrier for further development in health care service as the customers are not very demanding in general. Furthermore, there are very few laws that protect customer’s rights. This is different from those in most developed countries, where buyers demand a relatively high standard for product quality and there are strict laws and regulations to protect a customer’s well-being.

Opportunities

The long waiting lists in the developed countries to get treatment under the national health care service. For those patients who have to put up with an uncomfortable waiting period, they are willing to travel to get access to immediate treatment in Thailand.

The affordable international air fares and favorable exchange rates make it cheaper to get medical treatment in Thailand.

The Internet and the development of communications, new companies have emerged who acts as middlemen between international patients and hospital networks, giving patients easy access to information, prices and option. Thailand Health Profile Report Health Essay.

Threats

Political Instability

Thailand is still facing many challenges in its effort to strengthen its healthcare industry especially medical tourism. One of the country’s main concerns at the moment is maintaining political instability. The political situation is a factor should be closely monitored because it may dampen the confidence of foreign medical tourists and international patients.

Development Status

One other major barrier that Thailand must break to excel in this globalized world is its capacity for innovation. The current education system, which is very passive and places very little emphasis on practicality, doesn’t stimulate children to be critical, challenge ideas or think outside the box.

Thailand has no clear dominance in technological or basic research, and startup funding for a new entrepreneurial idea is scarce. Thailand Health Profile Report Health Essay. The number of patents originating from Thailand is extremely low and the country is far behind in its innovative capacity. This lack of innovative capacity is a major challenge that has to be addressed as a strong innovative capacity is integral to arrive at the high level of productivity necessary to achieve and sustain overall competitiveness in health care technologies.

Top 10 Foreign Patient countries in Thailand Classified by Nationality

Number of Foreign Patients in Thailand

 Country

2001

2002

2003

2004

2005

Japan

118,170

131,584

162,909

247,238

185,616

USA

49,253

59,402

85,292

118,771

132,239

UK

36,778

41,599

74,856

95,941

108,156

Middle East

n.a.

20,004

34,704

71,051

98,541

South Asia

34,857

47,555

69,574

107,627

98,308

ASEAN

n.a.

n.a.

36,708

93,516

74,178

China

26,893

27,438

46,624

57,051

57,279

Germany

19,057

18,923

37,055

40,180

42,798

Australia

14,265

16,479

24,228

35,092

40,161

France

16,102

17,679

25,582

32,409

36,175

Source: The Department of Export Promotion

Remark: 1. 2003-2005 calculated including revisit

2. After 2005, most of Thai private hospitals has not submit the information classified by nationality to the Ministry of Public Health. Thailand Health Profile Report Health Essay.

Cross-Industry Alliance (Cooperation Model, Cooperation Benefits, and Success Stories)

Medical Tourism

Medical tourism is a newly emerging cluster, which lies in the intersection between the tourism and medical cluster. Medical tourism’s overlap of the two clusters can be seen from the core activities of this cluster, which consist of activities from both the tourism and medical cluster.

Thailand has emerged as a leading medical tourism destination. The increase in the number of international patients shows that Thailand has great potential for medical tourism and the improvement of its marketing strategies will further increase the image of Thailand as a medical tourism destination.

The tourism part of this cluster can be seen in the left and center part of the map, including the international and local transportation, tour agents and operators, hotels, restaurants and other tourism activities, attractions and entertainment. As mentioned before, historically, Thailand has had a strong position in these areas.

The medical part of this cluster spreads from the right to center part with health care providers including leading private hospitals, cosmetic and LASIK surgery, dentistry, and alternative medicine, including the famous Thai massage and herbal treatment. Thailand Health Profile Report Health Essay. Except for the hospitals, who are an emerging player, the other sectors have been very active in Thailand.

Supporting players at the bottom, including:

Medical research affiliations and certifications: The second largest private Bangkok hospital is affiliated with Harvard Medical School for staff training; Bumrungrad is accredited by Chicago based accreditation institution, Joint Commission International.

Educational Institutions: National leading Chulalongkorn and Thamasat Universities, Mahidol Medical School; International Tourism Industry Management School led by leading Dusit Thani Hotel Group; Wat Pho Temple-affiliated traditional massage school.

Government Agencies: Ministry of Health and Ministry of Tourism and Sport with its affiliation, Tourism Authority of Thailand, which has fifteen offices abroad to invite many more tourists. In fact, Thai government has launched a campaign for Thailand to be the “Medical Hub of Asia,” emphasizing a combination of the recently-emerging medical industry with the traditional strength such as spas, traditional massage and herbal treatment. Thailand Health Profile Report Health Essay.

Success Stories

There are various reasons why the patients choose medical treatment and health care service in Thailand. For example, the low cost is very attractive for people without health insurance (estimated to be 40 million in the United States) or even for those insured people with certain pre-existing conditions that are not covered by their insurance policy.

Companies with privately funded health insurance policies are also attracted to the lower cost alternative, assuming a certain level of service is satisfied. People in a life-or-death condition with no options available in their own country would also be compelled to travel to find cure.

These patients would indeed prefer a lower cost option, as long as the quality and service level requirements are met. In other cases, there are certain medical procedures that are not covered by insurance, such as cosmetic or elective surgery, laser vision correction (LASIK) and dental treatments.

Traveling to Thailand for medical treatment may also serve other needs than lowering costs. For example, in some developed countries such as Canada, the United Kingdom and other European countries, patients were often placed in a long waiting list to get treatment under the national health care service. For those patients who have to put up with an uncomfortable waiting period, time is of the essence and they would not mind traveling to get access to immediate treatment in Thailand. Thailand Health Profile Report Health Essay.

Future Trends

According to the KASIKORN RESEARCH CENTER, ASEAN health service liberalization will enhance the opportunities for Thai medical care business investment into ASEAN countries. This is because of ASEAN cancellation of all pre-conditions to health service markets and expansion of ASEAN investors’ shareholdings of up to 70 percent beginning in 2010.

Positive factors that would support Thai entry into ASEAN medical business would include the potential in the excellent management of Thai hospitals that have attracted the highest number of foreign patients in ASEAN. Moreover, the impact of ASEAN trade and investment liberalization and the development of transportation logistics into the Indochina region will help facilitate travel within the region via land transportation

Therefore, offering greater opportunities to Thai private sector hospitals to expand into other cities in Thailand and support a growing number of foreign patients wishing to use medical care services in Thailand. Nevertheless, the expansion of Thai medical care services may face some challenges in personnel shortages within ASEAN, an investment destination – including.

It is expected that the effectiveness of liberalization in the movements of medical personnel within ASEAN in 2015 will be quite limited and may face challenges caused by competition with and that also aim to expand such investments within ASEAN and would like to become hubs for medical care within this region, as well.

Meanwhile, the expansion of Thai private hospitals into other ASEAN countries may aggravate personnel shortages domestically and affect our ability to become a major Asian medical service hub attracting foreign patients too. Thailand Health Profile Report Health Essay.

It is expected that the problem of competition in attracting medical personnel between service providers domestically, government and private sector, will continue to intensify, particularly if there is an inadequate government budget for medical personnel development.

Competitive Analysis

Thailand’s strength exists in the tourism related area such as spas, traditional massages, herbal treatments and other kinds of alternative medicine. Therefore, Thailand originally took its place in the right hand side of the spectrum together with its neighboring South East Asian countries. However, recently, led by some leading private hospitals including Bumrungrad, it has been shifting towards the left by taking on more complex medical procedures.

On the other hand, Singapore has been a leading country on the left hand side with its advanced biotech and healthcare cluster. India has also emerged recently, offering medical outsourcing with lower costs. India is also pioneering a medical contract outsourcing industry, which entails the outsourcing of a hospital’s administrative work, such as accounting and insurance claim processing.

Below is a cost comparison of major medical procedures in these countries. Moreover, Thailand’s main market roughly overlaps with those of Singapore, Malaysia and India. However, there are slight differences in each country’s area of strength. While Singapore is strong in a wide variety of medical procedures, other countries have relatively specific areas such as post-op care and cosmetic surgery (Thailand), gastroenterology (Malaysia), ophthalmology and alternative medicine (India), cornea transplants (Jordan), cosmetic surgery and vitiligo treatment (Costa Rica, Cuba) Thailand Health Profile Report Health Essay.

Medical Service Specialized in Each Country

Country

Countries of origin

of foreign visitors

Treatments sought

by foreign visitors

Thailand

South and South East Asia, Europe, and the US

bone-related procedures, cataracts, cardiac surgery, post-op care, cosmetic surgery, dentistry

Singapore

South and South East Asia, Korea, Japan, Australia, the UK and the US

general surgery, cardiac surgery, ophthalmology, orthopedics, gynecology, urology

Malaysia

Indonesia, India, Middle East, and the UK

cardiology, hematology

India

Bangladesh, Middle East, the UK, Europe, and the US

gastroenterology, neurology, cosmetic surgery, cardiac surgery, joint replacements

Jordan

Yemen, Sudan, Libya, Algeria, Tunisia, and Iraq

correction of spinal injuries, ophthalmology, cardiac surgery, alternative medicine, cornea transplants

Cuba

Central and Latin America, and the UK

alternative medicine, neurology, cosmetic surgery, ophthalmology, vitiligo treatments, joint replacements. Thailand Health Profile Report Health Essay.

Health Care Systems in Thailand

The majority of health care services in Thailand is delivered by the public sector, which includes 1,002 hospitals and 9,765 health stations. Universal health care is provided through three programs: the civil service welfare system for civil servants and their families, Social Security for private employees, and the Universal Coverage scheme theoretically available to all other Thai nationals. Some private hospitals are participants in these programs, though most are financed by patient self-payment and private insurance. According to the World Bank, under Thailand’s health schemes, 99.5% of the population has health protection coverage.

The Ministry of Public Health (MOPH) oversees national health policy and also operates most government health facilities. The National Health Security Office (NHSO) allocates funding through the Universal Coverage program. Other health-related government agencies include the Health System Research Institute (HSRI), Thai Health Promotion Foundation (“Thai Health”), National Health Commission Office (NHCO), and the Emergency Medical Institute of Thailand (EMIT). Although there have been national policies for decentralization, there has been resistance in implementing such changes and the MOPH still directly controls most aspects of health care.

Thailand introduced universal coverage reforms in 2001, becoming one of only a handful of lower-middle income countries to do so. Means-tested health care for low income households was replaced by a new and more comprehensive insurance scheme, originally known as the 30 baht project, in line with the small co-payment charged for treatment. Thailand Health Profile Report Health Essay. People joining the scheme receive a gold card which allows them to access services in their health district, and, if necessary, be referred for specialist treatment elsewhere. The bulk of finance comes from public revenues, with funding allocated to Contracting Units for Primary Care annually on a population basis. According to the WHO, 65% of Thailand’s health care expenditure in 2004 came from the government, while 35% was from private sources. Thailand achieved universal coverage with relatively low levels of spending on health but it faces significant challenges: rising costs, inequalities, and duplication of resources.

Although the reforms have received a good deal of criticism, they have proved popular with poorer Thais, especially in rural areas, and survived the change of government after the 2006 military coup. Then Public Health Minister, Mongkol Na Songkhla, abolished the 30 baht co-payment and made the UC scheme free. It is not yet clear whether the scheme will be modified further under the coalition government that came to power in January 2008.

Health policies and strategies of MOPH

The MOPH is authorized and responsible for the strengthening of the public health and hygiene, preventing and controlling diseases and recovering the energy-level of the population. It has established its goals and a 3-year strategy for pursuing the goals so that the subordinating agencies adhere to the principal goals and their strategy is in operation according to estimates of the public health budget required for achieving the goals.

The followings are the target of MOPH’s policies:

To improve the organization structure, culture and the operation procedure in order to have good administrative system and to become a learning organization of public health.

To develop and provide mechanism in facilitating the involvement of all concerned parties in monitoring the public health system as a whole.

To increase the capability of the medicines, public health and biology of health, in order to be on the front line of world competition. Thailand Health Profile Report Health Essay.

The middle-term goals of the MOPH’s services are following:

The important public health problems in different age groups of the population are to be lowered.

The people have health security with standard and quality health services, and to encourage people to take part in taking care of health and the public health environment.

The healthcare products and services are to be of the quality and up to the standard of international requirement.

To have good governance in the public health administration.

The MOPH’s strategies in pursuing the goals according to the policies are:

Improving the sanitation behaviour of the people and to prevent and control diseases with involvement of all concerned parties.

To increase the varieties and capacity of the research, including bio-medicines, development, transfer, applications of technology and knowledge.

To develop the system of health security and public health services to be holistically efficient with equal quality services for all.

To promote people’s involvement in developing public health, managing public health environment accordingly and efficiently.

To encourage innovations, develop mechanism of facilitating innovations of health products and services, which make use of domestic resources to further enhance the Thai traditional wisdom so that the products and services are of better quality and meet the international standard.

To develop and improve the systems and procedures of operations of public health management to make them better and more efficient. Thailand Health Profile Report Health Essay.

The devising of the public health strategic plan: The strategic plan is very important for the result-oriented management (or Management by Objectives). Therefore, the strategic plan will be designed carefully in order to conform to the desired goal and the strategy of achieving the goal of the superior operation unit, so as to achieve the goal successfully.

Organization of the health system

The organizational structure at the central level of the MOPH consists mainly of the Office of Permanent Secretary of MOPH and 3 task clusters, described below:

The Office of Permanent Secretary of MOPH is responsible for the drafting of policies, plans, and supervising, monitoring and appraising the outcomes of the operation units of the Ministry. It also administers to ensure that the execution is in line with the law, undertakes legislation of laws regarding the health establishments and other related affairs and is also responsible for the production and development of public health personnel.

The Task Cluster for the development of medicines is responsible for the development of medical science, the therapeutics and recovery of potency, development and transfers of medical knowledge and technology for therapy and recovery of health. The cluster is also responsible for establishing healthcare standard, and developing alternative medicines for the provision of quality public health services to the public for the purpose of good mental and physical health of the people. Thailand Health Profile Report Health Essay. The Task Cluster comprises 3 departments – the Department of Health, the Department of the Development of Thai Medicines and Alternative Medicines and the Department of Mental Health.

The Task Cluster for development of Public Health is responsible for the development of public health science for promoting health, controlling and preventing diseases, research and development of knowledge and technology, transfer of knowledge for promoting health and controlling and preventing diseases for the purpose of good mental and physical health of the people. It comprises 2 departments – the Department of Disease Control and the Department of Health.

The Task Cluster of Health Service Support is responsible for supporting the public health service providing units, the systems and mechanism facilitating public health service provision and the public health system. They are also responsible for administering the protection of consumers of healthcare services and drug products for the purposes that the general people can take care of their health efficiently and receive standard and quality health services and products. The Cluster consists of 3 departments – the Department of Service Support, the Department of Medical Science and the Food and Drug Administration. Thailand Health Profile Report Health Essay.

The organizational structure of the regional agencies which are under the administration of the Office of Permanent Secretary of MOPH, consist of Provincial Public Health Offices, hospitals, Ampur Public Health Offices, the PCUs and the community clinics. The above agencies are the major healthcare service providers who help the people promote health, control and prevent diseases, and provide medical treatment and recover health. They utilize the knowledge and technology that have been developed and transferred from the technical Department and adjust and apply them appropriately according to the specific requirements of their regions. The organizational relationship between the technical Department at the centre and the regional public health operation agencies is basically staff relationship in which the centre provides support to the regional agencies, but does not command.

For healthcare at the primary level, there are the PCUs providing the services within the scope of Tambol and village. They are responsible for arranging a suitable aggregate of health services for the rural people in their responsibility areas which normally have 1,000 – 5,000 people. There are fulltime public health personnel stationed at the public health units such as Sanitation Officers, Midwife Nurses and Technical Nurses. In addition, Dental Officers, Technical Nurses and Public Health Officers are also working there. Ampur Public Health Offices are responsible for the assistance, supports, supervision, monitoring and appraisal of their accomplishments.

On the aspect of decentralization of the authority of the public health administration, the Constitution of the Kingdom, 1997, the section 78 stipulates that the government is to decentralize its authority to empower the regional authorities to make them self-reliant and make their own decisions regarding the regional affairs through the legislation of acts, plan and procedure of achieving the goal of the decentralization within 4 years (2001-04). In case the regional organizations are not ready to assume their new role within 4 years, the decentralization period is expanded to 10 years (2001-10). Thailand Health Profile Report Health Essay. The regional organizations are stipulated to prepare themselves for the decentralization while the central government is stipulated to provide administrative assistance, and intellectual and technical supports for decentralization purpose. The Steering Committee of the Decentralization has also been established for the purpose of forming the policy and procedure of the decentralization.

The Steering Committee has so far drafted up two major plans:

The Master Plan of Decentralization which shapes the vision, the mindset and the direction of decentralizing the authority to the regional organizations. It also determines the tasks and operations that are to be assigned to the regional organizations. Some parts of the public health affairs are parts of the tasks and operations that are to be distributed out.

The Reformation Plan of Decentralization requires the establishment of specialized committee for the respective provinces, like the Regional Health Committee for the public health affairs.

The MOPH, in an effort to actualize the decentralization of the public health administrative authority to regional organizations, has designated the Regional Health Committees in 43 provinces. These regional committees are responsible for the coordination in forming policy, drafting plans of regional public health development, plans of resource requirement, and also planning budgeting and personnel. They are also responsible for defining the criteria and allocating the resources, supervising and inspecting and defining the criteria for appraising the outcomes of the regional public health administration. Currently, the committees are in the process of determining the forms and procedure of operation.

Outlook for the future

In the result-based management – Management by Objectives (MBO), the devising of the public health strategic plan will be according to the target areas and to cover all age and gender groups in order to improve the people’s health. One of the outstanding public health strategies is the Healthy Thailand strategy by the MOPH as the overall goal of the public health directing the health endeavours throughout the country.Thailand Health Profile Report Health Essay.  The policy of Healthy Thailand of the year 2004 concentrates on 5 health aspects – exercise, diet, emotion, disease reduction and environment according to different age groups and regions through holding appropriate activities. All related activities and plans governing them will be integrated so that the implementation of the plans can be achieved.

Health & Development

Public health bodies: In addition to the Ministry of Public Health, other important public health bodies in Thailand include the Health System Research Institute (HSRI), Thai Health Promotion Foundation (“ThaiHealth”), National Health Security Office (NHSO) , National Health Commission Office (NHCO), and the Emergency Medical Institute of Thailand (EMIT). Epidemiological transition: Thailand is witnessing both demographic and epidemiologic transitions.

The total fertility rate (TFR) has dropped from 2.4 in 1990 to 1.6 in 2006 with an estimated population growth rate of 0.7% for the period 2004-2015. HIV/AIDS, tuberculosis, malaria and emerging pathogens remain important and compounded with emerging drug resistance particularly among mobile/border populations. Non-communicable diseases (NCDs) are equally important as lifestyles change and the population ages.Thailand Health Profile Report Health Essay.  These include chronic diseases such as cardiovascular diseases and diabetes as well as those associated with the risk factors of smoking, unsafe use of alcohol, inactivity, unhealthy diet and environmental degradation. Injuries, particularly those related to road traffic accidents, represent one of the highest causes of morbidity and mortality in Thailand and extract a high economic toll on the country.

Many current public health challenges require multi-sectoral and multi-stakeholder collaboration as well as efforts to address their social determinants. Health systems: The national health budget increased from 5.8% of total government spending in 1993 to 11.3% in 2006. About 60% of all health expenditure comes from government sources. In 2001 the government introduced the Universal Health Care (UC) policy (the “30-Baht scheme”), in 2002 universal health care coverage, and in 2007 universal coverage without pay. Issues remain concerning health service quality, sustainability, and adequate health personnel. Public and national self-reliance in health: While the Ninth Health Development Plan emphasized a life-cycle health approach, promoting healthy lifestyles, improving the quality of health care, disease prevention and control, and preparing for the need of an ageing population, the Tenth Plan emphasizes public and national self-reliance in health and quality of services. Thailand Health Profile Report Health Essay.

Roles in Regional and sub-regional cooperation in health development: Thailand is an emerging development partner and active in a number of regional and sub-regional cooperative initiatives. There are 35 WHO Collaborating Centers in Thailand which together with other Centers of Excellence are organized into a network (called NEW-CCET).

Public Health Issues

Although infectious diseases, most notably HIV/AIDS and tuberculosis, remain serious public health issues, non-communicable diseases and injuries have also become important causes of morbidity and mortality. Major infectious diseases in Thailand also include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis.

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a serious problem in Thailand. The United Nations Programme on HIV/AIDS (UNAIDS) reported in November 2004 that the Thai government had launched a well-funded, politically supported, and pragmatic response to the epidemic. As a result, national adult HIV prevalence has decreased to an estimated 1.5 percent of all persons aged 15 to 49 years (or about 1.8 percent of the total population). It was also reported that 58,000 adults and children had died from AIDS since the first case was reported in 1984. The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behavior, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs. Thailand Health Profile Report Health Essay.

Food Safety

Food safety scares, like the rest of developing Asia, are not uncommon to Thailand. Moreover besides the ever common microbial contamination of street side food left out in the hot sun and dusty roads, as well as store food, contamination by banned or toxic pesticides and fake food products is also common. 3-MCPD, a genotoxic and carcinogenic substance, was found in extreme amounts (hundreds to thousands of times limits) in an Asia-wide (ex Japan and Korea) acid-hydrolyzed soy sauce scandal in 2001, including exports to Western nations, melamine in Thai food products along with 2008 Chinese milk scandal, and July 2012 consumer action groups demanding 4 unlisted toxic pesticides found on common vegetables (which are banned in developed countries) be banned. Chemical companies are requesting to add them to the Thai Dangerous Substances Act so they can continue to be used, including on exported mangoes to developed countries which have banned their use.

Medical and Healthcare Services Currently Provided in Thailand:

Medical Services

Medical Examination (Chulalongkorn Hospital)

Outpatient Department

Nursing Department

Dentistry

Extended Service Clinics

Social Security Services (Chulalongkorn Hospital/Somdej Na Sriracha Hospital)

On-line Consultancy

Anonymous Clinic

Nurses at Home Project

Medical Certificate Services (Chulalongkorn Hospital/Somdej Na Sriracha

Hospital)

Rabies Clinic

Immunological Clinic

New Tract Medicine Services

Immunological Clinic and Tourist

Consultancy

Biological Products

Chula Excimer Laser Center

Ostomy Clinic. Thailand Health Profile Report Health Essay.

Community Medicine/Community Health

Wednesday Club

Anti-AIDS Campaign in Slum Communities

Elderly Care Project, Klong Toey Slum

Community

Educational Services

Nursing College

Other Health related Services

First Aid Training

Knowledge for Life Project

Home Nursing Training

Health Education for the Disadvantaged,

Including inmates, no educated children

Rabies Hot Line

Health Restorative

Service at Home

Consultancy for HIV

AIDS infected and family

Disaster Relief Services Consumable and Life Pack Aids

Mobile Medical Units

First Aid Unit, Medical Supplies and Vehicles

Service Coverage (Map)

“Princess Pa Project” voluntary Project, the Thai Red Cross.Thailand Health Profile Report Health Essay.

Society

Blood Services

Blood Bags manufactured by the National Blood Service Center

Eye Bank

Eye Bank process

Cornea in Optisol

Cornea in Glycerine

Eye whites

Amniotic membrane

Fair and Equal-Opportunity Eye

Allocation

Organ Donation

Heart,

Lung,

Liver Allocation

Kidney Allocation

Child Aids

Biological Family Tracking

Family Finding

Child Follow-Through

Adoption Process

Chalerm Phrakiat Child Development Center (For Thai Red Cross Personnel)

Humanitarian Relief

Consumable aids and life packs

Mobile Medical Units

First Aid Units

Specialized Medicine

Units

Other Services

Dissemination of Red Cross Principles and

Humanitarian Laws in youths

Chalerm Prakiat 72 Pansa Iodine Nutrition Project

Community Service Activities

Strong industry growth outlook several key supportive factors

Thailand’s healthcare sector has bright prospects in light of the following supporting factors:

Low healthcare penetration.

An ageing population and a rising death rate from complex illnesses.

A limited supply threat due to high entry barriers.

Thailand’s competitive market position in medical tourism.

The first three factors ensure rapidly rising demand for healthcare from local people in Thailand. Nonetheless, we see greater demand prospects from provincial areas than from the Bangkok Metropolitan Region (BMR) due to the growing urbanization trend and lower penetration. Thailand Health Profile Report Health Essay.

Obstacles in medical emergencies

Emergency transport facilities in Thailand are not yet fully developed. Large hospitals in Thailand have mobile intensive care units where you can be have immediate treatment in emergency situations. However, you will rarely see an ambulance racing the streets of Bangkok. Although traffic accidents are attended to, volunteer organizations are normally the ones to provide rescue units.Passers-by will also assist in emergencies. For traffic accidents, you can always seek help from the Police Hospital at the Ratchaprasong Intersection (if you are in the area).

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In terms of emergency transport, the main obstacle in medical emergencies is the traffic in Bangkok. Unwanted delays are unavoidable, unless you are in close proximity to a hospital. Generally speaking, cars do not automatically give way to responding ambulances. Thailand Health Profile Report Health Essay. Therefore, if you have a medical condition that may need immediate attention, where possible, stay in a place which is near to a suitable hospital.

Having a health service that is able to treat controlled and stable conditions is one thing, but being capable of dealing with emergency procedures is another. Unfortunately, Thailand needs some major improvements in this regard.

Money is important

When you are in Thailand, it is important to have your medical insurance documents with you; either that or another form of payment. In the case of a hospital admission, you will be required to pay up front for the treatments. It appears that money plays an even larger part than normal when discussing the healthcare system of Thailand. In most European countries, problems like these are normally avoided because the patients have mandatory medical insurance and hospitals can be confident about getting paid. It is recommended that you avail of private health insurance when considering Thailand as a place to visit or live. Thailand Health Profile Report Health Essay.