1. HealthCare System in Thailand: Past - Present and Where is the Future ?
Dr. Pradit Sintavanarong
Minister of Ministry of Public Health, Thailand

2. Population of Thailand
Thailand Population Census
Population of Thailand
2011
2012
2013
Total Population
63,891,000
64,413,000
64,623,000
   - Male
31,445,000
31,683,000
31,438,000
   - Female
32,446,000
32,730,000
33,185,000
Urban area
23,078,000
28,406,000
29,662,000
Rural area
40,813,000
36,007,000
34,961,000
Children (under 15 years)
13,010,000
12,892,000
12,123,000
Labor force ( years)
43,091,000
43,410,000
42,983,000
Elderly (60 years and over)
7,790,000
8,111,000
9,517,000
School ages ( years)
15,192,000
15,092,000
14,027,000
Women of reproductive ages( years)
17,711,000
17,712,000
17,388,000
Crude birth rate (per 1,000 population)
12.4 12
11.6
Crude death rate (per 1,000 population)
6.9
7.1
7.7
Natural growth rate (percent)
0.6
0.5
0.4
Infant mortality rate (per 1,000 live births)
12.3
11.8
11.2
Child mortality rate (per 1,000 live births)
14.3
13.7
18.4
Total fertility rate
1.5
1.6
Source: Institute for Population and Social Research, Mahidol University

3. Estimated Population of Thailand in the Next 20 Years (2033)
Thailand Population Census
Estimated Population of Thailand in the Next 20 Years (2033)
65,759,000
   - Male
31,633,000
   - Female
34,126,000
Source: Institute for Population and Social Research, Mahidol University;
Estimated Population at Midyear 2013 (1st July)

4. Health statistics

5. Thailand Health Status
Coverage of Health Insurance %
Life Expectancy at birth (2010) ( Male 71 (71.1), Female 77 (78.1) )
Crude birth rate (per 1,000) (11.6)
Crude death rate (per 1,000) (7.7)
IMR (per 1,000 live births) (11.2)
MMR (per 100,000 live births)
Source: Ministry of Public Health , Public Health Statistics 2011
( ) = Institute for Population and Social Research, Mahidol University
IMR = Infant Mortality Rate
MMR = Maternal Mortality Rate
CMR = Child Mortality Rate 5

6. Aged Society Aged Society Elderly = 12.63% of Total Population
Year 2553
Year 2554
Year 2555
Age Group
count
percentage
Ages 0-14
12,672,935
19.89
12,496,939
19.47
12,241,023
19.05
Ages15-59
43,577,838
68.41
43,892,616
68.39
43,911,198
68.33
Ages 60 and Over
7,450,930
11.70
7,791,446
12.14
8,114,144
12.63
Total
63,701,703
64,181,001
64,266,365
Elderly = 12.63% of Total Population
Source: Bureau of Policy and Strategy, Ministry of public health

7. Proportion of elderly (>65 years old)
Japan
China
Thailand
Korea
World
Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat,  World Population Prospects: The 2010 Revision

8. Morbidity Disease Year 2011 Year 2012 Infectious disease 2007.28
Non communicable diseases
Circulatory diseases
Accident
Cancer
712.36
700.91
467.74
724.18
762.75
483.34
Rate per 100,000 populations
Source: Bureau of Policy and Strategy, Ministry of public health

9. Mortality Disease 2007 2008 2009 2010 2011 Infectious disease 60.6
61.2
60.7
64.9
64.6
Non communicable diseases
Circulatory diseases
Accident
Cancer
208.25
55.2
68.1
84.9
209.73
56.0
66.1
87.6
209.67
88.3
215.79
61.9
62.7
91.2
227.32
68.8
63.4
95.2
Rate per 100,000 populations
Source: Bureau of Policy and Strategy, Ministry of public health

10. Mortality
Rate per 100,000 populations
Source: Bureau of Policy and Strategy, Ministry of public health

11. Major Causes of Death in Thailand, 1967-2009
Source: Thailand Health Profile

12. DALYs attributable to risk factors in Thailand
Source: IHPP, Burden of disease, Thailand, 1999, 2004, and 2009

13. Evolution of health system in Thailand

14. Mandatory rural services
Evolution of the Thai Health System
CSMBS 1980
Health Card 1983
SSS 1990
UCS
NHSO
Low Income Scheme
1997 Constitution
Economic crisis
1980s
1968
1975
2001
2007/08/09
1828
1888
1918
1942
1990s
1946
1978
1999
2006
King Rama 3
started the
Western medicine
Department of Public Health, MoI
Mandatory rural services
HFA/ PHC policy
1992
HSRI
Local Health Funds
HAI
LGs
EMIT
MoPH
Scaling up District Health System
(DH + HC)
Scaling up district health system = expansion of district hospitals to cover all districts and expend health centers to cover all Tambols.
A decade of health center development was a ten year plan for upgrading capacity of health centers.
1992
A decade of health center development
ThaiHealth
Siriraj Hospital
established
First MoPH nursing college
NHCO
MoPH = Ministry of Public Health, HSRI = Health System Research Institute, LGs = local governments
ThaiHealth = Thai Health Promotion Foundation, NHSO = National Health Security Office,
NHCO = National Health Commission Office, EMIT = Emergency Medical Institute of Thailand,
HAI = Hospital Accreditation Institute

15. Principles of organizing healthcare system in Thailand
The 1997 Constitution was adopted as principle legal framework for moving toward welfare state by providing Universal Health Coverage,
‘access to needed health services is a basic right of the Thai population’
The UHC policy in Thailand aims to enable access to needed services to all Thai people and protecting them from catastrophic health expenditure
Put emphasis on ensuring access for all at an affordable cost rather than providing the best to some
Health service delivery system has been organized as multi-level system to ensure geographical equity while maintain efficiency of the system.

16. Multiple Actors in Health
MOPH
Ministry of Public Health
HSRI
Governor
Health System Research Institute
NHSO
Local Authorities
National Health Security Office
ThaiHealth
Thai Health Promotion Foundation
Area
Tumbon health fund
NHCO
National Health Commission
EMIT
PPP
Emergency Medical Institute of Thailand
Public Private Partnership
HAI
Health Accreditation Institute
Output/ Outcome/ Impact

17. Governance of the health system
MoPH had been sole actor in the health system for six decades; however, following various reforms, there are various actors involving in governing the health system.
Decentralization: various public health functions have been transferred to local governments
Establishment of NHSO  separation of purchasing and providing functions
ThaiHealth dealing with social determinants of health
NHCO -> citizen empowerment in health
EMIT  pre-hospital care system
HAI  hospital accreditation
Following various reforms, there has been brain drain from MoPH to those new autonomous agencies and resulted in weakening MoPH’s role in directive the health system.

18. Healthcare financing

19. General government Revenue and Expenditure 2003-2011
This slide shows general government revenue as compared with GDP and government expenditure as % of GDP. Percentage of government budgets spending on education, health care, and military
Revenue is cash receipts from taxes, social contributions, and other revenues such as fines, fees, rent, and income from property or sales. Grants are also considered as revenue but are excluded here.
Expense is cash payments for operating activities of the government in providing goods and services. It includes compensation of employees (such as wages and salaries), interest and subsidies, grants, social benefits, and other expenses such as rent and dividends.
General government final consumption expenditure (formerly general government consumption) includes all government current expenditures for purchases of goods and services (including compensation of employees). It also includes most expenditures on national defense and security, but excludes government military expenditures that are part of government capital formation.
Note: Revenue excluding grants, GGCE = general government consumption expenditure, GGE = General government expenditure
Source: Thailand Data;

20. Total Health Expenditure : ↑ government spending, ↓ out-of-pocket payment, but maintain the level of spending to GDP
UHC achieved
There was rapid increase in total health expenditure prior to the 1997 economic crisis, 15-19% per annum. Total health expenditure was increased by 19% in 2002 according to the introduction of UCS. Average annual growth was around 8-10% since then and went up to 17% in Mark increase in the amount and proportion of government spending on health care was also observed in opposite to the declining of proportion of out-of-pocket spending. However, the level of spending in relation to the economy of the country was quite stable or just slightly increased, only 4% of GDP.
Economic crisis
Source: NHA

22. CSMBS expenditure, 1994 – 2012 rapid cost escalation in opposite to declining of beneficiaries
Per capita expense ≈ 12,000/ year
CSMBS expense on OP service increased sharply following the introduction of direct disbursement for OP services together with the Fee-for-service payment on OP services, average annual growth was 20 – 40% while expense on IP was much better controlled. Price control by DRG and limited available beds in public hospitals best explain the relatively well control of IP expenditure. From 2009 onward, there have been various intensive supply side interventions which decelerated the increase rate.
Source: Comptroller’s General Department, MOF
Note: direct disbursement of OP services started in 2004 for chronic conditions, 2006 extended to pensioners, and 2009 extended to cover all CSMBS members

23. SSS expenditure 1994 – 2010 Per capita expense 2010 = 2,750 Baht
1404
1284
1250
1100
900
800
700
Increase in SSS expenditure was driven by two main factors, increase in the number of beneficiaries and increase in the capitation rate.
xxx
capitation
Source: expenses from NHA excluding expense on administration
Number of beneficiaries at the end of each year from SSO

24. งบกองทุนหลักประกันสุขภาพแห่งชาติ
ปีงบประมาณ
เป้าหมายประชากรสิทธิ UC (ล้านคน)
อัตราค่าเหมาจ่ายรายหัว (บาท/คน/ปี)
งบเหมาจ่ายรายหัวรวมเงินเดือน (ล้านบาท)
% เปลี่ยนแปลง
ปี 2545
45.000
1,202.40
51,407.71
ปี 2546
46.000
56,091.23
9.1%
ปี 2547
46.820
1,308.50
61,212.39
ปี 2548
47.000
1,396.30
67,582.60
10.4%
ปี 2549
47.750
1,659.20
82,023.00
21.4%
ปี 2550
46.066
1,899.69
91,369.05
11.4%
ปี 2551
46.477
2,100.00
101,984.10
11.6%
ปี 2552
47.026
2,202.00
108,065.09
6.0%
ปี 2553
47.240
2,401.33
117,969.00
9.2%
ปี 2554
47.997
2,546.48
129,280.89
9.6%
ปี 2555
48.333
2,755.60
140,609.40
8.8%
ปี 2556
48.445
141,539.75
0.7%
ปี 2557
48.852
2,895.09
154,257.98
8.9%
Mark increase in the per capita budget of UCS was observed in , increased by 19, 15, and 11% respectively and increased by 5-9% after that. Increase in the per capita budget of UCS came from two main factors, utilization rate and unit cost. The sharp increase in 2006 was partly due to the recognition of under financed of the scheme at the beginning. Increase in utilization and laobur cost best explained the increase in the later phase. Comparing
ที่มา : สำนักงานหลักประกันสุขภาพแห่งชาติ

26. Number of use persons, OP visits, and IP admissions of UCS, 2003-2012
Approximately 78% of UCS beneficiaries (37 million persons) used benefits from the scheme. OP visits increased from million visits in 2003 to visits in 2012, this resulted in increase in utilization rate from 2.45 visits/ person/ year to 3.37 visits/person/year. IP admission increased from 4.3 million admissions in 2003 to 5.6 million admissions in 2012, this resulted in increase in utilization rate from 0.94 to 1.15 admissions/person/year
Data from NHSO: 78% of UCS members used benefits, OP visits increased from 2.45 to 3.37 visits/person/year, IP admissions increased from 0.94 to 1.15 admissions/person/year

27. รายงานสรุปจำนวนการใช้บริการ OP ปี 2553 – 2555 สิทธิ UC
จำนวนคน
จำนวน Visit
2553
27,098,157
144,809,385
2554
29,671,976
166,184,132
2555
32,352,507
167,790,950
Mark increase in the per capita budget of UCS was observed in , increased by 19, 15, and 11% respectively and increased by 5-9% after that. Increase in the per capita budget of UCS came from two main factors, utilization rate and unit cost. The sharp increase in 2006 was partly due to the recognition of under financed of the scheme at the beginning. Increase in utilization and laobur cost best explained the increase in the later phase. Comparing
ที่มา : สำนักงานหลักประกันสุขภาพแห่งชาติ

28. รายงานสรุปจำนวนการใช้บริการ OP ปี 2555 UC Accumulative patient count
Visit count group
Visit count
Patient count
Accumulative patient count
1 - 3 1
10,123,016 2
5,618,033
15,741,049 3
3,615,457
19,356,506
4 - 6 4
2,634,825
21,991,331 5
2,037,527
24,028,858 6
1,620,063
25,648,921
7 - 9 7
1,293,477
26,942,398 8
1,047,112
27,989,510 9
846,614
28,836,124 10
688,628
29,524,752 11
561,665
30,086,417 12
455,115
30,541,532
13 ขึ้นไป
2,140,938
32,682,470
Mark increase in the per capita budget of UCS was observed in , increased by 19, 15, and 11% respectively and increased by 5-9% after that. Increase in the per capita budget of UCS came from two main factors, utilization rate and unit cost. The sharp increase in 2006 was partly due to the recognition of under financed of the scheme at the beginning. Increase in utilization and laobur cost best explained the increase in the later phase. Comparing
ที่มา : สำนักงานหลักประกันสุขภาพแห่งชาติ

29. รายงานสรุปจำนวนการใช้บริการ OP ปี 2555 UC Accumulative patient count
Visit count group
Visit count
Patient count
Accumulative patient count
13 – 15 13
369,525
30,911,057 14
297,834
31,208,891 15
241,517
31,450,408
16 – 18 16
196,252
31,646660 17
160,178
31,806,838 18
131,145
31,937,983
19 – 21 19
108,554
32,046,537 20
89,594
32,136,131 21
73,962
32,210,093
22 – 24 22
61,340
32,271,433 23
51,668
32,323,101 24
43,466
32,366,567
25 ขึ้นไป
315,903
32,682,470
Mark increase in the per capita budget of UCS was observed in , increased by 19, 15, and 11% respectively and increased by 5-9% after that. Increase in the per capita budget of UCS came from two main factors, utilization rate and unit cost. The sharp increase in 2006 was partly due to the recognition of under financed of the scheme at the beginning. Increase in utilization and laobur cost best explained the increase in the later phase. Comparing
ที่มา : สำนักงานหลักประกันสุขภาพแห่งชาติ

30. Increase in cost of MoPH hospitals, 2009-2011
On average, salary of hospital staffs increased by 6-10% per annum
Non-salary labor cost of district hospitals increased sharply by 50% in 2009, and it increased by 30-40% for general and regional hospitals in 2009 and 2010
All type of hospitals had a declined rate of expense on drugs
Source: Health Insurance System Research Office; analysis of financial report of MoPH hospitals

31. Traffic Accident Insurance
Losses incurred varied from 40-50% of collected revenues
Source: Office of Insurance Commission

32. Provincial Health Administration
Ministry of Public Health
Ministry of Interior
Permanent Secretary
Permanent Secretary
Technical Departments
Province
Office of the
Permanent Secretary
Provincial Administration Offices
Director-General
Governor
Provincial Public Health Offices (76)
Provincial Chief Medical Officers
Regional & General Hospital
Community Hospitals
Districts
Governors
Municipalities
Primary Care Unit
Tambol Health Promoting Hospitals
District Health Offices
Tambol Administration Offices

33. Other public hospitals
Health service delivery system in Thailand
Health centers
9,768
Municipality Medical Centers 365
District hospitals
776
Provincial hospitals 68
Pharmacy
11,154
Private clinics
17,671
Other public hospitals
120
Private hospitals
323
Regional hospitals 28
University hospitals 17
Other MoPH hospitals 55
MOPH facilities
Sub-district
District
Province
Health service delivery system in Thailand is a public-private mix. MoPH facilities are backbone of the Thai health care system, they are organized as a multi-level system. At the grass root level, there are health centers, and there are district hospital at the district level, provincial and regional hospital at the provincial level; moreover, there are specialized hospitals providing tertiary care.
Health facilities of other public agencies are not organized in a systematic way and have specific purpose, i.e military, interior, education, etc. Many municipalities have medical health centers locating in town area.
Private facilities include private clinics, pharmacies, and private hospitals, they are usually located in big cities and urban settings.
Source:
1. Thailand Health Profile
2. Bureau of Policy and Strategy, MoPH,

34. Private Hospital Clinics (2013)
Private Hospitals
Bangkok 98, Other provinces 224
Total 322
Medical clinics
Bangkok 3,970 , Other provinces 14,533
Total 18,503
Drugstores
Bangkok 4,912 , Other provinces 11,780
Total 16,692
Traditional medicine Drugstores
Bangkok , Other provinces 1,615
Total 2,058
Source: Bureau of Policy and Strategy, Bureau of Sanatorium and Art of Healing, Food And Drug Administration; Ministry of public health

35. Health Facilities in the Public Sector (2010)
Administrative Level
Health facility
Bangkok
5 medical school hospitals
26 general hospitals
13 specialized hospitals/institutions
68 community health care centers
Regional level
6 medical school hospitals
33 regional hospitals
48 specialized hospitals
Provincial level
83 general hospitals
District level
774 community hospitals
284 municipal health centers
Sub-district level
9,768 health promoting hospitals
Village level
198 community health posts
48,049 rural community primary health care centers
3,108 urban community primary health care centers
1,055,000 Village Health Volunteers
Source : Bureau of Health Administration; Ministry of public health

36. Human resources

37. Population to provider ratios, 1979 - 2009
Source: Thailand Health Profile

38. Disparities of population/healthcare provider ratios for Bangkok and the Northeast, 2001 - 2009
There was mark reduction in the disparities of population to health care provider ratios for Bangkok and the Northeast during
Population to doctor ratio of the Northeast remained 5 time of Bangkok while the ratios of other professions were 1.5 – 2 times of Bangkok
Source: Thailand Health Profile

39. Doctor and nurse to 1,000 population
among ASEAN countries
Thailand has relatively low numbers of doctor and nurse to 1,000 populations compared with countries at the same level of economy
Source: Kanchanachitr et al (2011)

40. Limited production capacity
Currently, annual production increases to 2,500 for doctor and 9,000 for nurse; however, the production capacity remains lower than other countries.
Source: Kanchanachitr et al (2011) 40

41. Pharmaceutical industry

42. Pharmaceutical industry in Thailand
During the period , with a high economic growth and new drug marketing monopolies under the Drug Act, the value and proportion of imported drugs was rising rapidly.
The proportion of imported drugs was rising steadily to 56.3% in 2005, 64.5% in 2009, and 68% in 2010
Source: Drug Control Bureau, Food and Drug Administration, MoPH

43. Use of drugs outside national ED list in 31 hospitals
Percentage of prescribed items
Percentage of reimbursements
Use of drugs outside national ED list in 31 hospitals
University hosp
MoPH hosp
Other public hosp
Data error
Bubble size represents amount of reimbursement
Type of hospital
Expense on drugs accounted for 83% of total OP expenses. 34 big hospitals shared 35% of total OP visits of CSMBS members but shared 60% of the reimbursements. Prescribing of drugs outside the national essential drug list and original products was major cause of the high expense among these hospitals. Reimbursements of NED drugs accounted for 50-80% of total reimbursements among these hospitals.

44. Antimicrobial drug resistance (1)
Antibiotic use, low / middle income countries
OP penicillin use and resistance
Source: Werner C. (2004)
In Thailand, important antibiotic resistant bacteria are
Enterobacteriaceae (Quinolone resistance, <20% in community, 30-70% in hospital),
Staphylococcus aureus (Penicillin resistant 1% in community, 30-70% in hospital)
Pseudomonas aeruginosa (Carbapenam resistance 10-30%)
Acinetobacter baumanni. (Carbapenem resistance 60-85% for hospital infection)
Source: report of workshop on antimicrobial drug resistance, Bangkok, 6-10 August 2012

45. Role of Government Pharmaceutical organization (GPO)
Aim to ensure security of drug supply and to maintain price level of necessary pharmaceutical supplies to ensure accessibility for all Thais
Production
Stocking
distribution
Trade of between national security and promoting local pharmaceutical industry (push and pull)
Competing with local pharmaceutical firms in producing generic drugs
Production of vaccines

46. Time line of Health Sector Reform

47. Time line of Health Sector Reform
Scaling up district health system
Health volunteer
Community-based health insurance (health card)
PHC era
Introduction of Universal Health Coverage
Expansion to cover high cost services i.e. ARV, RRT
Universal Coverage
Population aging
Increase demand for health care
Increase burden of chronic care
Use of original & NED drugs
Demand drive by Advance medical technology
Increasing health expenditure
Sustainability doubted
Control of health care expenditure
Harmonization of health insurance schemes
Regional health service plan
Health sector reform 1
Sustainability
Healthcare expenditure
Quality and safety
Management
Health sector reform 2

48. Current issues of concern
Downsizing public sector policy of various governments put pressure on public health sector
Increased workload according to universal coverage policy
Limited public hospital capacity in recruitment and retain health professions, especially professional nurse
Major incentive for working in public hospital with greater workload and lower salary is being a civil servant
Disparities in financial compensation level for different health professions in the public sector

49. Health Sector Reform: issues for debate
Whether Thailand will move towards full welfare state, particularly for health care
Wealth & Health
Balancing of revenue and expenditure; how to generate additional revenue for health care
Equal basic benefits to all or comprehensive benefits
Explicit cost sharing policy to prevent unnecessary use , especially high cost medicines
Long-term financial sustainability

50. Challenges for further reforms1
Burden Of Disease and old aged dependency challenges
Governance of the health system
Role of MoPH and other partners and their relationship
Government fiscal space and long term financial sustainability
Harmonization of the three main schemes
Health systems capacity to cope with
Increased demand within very strained health workforces
Decentralization context –threats and opportunities
Public private dialogues, better trust and collaboration 2 3 4 5

51. การดูแลและพัฒนาคุณภาพชีวิตของประชาชนที่แบ่งตามช่วงวัย
ช่วงอายุ 0 – 5 ปี
เด็กเกิดจากมารดาซึ่งมี ANC ครบถ้วนในช่วงระยะเวลาที่เหมาะสม และคลอดในห้องคลอด
เด็กได้รับน้ำนมมารดาและอาหารเสริมในระยะเวลาที่เหมาะสม
เด็กได้รับวัคซีนที่จำเป็นต่างๆครบถ้วน
การได้รับการรักษาทางการแพทย์ที่พอเพียง
เด็กได้รับการเตรียมตัวสำหรับการพัฒนาในช่วงวัยต่อไปอย่างเหมาะสมผ่านศูนย์ดูแลเด็กเล็กและโรงเรียนอนุบาล

52. การดูแลและพัฒนาคุณภาพชีวิตของประชาชนที่แบ่งตามช่วงวัย
ช่วงอายุ 6 – 19 ปี
การบริการทางการแพทย์ที่พอเพียง
เด็กและเยาวชนได้รับวัคซีนที่จำเป็น และวัคซีนกระตุ้นครบถ้วน
เด็กและเยาวชนได้รับการพัฒนาทักษะเพื่อการเข้าสู่ช่วงวัยทำงานต่อไปอย่างเหมาะสมกับสถานการณ์และปัญหาด้านสาธารณสุข เช่น
ยาเสพติด สุรา บุหรี่
การตั้งครรภ์ไม่พร้อม
โรคติดต่อทางเพศสัมพันธ์ รวมทั้ง HIV/AIDS
ปัญหาอุบัติเหตุ
ปัญหาทางการโภชนาการ โดยเฉพาะ โรคอ้วน
การออกกำลังกาย
ปัญหาการติดการพนันและเกมส์
การมี E.Q. ที่เหมาะสม
ความรับผิดชอบต่อสังคม

53. การดูแลและพัฒนาคุณภาพชีวิตของประชาชนที่แบ่งตามช่วงวัย
ช่วงอายุ 20 – 59 ปี
ได้รับการดูแลส่งเสริมสุขภาพและการคัดกรอง โดยมีการกระตุ้นเตือนให้ความรู้ผ่านช่องทางต่างๆอย่างเหมาะสม
ได้รับบริการด้านสุขภาพที่พอเพียงในกรณีที่เจ็บป่วย
ได้รับการเตรียมตัวที่จะเข้าสู่ช่วงอายุวัยชราต่อไป
ช่วงอายุ > 60 ปี
ได้รับการซ่อมแซมสุขภาพในกรณีที่จำเป็น
ได้รับการส่งเสริมให้มีสุขภาพที่แข็งแรงจนถึงช่วงสุดท้ายของวัย
ได้รับการดูแลจากลูกหลานและชุมชนอย่างอบอุ่น

54. Reform direction

55. Reform direction Restructuring health sector
Separation regulatory role and service provision role in the MoPH
Strengthening MoPH functions as National Health Authority
Policy, direction, and guidelines on financing
Policy on human resources
Regulation and supervision
Monitoring and evaluation
Implementing cost accounting system in hospitals
Reorganize relationships between MoPH and various main actors

56. Reform direction Regional health service commissioning
Decentralize administration of service provision to 12 regional MoPH areas (service plan)
Improve efficiency of resources use by sharing resources
Improve capacity of service provision within the regions
Better referral system
Greater accountability by setting KPIs
Greater cooperation between purchaser and providers in planning, purchasing, and service provision

57. Reform direction Financing reform
Expansion of health protection coverage by compulsory contributory insurance
Migrant workers and dependents
Foreign visitors
Foreign residents
Reform Traffic Accident Insurance to improve effectiveness and efficiency of the system
Pharmaceutical cost control of CSMBS and reform payment system for better cost control
Reform payment system to support MoPH service plan 57

58. Reform direction Harmonization of current health insurance schemes
National Clearing House
National Information center
Harmonization of benefit package and payment system
Accident and Emergency services
Anti-Retro Viral Therapy
Cancer

59. National Health Authority
โครงสร้างการทำงานระบบสาธารณสุขประเทศไทย
National Health Authority
Regulator
Provider
Purchaser
Supplement / Agent
สปสช.
สวรส.
สช.
สพฉ.

60. Increase demand for health care
Walk in across border for medical visit
MOPH hospitals at border areas provide unpaid care around 250 million Baht a year
Immigrant workers
Illegal migrants & dependents, both registered and non-registered ≈ 3 mil.
Legal skilled migrants & dependents ≈ 1 mil. (attracted by 2 mm public project on infrastructure)
Medical Hub
≈ 800,000/year, not much affected by AEC

61. Health services use by non-Thais
Illegal migrant workers & dependents ≈ 3 m, share 15-20% of OP visits and 20-35% of IP admissions in provinces with high density of migrant workers.
Non-Thais patients shared ≈ 30% of OP services and 35-50% of IP services in hospitals at west-border of Thailand
There are ≈ 1 million foreign patients under the medical hub

62. Policies response to increase demand for healthcare of Non-Thais
At the border;
Supporting capacity building of health facilities in nearby countries at border areas
Supporting governments of neighborhood countries in moving towards UHC
Providing health protection to Non-Thais and generate additional source of finance by compulsory contributory insurance
Migrant workers and dependents
Foreign visitors

65. Policies response to increase demand for healthcare of Non-Thais (2)
Medical hub (academic training and conference, medical care, dental care, spa and Thai traditional medicine)
Promoting Thailand as center of medical education, academic training, and conferences)
Loosening professional barrier in importing foreign professions
Reduce income gap between public and private sector in order to prevent brain drain

66. Inspiration

67. ชายคนแรกตอบ
“ผมกำลังทำงานหาเงินเพื่อเลี้ยงชีพอยู่”
คนที่สองตอบว่า
“ผมกำลังฝึกหัดเพื่อเป็นนักแกะสลักหินชั้นยอด”
ชายคนที่สามตอบ
“ผมกำลังสร้างวิหารอยู่ครับ เป็นวิหารที่จะอยู่เป็นร้อยๆ
ปีและเป็นแรงบันดาลดลใจให้คนรุ่นหลังอีกหลายชั่วอายุ
คนหลังจากผมตายไปแล้ว”

68. Bamboo seeding ( water for 4 yrs )
After off from land : grow 60 fts in 9 m

69. Bamboo seeding After off from land
( water for 4 yrs )
After off from land
grow 60 fts in 9 m

70. A journey of a thousand miles begins with a single step.
Chinese proverb

71. ระยะทางจากโลกถึงดวงจันทร์
1/4 ล้าน
ไมล์
ระยะทาง 3 กม. แรก ใช้พลังงานไป 50 % ของทั้งหมด

72. Attitude is a little thing
that
makes a big difference
Winston Churchill

73. Thank you