Current status, problems, and challenges in public health in Thailand Dr. Phusit Prakongsai, MD. Ph.D. International Health Policy Program – IHPP Ministry of Public Health, Thailand Presentation to Asian Consultation Workshop on Education for Global Health Leadership Melia Hotel, Hanoi, Vietnam November 4-5, 2008

Mortality profiles by income groups, 2005 Sources: WHO projection baseline scenario *Thai working group, BOD 2004 * *

% of Total national deaths Top ten mortality in 2004 Source: Thai Working Group on BOD

% of Total Top ten DALY loss in 2004 (total 9.9 DALY loss)

Profile of DALY loss by age groups Thailand 2004

Risk Burden in 2004

International Health Policy Program -Thailand 7 Health expenditure in Thailand by function in 2001 and 2005

Household consumption: tobacco, alcohol and health Median household expenditure (Baht per month) Sources: Analyses from 2006 SES

Informal exemption User fees 1-3 rd NHP Provincial hospitals Health Infrastructure Thailand: historical development of achieving universal coverage 1975 LIC 1990 Establishment ofprepayment schemes Expansion ofprepayment schemes 1980 CSMBS 1983 CHF 1990 SSS 4 th -5 th NHP ( ) District hospitals Health centers UniversalCoverage CSMBS SSS 2001 Universal Coverage SSS LIC  MWS 1994 PVHI

Health care finance and service provision of Thailand after achieving universal coverage (UC) General tax General tax Standard Benefit package Tripartite contributions Payroll taxes Risk related contributions Capitation Capitation & global Co-payment budget with DRG for IP Services Fee for services Fee for services - OP Population Patients Ministry of Finance - CSMBS (6 million beneficiaries) National Health Insurance Office The UC scheme (47 millions of pop.) Social Security Office - SSS (9 millions of formal employees) Voluntary private insurance Public & Private Contractor networks

International Health Policy Program -Thailand 11 Share of public and private financing sources from total health expenditure in Thailand,

International Health Policy Program -Thailand 12 Number of public health workers and health centre for primary care in Thailand, More than 70% of health centres have the public health workers below the national standard (1 public health worker: 1,250 population) More than 17% of health centres are responsible to more than 10,000 population.

International Health Policy Program -Thailand 13 Public health education in Thailand The Ministry of Public Health (MOPH) produces most of the certificate level HRH for its own facilities; whereas University Faculty of Medicine, Nursing, etc. produces graduates with Bachelor degrees, The Faculty of Public Health at Mahidol University and others are functioning as Public Health administrators mostly serving medical doctors with or without Public Health education, There is no standard for the design of the public health curriculum in Thailand, only a common feature with core and elective courses for two-year programme, There is an increasing trend in cooperation between university based department and MOPH in designing and implementing a module-based graduate Public Health programmes.

International Health Policy Program -Thailand 14 Conclusion (1) Thailand is facing epidemiological transition from CD to NCD, and disease burden (in term of DALY loss) from NCD is increasing, There is an urgent need to prepare public health competency of health personnel to address disease and illness from life styles and risk behavior, There is an increase in public investment in health, and share of household out-of-pocket payments is decreasing, However, a very small amount of health resources were spent on health promotion and disease prevention, and mostly on conventional clinical based prevention and health promotion services.

International Health Policy Program -Thailand 15 Conclusion (2) Households in Thailand spent more on harmful products to health (tobacco and alcohol), compared to household health spending, Achieving universal coverage (UC) in 2001 with the comprehensive benefit package including disease prevention and health promotion, and using primary care unit as a gatekeeper, is an advantage for primary health care reform in Thailand, There is an urgent need to address the issue of inequitable distribution of health facilities and human resources for health among regions, and between urban and rural areas in Thailand.