Thailand has had "a long and successful history of health development," according to the World Health Organization. Life expectancy is seventy years at birth, ninety-eight and ninety-six percent of the population have access to improved drinking water and sanitation (respectively), and a system providing universal health care for Thai nationals has been established since 2002. Health and medical care is overseen by the Ministry of Public Health, along with several other non-ministerial government agencies, with total national expenditure on health amounting to 4.3 percent of GDP in 2009. Although HIV/AIDS, tuberculosis, malaria and other infectious diseases remain serious public health issues, non-communicable diseases and injuries have also become important causes of morbidity and mortality.[1]
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According to the World Health Organization's Global Health Observatory (data from 2009), life expectancy at birth in Thailand is 66 years for males and 74 for females. Mortality rate is 205 per 1,000 adults 15 to 59 years of age, and under-5 mortality rate is 14 per 1,000 live births. Maternal mortality ratio is 48 per 100,000 live births (2008), compared to a regional average of 240, while prevalence of HIV is 13 per 1,000 adults 15–49 years (regional average 3) and prevalence of tuberculosis is 189 per 100,000 population (regional average 278). Years of life lost distributed by cause was 24% from communicable diseases, 55% from non-communicable diseases, and 22% from injuries (2008).[2]
In 2009, annual spending on health care amounted to 345 international dollars per person in purchasing power parity (PPP). Total expenditures represented about 4.3% of the gross domestic product (GDP); of this amount, 75.8% came from public sources and 24.2% from private sources. Physician density was 2.98 per 10,000 population in 2004, with 22 hospital beds per 100,000 population in 2002.[3]
Data for utilization of health services in 2008 include 81% contraceptive prevalence, 80% antenatal care coverage with at least four visits, 99% of births attended by skilled health personnel, 98% measles immunization coverage among one-year-olds, and 82% success in treatment of smear-positive tuberculosis. Improved drinking-water sources was available to 98% of the population, and 96% were using improved sanitation facilities (2008).[2]
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.
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 ("ThaiHealth"), 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. 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.[4] 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.[5][6][7]
Most hospitals in Thailand are operated by the Ministry of Public Health. Private hospitals are regulated by the Medical Registration Division under the MOPH's Department of Health Service Support following the Sanatorium Act, B.E. 2541. Other government units and public organisations also operate hospitals, including the military, universities, local governments and the Red Cross. As of 2010, there are 1,002 public hospitals and 316 registered private hospitals.
Provincial hospitals operated by the MOPH's Office of the Permanent Secretary are classified as follows:[8]
While all three types of hospitals serve the local population, community hospitals are usually limited to providing primary care, while referring patients in need of more advanced or specialised care to general or regional hospitals.
The term general hospital, when referring to private hospitals, refer to hospitals which provide non-specialised care. Private hospitals with less than 30 beds are officially termed health centres. Both are defined as accepting patient admissions.
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.[1] Major infectious diseases in Thailand also include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis.[9]
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.
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