Health in Thailand

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]

Health indices

According to the World Health Organization (WHO)'s Global Health Observatory (data from 2009), life expectancy at birth in Thailand is 66 years for males and 74 for females. The mortality rate is 205 per 1,000 adults for those in the 15 to 59 years of age range, and the under-5 mortality rate is 14 per 1,000 live births. The maternal mortality ratio is 48 per 100,000 live births (2008), compared to a regional average of 240. The prevalence of HIV is 13 per 1,000 adults aged between 15 and 49 years (regional average 3), and the 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 includes: 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 were available to 98% of the population, and 96% were using improved sanitation facilities (2008).^[2]

Health care systems

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 have health protection coverage.^[4]

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. Thailand achieved universal coverage with relatively low levels of spending on health but it faces significant challenges: rising costs, inequalities, and duplication of resources.^[4]

^[5] 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.^[6][7][8]

Hospitals

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:^[9]

• Regional hospitals are located in province centres, have a capacity of at least 500 beds and have a comprehensive set of specialists on staff.
• General hospitals are located in province capitals or major districts and have a capacity of 200 to 500 beds.
• Community hospitals are located in the district level and further classified by size:
  • Large community hospitals have a capacity of 90 to 150 beds.
  • Medium community hospitals have a capacity of 60 beds.
  • Small community hospitals have a capacity of 10 to 30 beds.

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 fewer than 30 beds are officially termed health centres. Both are defined as accepting patient admissions.

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.^[1] Major infectious diseases in Thailand also include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis.^[10]

HIV/AIDS

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.

The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the anti-retroviral drug Tenofovir as a prevention measure. The results of the study were released in mid-June 2013 and revealed a 48.9% reduced incidence of the virus among the group of subjects who received the drug, in comparison to the control group who received a placebo. The Principal Investigator of the study stated in the Lancet medical journal: “We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use.”^[11]

Food Safety

Food safety scares, like the rest of developing Asia, are not uncommon to Thailand. Moreover besides the ever common microbial contamination of streetside 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.^[12]

See also

• Birth in Thailand

References