Health Care Delivery and Referral System in Thailand Wilailuk Wisasa, M Econ, Bureau of Policy and Planning National Health Security Office

Background GNI/cap - US $ 4,210 (2010) Population - 67 million Total fertility rate – 1.6 (2009) Life expectancy at birth – 74.1 years Under 5 Mortality – 14/ 1000 live births Maternal mortality – 48/100,000 live births Health Expend/cap – US $175 (2009) Physicians/cap – 4/10,000 ANC & SBA coverage - 99-100% (2009).

Health Care System in Thailand Government Sector - Ministry of Public Health - Other Governmental Agencies Non-Governmental Organizations Private Sector

Health Care Delivery System Government owned 70% of Bed MOPH Facilities Health Center (no Bed) Primary Care Units (PCU) Community Hospital (10-90 Beds) General/Regional Hospital (300-1,000 Beds) Private Hospitals 30% of Bed not-for-profit Hospital for-profit Hospital

Public Health Services Facilities Bangkok 5 Medical school hospitals 29 General hospitals 19 Specialized hospitals and institutions 83 community health care centres Regional Level 25 Regional hospitals 38 Specialized hospitals Provincial Level 67 General hospitals (MOPH) 56 Hospitals under Ministry of Defense District Level 725 Community hospitals 212 Municipal health centers Sub-district (Tambon) level 9,791 Health centers 72,192 community PHC centres Village Level 834,711 Village Health Volunteers

Primary Health Services in Thailand Primary Health Services under the responsibility of MoPH: -Health Centres - Primary Care Units (PCU) Primary Health Services under the responsibility of BMA: - community Health Care Centres

Private Hospitals and Clinics (Bangkok 115, other provinces 321) 10,819 Medical clinics 11,094 Drugstores 2,106 Traditional medicine drugstores. 7 7

Health Service Delivery Infrastructure (Ministry of Public Health) Regional Hospitals General Hospitals Community Hospitals Health Centers Community PHC’s Centres Other Hospital (Under Department) Village Health Volunteers 25 67 725 9,738 72,192 834,711

Excellent Centers PCU Health Service Infra-structure General, Regional Hos.(95) 3 o MC Province( 200,000-2M.) Community Hos.(741) 2 o MC District(10,000-100,000) Health Center (9,770) 1 o MC Subdistrict(1-5,000) CPHC. Center PHC Village (80,000) PCU SELF CARE Family

Thai Health Care Structure Principles Equity Accessibility Quality 2 Million Ex.cent. 1 Million Tertiary Care Referral System 0.2 Million High level Middle level Secondary care Low level 80,000 30,00-50,000 10,000 Primary Care Community-Family-Self Care

Health Infrastructures

Community Hospital Main Primary Care Unit (PCU)

Health center – close to client PCU

Population Ratios of Major Health Personnel in Thailand (2008) Region Doctors Dentist Pharmacists Nurses Bangkok North Northeast Central (Except BKK) South Whole country 1:756 1:4,862 1:8,062 1:3,620 1:4,825 1:3,395 1:2,975 1:27,188 1:38,232 1:17,334 1:25,334 1:15,295 1:2,121 1:16,588 1:25,783 1:11,353 1:13,210 1:10,158 1:303 1:1,021 1:1,696 1:847 1:961 1:905

Model on Referral System Development Community Hospital Referral Center (Region) Situation Assessment Support Resources Monitoring &Evaluation Share Resources HC Community Hospital Community Hospital Regional Coordinating Referral Center Staff 24 Hrs. Technical Support Update data Regional/General Hospital General Hospital Community Hospital Referral Center High Care HC Community Hospital Community Hospital General Hospital Referral Center Continue/Chronic Care, Home Care HC HC HC Community Hospital General Hospital Referral Center HC HC

Stimulus Package Plan (SP II) 2010-2014 Ex. Centers • 163 [ 40 Cardiac, 26 Cancer, 51 Trauma] • 1 Thai Traditional Medicine • 10 Centers for showing Health products ( 17 MB) 10 Health production offices(7 MB) 4,800 Food Safety places (12 MB) • Health Manpower Development 10,376 MB. [Production : 1,620 Doctors, 2,500 Nurses, 6,000Asst. Nurses 400 Dental Public Health , 750 Health Technical Officers, Capacity Building : 25,000 persons] 5,870MB. Sounthern Border Health Development (2,659 MB) 395 MB. Tertiary Care 115 Regional/General Hospitals 2 Elderly Health Care Services Centers 22,302 MB. 76 MB Secondary Care 235 Node of Community Hospitals 13,499 MB. Primary Care 14,763Tambol Health Promoting Hospitals 14,763 MB The National Economic and Social Development Broad Office and Ministry of Public Health, as the key actors, formulate 10 Mega projects for investment in health services system development at all levels about 104,000 million baht in 3 areas: First, infrastructure and networking of health services system and referral system Second, human resource for health And Finally, health information system In the previous government, the project was agreed in principle. The need to solve health problems and upgrade the health services is still a key priority for the Thai Ministry of Public Health and the current government is enthusiastic about investing in health by revitalizing the Mega project. Supportive Health Services System • 1,100 Accommodation Units, Offices, Cars • 1 Health Information System Infrastructure • 18 Referral Health Service Centers 14,625 MB. 2,974 MB. 616 MB. 14 Projects for Investment in Health Development ( 86,685 Million Baht)

The Three Main Financial System in Thailand Civil Servant Medical Benefit Scheme (CSMBS) and State Enterprise Benefit. It is not social insurance scheme but in stead it serves as fringe benefit for Govt. officers and operated by Ministry of Finance. Social Security Scheme (SSS) for employees working in the private company with employs more than 1 employee Universal Coverage Scheme (UC) for the rest of the population

Enabling Factors for Achieving UC Strong political support Health system capacity and its resilience to rapid nationwide program scaling-up Nationwide extension of PHC coverage, and mandatory rural health services by new graduate medical doctors and other health workers Integral relationship among researchers-reformists-politicians

UC Benefit Package It is quite comprehensive comprising OP, hospitalization, health promotion and disease prevention, most of high cost case, dental care, medicines, operations including heart surgery, HIV/AIDS treatment and prosthesis replacement Except: special nursing fee, eye glasses and some really high cost treatment

Policy Recommendations and Perspective for the Future ◙ Strengthening the national policy and strategic approach with participation of all stakeholders to drive and formulate integrated action plans and necessary associated implementation. ◙ Increasing accessibility in quality health services for all and to invest in cost-effectiveness interventions. ◙ Strengthening to success in higher level of primary health care, community health care services, comprehensive national health promotion program, and decentralization in health. ◙ Preparation for elderly: economic security, health security, social security The policy recommendations and perspective for the future to fulfill the health needs and solving the health problems should be provided. The 4 main directions have been proposed. First, Strengthening the national policy and strategic approach with participation of all stakeholders to drive and formulate integrated action plans and necessary associated implementation under the said plans. Second, Increasing accessibility in quality health services for all and to invest in cost-effectiveness interventions by: - strengthening of health care systems to provide access to universal health care coverage and integrity of health care system. - Increasing resources in the production of sufficiency health care services. - Reducing health-related risk factors and unhealthy behaviors through cost-effectiveness interventions. Third, Enhancing to success in higher level of primary health care, community health care services, comprehensive national health promotion program, and decentralization in health in various aspects. Finally, Preparation for elderly should be lifetime process starting from youth and covering all critical aspects of life in to various action for providing economic security, health security, and social security. Under the umbrella of the Mega project, The Project of Comprehensive Care for the Elderly is aimed at developing infrastructure and extensive services system as well as referral networks nationwide.

Thank you & Sawasdee