Government Spending and Central-Local Relations in Thailand's Health Sector
This paper focuses on efficiency and equity in the financing of health services, and the evolving role of central and local government in the health sector. Thailand has seen significant improvements in health outcomes and succeeded in expanding th...
| Main Authors: | , , |
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2013
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/2012/08/17398753/government-spending-central-local-relations-thailands-health-sector http://hdl.handle.net/10986/13574 |
| Summary: | This paper focuses on efficiency and
equity in the financing of health services, and the evolving
role of central and local government in the health sector.
Thailand has seen significant improvements in health
outcomes and succeeded in expanding the coverage of health
protection schemes over the last decades. While the
achievements of Thailand's health system are
undeniable, this paper highlights three key challenges: (i)
inequalities in utilization and spending under different
health financing schemes and across geographic areas; (ii)
mounting cost pressures; and (iii) fragmentation of
financing and unresolved issues concerning the respective
roles of central and local governments. This paper shows
that although some of the differences in utilization and
spending across schemes can be explained by the age profile
of members, significant variations remain even after
controlling for differences. It documents large variation in
resources and spending across regions, both for the system
as a whole and within the respective health financing
schemes. In addition, the paper highlights pressures to
increase government health spending that are primarily the
result of rising spending in the Universal Coverage (UC) and
Civil Servant Medical Benefit Scheme (CSMBS) schemes. Cost
pressures are likely to persist due to rising incidence of
chronic disease, population aging, continuing pressure from
health workers for greater compensation, demands for
expanded benefits under the respective schemes, and the
rising expectations of patients. Finally, the paper argues
for a more systematic and decisive approach to
decentralization of prevention and promotion functions,
based on more detailed specification of the roles and
responsibilities of central and local government. It also
suggests that the current approach to primary care
decentralization through voluntary transfer of health
centers has limited potential, and that there is a need to
consider local management of networks of providers that
combine both general hospital and primary care services. |
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