Thailand Public Finance Management Report : Government Spending and Central-Local Relations in Thailand’s Health Sector
This discussion paper is one of five discussion papers for the Thailand public financial management report. It focuses on efficiency and equity in the financing of health services, and the evolving role of central and local government in the health...
| Main Authors: | , , |
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| Format: | Report |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2017
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/136461468117866298/Thailand-Public-finance-management-report http://hdl.handle.net/10986/27401 |
| Summary: | This discussion paper is one of five
discussion papers for the Thailand public financial
management report. It focuses on efficiency and equity in
the financing of health services, and the evolving role of
central and local government in the health sector. Over the
last few decades, Thailand has seen significant improvements
in health outcomes, reflecting sustained public investment
in both infrastructure and human resources. Thailand has
also succeeded in expanding the coverage of health
protection schemes, culminating in the introduction of the
Universal Coverage (UC) scheme in 2001. These efforts have
broadened access to health services, contributed to greater
and more equitable utilization, and helped reduce the
financial burden and the risk of impoverishment associated
with health care expenses. However, there are fewer data on
broader measures of health system performance, including
dimensions of quality. Overall, available evidence suggests
a mixed picture. For instance, while there has been
improvement in the management of chronic conditions, a
significant number of cases remain undiagnosed or untreated.
Similarly, Thailand has seen recent improvement in 2-year
survival rates from cancer and heart attacks, but still lags
far behind Organization for Economic Co-operation and
Development (OECD) countries. While the achievements of
Thailand's health system are undeniable, this paper
highlights three key challenges: (i) inequalities in
utilization and spending; (ii) mounting cost pressures; and
(iii) fragmentation of financing and unresolved issues
concerning the respective roles of central and local
government. This paper provides evidence of regional
differences in diagnosis and management of chronic disease,
and of survival rates from cancer and heart attacks. These
data do not suggest a strong relationship between the health
system and spending on the one hand, and on quality or
health outcomes on the other. Indeed, efficiency may be a
greater concern, with over-provision now a growing problem
in some parts of the health system. However, more evidence
is needed on these issues. For example, while high levels of
spending and utilization in the Civil Servant Medical
Benefit Scheme (CSMBS) are often noted, it is less clear
whether this is associated with better outcomes (e.g. higher
cancer survival rates or improved health outcomes for the
elderly). The implications of geographic disparities in
spending in the Social Security Scheme (SSS) and the CSMBS
also warrant further attention. |
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