Health Systems in Transition Vol. 5 No. 5 2015 The Kingdom of Thailand Health System Review Written by: Pongpisut Jongudomsuk, National Health Security Office, Nonthaburi, Thailand Samrit Srithamrongsawat, National Health Security Office, Nonthaburi, Thailand Walaiporn Patcharanarumol, International Health Policy Program, Nonthaburi, Thailand Supon Limwattananon, Khon Kaen University, Khon Kaen, Thailand Supasit Pannarunothai, Naresuan University, Phitsanulok, Thailand Patama Vapatanavong, Institute for Population and Social Research, Mahidol University, Nakorn Prathom, Thailand Krisada Sawaengdee, International Health Policy Program, Nonthaburi, Thailand Pinij Fahamnuaypol, Health Information Systems Development Office, Nonthaburi, Thailand Editor: Viroj Tangcharoensathien, International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand Asia Pacific Observatory on Health Systems and Policies i WHO Library Cataloguing in Publication Data The Kingdom of Thailand health system review (Health Systems in Transition, Vol. 5 No. 5 2015) 1. Delivery of healthcare. 2. Health care economics and organization. 3. Health care reform. 4. Health system plans – organization and administration. 5. Thailand. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 713 6 (NLM Classification: WA 540 JT3) © World Health Organization 2015 (on behalf of the Asia Pacific Observatory on Health Systems and Policies) All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). 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The named authors alone are responsible for the views expressed in this publication. ii Contents Preface ................................................................................................................. xii Acknowledgements .......................................................................................... xiv List of abbreviations ......................................................................................... xvi Abstract ............................................................................................................... xxi Executive Summary .........................................................................................xxii Background .........................................................................................................xxii The health systems context and achievement ..............................................xxii Health systems reforms ..................................................................................xxvi Health systems performance ........................................................................xxvii 1 Introduction ................................................................................................. 1 Chapter summary ................................................................................................. 1 1.1 Geography and socio-demography .......................................................... 2 1.2 Economic context ........................................................................................ 5 1.3 Political context ........................................................................................... 7 1.4 Health status ................................................................................................ 9 2 Organization and governance ................................................................ 17 Chapter summary ............................................................................................... 17 2.1 Overview of the health system ................................................................ 18 2.2 Historical background .............................................................................. 21 2.3 Organization ............................................................................................... 22 2.4 Decentralization and centralization ....................................................... 24 2.5 Planning ...................................................................................................... 27 2.6 Intersectorality ........................................................................................... 29 2.7 Health information management ........................................................... 30 2.8 Regulation ................................................................................................... 35 2.9 Patient empowerment .............................................................................. 46 3 Financing .................................................................................................... 51 Chapter summary ............................................................................................... 51 3.1 Health expenditure .................................................................................... 52 3.2 Sources of revenue and financial flows ................................................. 55 iii 3.3 Overview of the statutory financing system .......................................... 62 3.4 Out-of-pocket payments .......................................................................... 71 3.5 Voluntary health insurance ...................................................................... 73 3.6 Other financing .......................................................................................... 74 3.7 Payment mechanisms .............................................................................. 75 4 Physical and human resources .............................................................. 86 Chapter summary ............................................................................................... 86 4.1 Physical resources .................................................................................... 87 4.2 Human resources ...................................................................................... 95 5 Provision of services ..............................................................................110 Chapter summary ............................................................................................. 110 5.1 Public health ............................................................................................ 112 5.2 Patient pathways ..................................................................................... 115 5.3 Primary/ ambulatory care ...................................................................... 116 5.4 Specialized ambulatory care/inpatient care ....................................... 117 5.5 Emergency care ....................................................................................... 124 5.6 Pharmaceutical care ............................................................................... 131 5.7 Rehabilitation/intermediate care .......................................................... 138 5.8 Long-term care and informal care ....................................................... 146 5.9 Palliative care ........................................................................................... 153 5.10 Mental health care .................................................................................. 156 5.11 Dental care ............................................................................................... 160 5.12 Complementary and alternative medicine .......................................... 164 6 Principal health reforms .......................................................................170 Chapter summary ............................................................................................. 170 6.1 Analysis of