Health Care Delivery and Referral System in Thailand

Wilailuk Wisasa, M Econ,

Bureau of Policy and Planning

National Health Security Office

2

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).

Background

Health Care System in ThailandHealth Care System in Thailand

Government Sector- Ministry of Public Health- Other Governmental

Agencies

Non-Governmental Organizations

Private Sector

Health Care Delivery SystemHealth 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

7

Private Hospitals and Clinics

436 Private hospitals

(Bangkok 115, other provinces 321)

10,819 Medical clinics

11,094 Drugstores

2,106 Traditional medicine drugstores.

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

2567

7259,738

72,19225

834,711

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) SELF CARE Family

Health Service Infra-structure

Excellent Centers

Thai Health Care Structure

Community-Family-Self Care

Ex.cent.Tertiary Care

High level

Middle level Secondary care

Low level

Primary Care

Principles• Equity• Accessibility• Quality

2 Million

1 Million

0.2 Million

8 0,000

3 0,00-50,000

Referral System

10,000

Health Infrastructures

Community HospitalMain Primary Care Unit (PCU)

Health center – close to client PCU

Population Ratios of Major HealthPopulation Ratios of Major HealthPersonnel in Thailand (2008)Personnel in Thailand (2008)

• Bangkok• North• Northeast• Central (Except BKK)

• South• Whole country

1:7561:4,8621:8,0621:3,620

1:4,8251:3,395

1:2,9751:27,1881:38,2321:17,334

1:25,3341:15,295

1:2,1211:16,5881:25,7831:11,353

1:13,2101:10,158

1:3031:1,0211:1,696

1:847

1:9611:905

Doctors Dentist Pharmacists NursesRegion

Model on Referral System Development

Referral Center (Region)

• Situation Assessment

• Support Resources

• Monitoring &Evaluation

• Share Resources

Community

Hospital

Referral

Center

High Care

Referral

Center

Referral

Center

Regional Coordinating Referral Center

•Staff 24 Hrs.

•Technical Support

•Update data

Regional/General HospitalGeneral Hospital

Community Hospital

Community Hospital

Community Hospital

General Hospital

HC

HC

HC

HC

Community Hospital

Continue/Chronic Care, Home Care

HC

Community Hospital

General Hospital

Community Hospital

HC

HC

Ex. Centers • 163

[ 40 Cardiac, 26 Cancer,

51 Trauma] • 1 Thai Traditional

Medicine

Tertiary Care 115 Regional/General

Hospitals 2 Elderly Health Care Services

Centers

Secondary Care

235 Node of Community Hospitals

Primary Care 14,763Tambol Health Promoting Hospitals

14 14 Projects forProjects for Investment in HealthInvestment in Health DevelopmentDevelopment 86685( , 86685( ,Million BahtMillion Baht))

10,376 MB.

22,302 MB.

76 MB

13,499 MB.

14,763 MB

[Production : 1620,Doctors,

2 , 500 Nurses, 6,000Asst. Nurses

400 Dental Public Health , 750 Health Technical

Officers,

Capacity Building : 25000, persons]

5 ,870MB.

Sounthern Border

Health Development

(2,659 MB)

Supportive Health Services System• 1,100 Accommodation Units, Offices, Cars

• 1 Health Information System Infrastructure

• 18 Referral Health Service Centers

2974,MB.

• Health Manpower Development

• 10 Centers for

showing Health products ( 17 MB)

10 Health production offices(7 MB)

4,800 Food Safety places (12 MB)

14625, MB.

616 MB.

395 MB.

Stimulus Package Plan (SP II) 2010-2014

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 andPerspective 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