Late last year, Thai rock star Artiwara Kongmalai – also known as Toon Bodyslam – undertook a charity run of 2,215 kilometres across Thailand to raise donations to buy medical equipment for 11 state hospitals. The mega-marathon drew massive public attention. It also sparked public debate on how badly underfunded the country’s public health budget is. However, this isn’t the first time the government’s ability to keep the healthcare system afloat has been questioned.
Healthcare and public finance experts have warned for years that public health would become a burden the state was ill-prepared to subsidise and have urged reform. Thais are currently covered by three health insurance regimes with different benefits. The largest is the tax-funded universal health coverage (UHC), known as the 30-baht scheme, which covers 70% of the population.
Launched in 2002, the UHC gives underinsured or poor Thais universal access to essential healthcare services at almost no cost. Its costs account for 40% of all spending on public health care. The rest of the population, including private-sector employees, subscribe to self-financed social security schemes and the tax-funded Civil Servant Medical Benefit Scheme, which covers state officials and their family members. Figures from the Thai Health Promotion Foundation show that public health expenditure in 2014 accounted for 13% of the state budget.
This proportion of spending may not sound alarming. But the sustainability of public healthcare spending has to be questioned given that it has increased by 12% a year on average over the last 12 years.
The Thailand Development Research Institute (TDRI) has provided estimates for Thailand’s total public health expenditure for the three schemes over the next 15 years, based on the Organisation for Economic Co-operation and Development’s framework. The TDRI estimates that spending on public healthcare in 2032 will stand at 480 billion baht or more.
It will then rise at a mean rate of 2.14% a year. But this spending will explode to 1.4 trillion baht given that Thailand, like many countries, is fast becoming an ageing society with more elderly in need of healthcare support. Over 20% of the population will soon be aged 60 or over.
The situation will become more challenging for the country’s public health financing. Evidence shows that many Thais will suffer from non-communicable diseases (NCDs) when they grow older.
According to a report by the Ministry of Public Health in 2008, total public expenditure for the treatment of five major NCDs – cancer, hypertension, heart disease, stroke and diabetes – stood at approximately 25 billion baht. At present, the money the state spends on treating NCDs ranks among the top healthcare costs for chronic diseases. In sum, public health spending will unavoidably increase and the government needs to be prepared for this challenge.
In tacking NCDs, it should come up with preventive measures as these diseases are mainly caused by one’s lifestyle. NCD prevention should be incorporated into the state’s disease control plan. Secondly, the government should consider ways to bring about cooperation among the three health insurance schemes and create a central information management system.
One of the obstacles it faces is that it is difficult to gather healthcare data from the different state agencies running the three schemes. The lack of shared data makes the state’s estimation of public health expenditure imprecise. It also makes its management and control of spending difficult.
Toon’s charity run has triggered awareness that good healthcare requires adequate funding. The government should capitalise on this momentum by taking positive action. “The sustainability of public healthcare spending has to be questioned.”
Kwankamon Thanadkah and Alongkorn Chaladsook are researchers at the Thailand Development Research Institute (TDRI). Policy analyses from the TDRI appear in the Bangkok Post on alternate Wednesdays.
This article is first published in the Bangkok Post on February 28, 2018.