WORAWAN CHANDOEVWIT
PHASITH PHATCHANA
Despite the promises from political parties to fix disparities in the public health system, they have overlooked one glaring problem that affects half of the population – the gender health gap.
And no matter which parties succeed in forming the next government after last Sunday’s general election, they need to explain why men receive more than women for every baht spent on public health services.
The inequality is stark. Statistics show that women seek medical care from public hospitals more than men. Yet the government spends more of its health budget on taking care of men’s health issues.
What’s more, the public health expenses for women are mostly for pregnancies and childbirth. Men’s medical treatments are mostly for injuries and traffic accidents.
This gap is clear from our research on health inequality in Thailand. So are the urban-rural gap and the unequal access to healthcare among different regions.
Our study also looks at the age factor and found that the most vulnerable age group is people over 60 suffering from chronic illnesses, followed by children under the age of five years.
Interestingly, the number of females seeking medical assistance is higher than men in all age groups across regions.
Our study exploring health inequality in Thailand regarding gender, age and geographical differentials derives from two data sources: Health and Welfare Surveys from the National Statistical Office from 2007-2015, and health records from the National Health Security Office in 2015.
We found the number of people receiving medical services increases over time across the country, reflecting easier access to healthcare.But there are differences between gender, age groups and regions.
For example, the number of females reporting sick is higher than males in all age groups across all regions.
Morbidity rate is the number of people reporting sick per 100,000 persons. For women, their morbidity rate rose from 19,700 in 2007 to 25,100 in 2015. Statistics show that women report sick more than men by 4,000-5,000 per 100,000 persons.
Our study also confirms the urban-rural gap with rural women’s morbidity rate higher than their urban peers by 2,000 per 100,000 persons.
Interestingly, women living in the North and Northeast use public hospitals more than women in other regions.
Given that people over 60 are the most vulnerable group for illnesses, women in the North over 60 are most likely to get sick and are therefore the most in need of health interventions.
Even though women are more likely to be sick than men, men use more health resources every year in all age groups and regions.
Between 2007 and 2015, male in-patients stayed at hospital a day longer than female inpatients on average.
Among those aged 15-39 years, almost a third of male in-patients received medical treatment due to traffic accidents and injuries while 60% of female in-patients got healthcare services for pregnancy and related health matters.
Geographically, the South has greater differentials of healthcare use between male and female in-patients than other regions, reflecting women’s poorer access to healthcare services in this region.
Unsurprisingly, although there are more patients in rural areas, Bangkok and other big cities use more health resources judging by the longer hospital stays per visit.
On average, in-patients in Bangkok stay nine days per hospital visit, which is three to four days longer than other regions.
This is followed by the North and the Central Plains, while the South and Northeast use the least health resources, respectively.
That is understandable. Public hospitals in Bangkok use more health resources because they serve as medical centres to treat patients with complex and severe conditions from all parts of the country.
This also shows there is a need to bridge this gap by improving healthcare technology and expertise in the provinces.
While bigger health budgets are necessary to improve health services to reach more people, especially in rural areas, people who need medical assistance the most may be missed if policymakers are not aware of gender, age, and regional differentials.
If tackling health disparity is the goal of the next government and health policymakers, the findings on gender health disparity and the most vulnerable groups should remind them where to start.
Although more people can now access health services due to the development of health systems and economic development, women, the elderly and young children remain most vulnerable to illnesses.
It is unacceptable that although women report more frequent illnesses, men consume more health resources from their high-risk behaviour.
Given the urban-rural gap, the rapidly ageing society and women’s longer life spans, the health system’s challenge is how to assist elderly women suffering chronic diseases, especially those in the North and Northeast.
Apart from attending to women’s health needs better, the government must find ways to reduce preventable causes of illnesses, particularly traffic accidents and injuries among the male population, which unnecessarily consume excessive health resources.
Yet prevention is better than cure.Since most illnesses derive from high-risk behaviour and unhealthy lifestyles, the measures to promote good health should start from early childhood.
To ensure people don’t stray from this path, the measures should be re-emphasised in every age group, with an eye on gender disparity, age vulnerability and the urban-rural gap.
Worawan Chandoevwit, PhD, is an Associate Professor at the Faculty of Economics, Khon Kaen University, and an adviser for the Thailand Development Research Institute. Phasith Phatchana is a Research Assistant at MahidolOxford Tropical Medicine Research Unit (MORU). Policy analyses from the