Health Care Delivery and
Referral System in Thailand
Wilailuk Wisasa, M Econ,
Bureau of Policy and Planning
National Health Security Office
Background

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
2

Health Expend/cap – US $175 (2009)

Physicians/cap – 4/10,000

ANC & SBA coverage - 99-100%
(2009).
Health Care System in Thailand
Government Sector
- Ministry of Public Health
- Other Governmental
Agencies
Non-Governmental
Organizations
Private Sector
Health 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
Private Hospitals and Clinics
436 Private hospitals
(Bangkok 115, other provinces 321)
10,819 Medical clinics
11,094 Drugstores
2,106 Traditional medicine drugstores.
7
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
25
67
725
9,738
72,192
25
834,711
Health Service Infra-structure
Excellent Centers
General, Regional Hos.(95)
Community Hos.(741)
3 o MC
2 o MC
Health Center (9,770)
1 o MC
CPHC. Center
(80,000)
PHC
SELF CARE
Province( 200,000-2M.)
District(10,000-100,000)
Subdistrict(1-5,000)
Village
Family
Thai Health Care Structure
Principles
• Equity
2 Million
Ex.cent.
• Accessibility 1 Million
Tertiary Care
• Quality
0.2 Million
80,000
30,00-50,000
10,000
Referral System
High level
Middle level Secondary care
Low level
Primary Care
Community-Family-Self Care
Health Infrastructures
Community Hospital
Main Primary Care Unit (PCU)
Health center – close to client PCU
Population Ratios of Major Health
Personnel in Thailand (2008)
Region
•
•
•
•
Bangkok
North
Northeast
Central
Doctors
Dentist
Pharmacists
Nurses
1:756 1:2,975 1:2,121
1:4,862 1:27,188 1:16,588
1:8,062 1:38,232 1:25,783
1:3,620 1:17,334 1:11,353
1:303
1:1,021
1:1,696
1:847
1:4,825 1:25,334 1:13,210
1:3,395 1:15,295 1:10,158
1:961
1:905
(Except BKK)
• South
• Whole country
Model on Referral System Development
Community
Hospital
Referral Center (Region)
• Situation Assessment
• Support Resources
HC
Community
Hospital
• Monitoring &Evaluation
Community
• Share Resources
Hospital
Regional Coordinating Referral Center
Regional/General
Hospital
General Hospital
Community
Hospital
Center
High Care
Continue/Chronic
Care, Home Care
HC
•Technical Support
•Update data
Referral
Community
Hospital
•Staff 24 Hrs.
HC
General Hospital
Center
HC
General Hospital
Referral
Referral
Community
Hospital
Community
Hospital
HC
Center
HC
HC
Stimulus Package Plan (SP II)
Ex.
• 10 Centers for
2010-2014
Centers
showing Health
• Health Manpower
Development
• 163
[Production : 1,620 Doctors,
2,500 Nurses, 6,000Asst. Nurses
10,376 MB.
[ 40 Cardiac,
26 Cancer,
51 Trauma]
• 1 Thai Traditional
Medicine
products ( 17 MB)
 10 Health
production
offices(7 MB)
395 MB.
400 Dental Public Health ,
 4,800 Food Safety
750 Health Technical Officers,
Tertiary Care
places (12 MB)
Capacity Building :
 115 Regional/General Hospitals 22,302 MB.
25,000 persons]
 2 Elderly Health Care Services
76 MB
Centers
5,870MB.

Sounthern Border
Health Development
(2,659 MB)
Secondary Care
 235 Node of Community Hospitals
13,499
MB.
Primary Care
 14,763Tambol Health Promoting Hospitals
14,763 MB
Supportive Health Services System
• 1,100 Accommodation Units, Offices, Cars
• 1 Health Information System Infrastructure
• 18 Referral Health Service Centers
14,625 MB.
2,974 MB.
616
MB.
14 Projects for Investment in Health Development ( 86,685 Million Baht)
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 researchersreformists-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 and
Perspective 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