Health in Thailand

Thailand has had "a long and successful history of health development," according to the World Health Organization. Life expectancy is seventy years and a system providing universal health care for Thai nationals has been established since 2002.^[1]

Health and medical care is overseen by the Ministry of Public Health (MOPH), along with several other non-ministerial government agencies, with total national expenditures on health amounting to 4.3 percent of GDP in 2009.

Non-communicable diseases form the major burden of morbidity and mortality, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues.^[2]

Health infrastructure

Siriraj Hospital, Bangkok, the oldest and largest hospital in Thailand.

The majority of health care services in Thailand is delivered by the public sector, which includes 1,002 hospitals and 9,765 health stations. Universal health care is provided through three programs: the civil service welfare system for civil servants and their families, Social Security for private employees, and the universal coverage scheme theoretically available to all other Thai nationals. Some private hospitals are participants in these programs, though most are financed by patient self-payment and private insurance. According to the World Bank, under Thailand’s health schemes, 99.5 percent of the population have health protection coverage.^[3]

The MOPH oversees national health policy and also operates most government health facilities. The National Health Security Office (NHSO) allocates funding through the universal coverage program. Other health-related government agencies include the Health System Research Institute (HSRI), Thai Health Promotion Foundation ("ThaiHealth"), National Health Commission Office (NHCO), and the Emergency Medical Institute of Thailand (EMIT). Although there have been national policies for decentralization, there has been resistance in implementing such changes and the MOPH still directly controls most aspects of health care.

Thailand introduced universal coverage (UC) reforms in 2001, becoming one of only a handful of lower-middle income countries to do so. Means-tested health care for low income households was replaced by a new and more comprehensive insurance scheme, originally known as the 30 baht project, in line with the small co-payment charged for treatment. People joining the scheme receive a gold card which allows them to access services in their health district, and, if necessary, be referred for specialist treatment elsewhere.^[3]

The bulk of health financing comes from public revenues, with funding allocated to contracting units for primary care annually on a population basis. According to the WHO, 65 percent of Thailand's health care expenditure in 2004 came from the government, while 35 percent was from private sources. Thailand achieved universal coverage with relatively low levels of spending on health, but it faces significant challenges: rising costs, inequalities, and duplication of resources.^[3][4]

Although the reforms have received a good deal of criticism, they have proved popular with poorer Thais, especially in rural areas, and survived the change of government after the 2006 military coup. Then Public Health Minister, Mongkol Na Songkhla, abolished the 30 baht co-payment and made the UC scheme free. It is not yet clear whether the scheme will be modified further under the military government that came to power in May 2014.^[5][6][7]

In 2009, annual spending on health care amounted to 345 international dollars per person in purchasing power parity (PPP). Total expenditures represented about 4.3 percent of gross domestic product (GDP). Of this amount, 75.8 percent came from public sources and 24.2 percent from private sources. Physician density was 2.98 per 10,000 population in 2004, with 22 hospital beds per 100,000 population in 2002.^[8]

Data for utilization of health services in 2008 includes: 81 percent contraceptive prevalence, 80 percent antenatal care coverage with at least four visits, 99 percent of births attended by skilled health personnel, 98 percent measles immunization coverage among one-year-olds, and 82 percent success in treatment of smear-positive tuberculosis. Improved drinking-water sources were available to 98 percent of the population, and 96 percent were using improved sanitation facilities (2008).^[9]

Hospitals

Most hospitals in Thailand are operated by the Ministry of Public Health. Private hospitals are regulated by the Medical Registration Division. Other government units and public organisations also operate hospitals, including the military, universities, local governments and the Red Cross. As of 2010, there were 1,002 public hospitals and 316 registered private hospitals.

Provincial hospitals operated by the MOPH's Office of the Permanent Secretary are classified as follows:^[10]

• Regional hospitals (โรงพยาบาลศูนย์) are in provincial centres, have a capacity of at least 500 beds and have a comprehensive set of specialists on staff.
• General hospitals (โรงพยาบาลทั่วไป) are in province capitals or major districts and have a capacity of 200 to 500 beds.
• Community hospitals (โรงพยาบาลชุมชน) are at the district level and further classified by size:
  • Large community hospitals have a capacity of 90 to 150 beds.
  • Medium community hospitals have a capacity of 60 beds.
  • Small community hospitals have a capacity of 10 to 30 beds.

While all three types of hospitals serve the local population, community hospitals are usually limited to providing primary care (District Health Promotion Hospital : โรงพยาบาลส่งเสริมสุขภาพตำบล, รพ.สต.), while referring patients in need of more advanced or specialised care to general or regional hospitals.

The term general hospital, when referring to private hospitals, refers to hospitals which provide non-specialised care. Private hospitals with fewer than 30 beds are officially termed health centres. Both are defined as accepting patient admissions.

Water and sanitation

In 2008, 98 percent of the population had access to an improved water source.^[1] Ninety-six percent of the population have access to improved sanitation facilities.^[1]

Health status

Non-communicable diseases form the major burden of mortality and mortality in Thailand, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues.^[2] The mortality rate is 205 per 1,000 adults for those aged between 15 and 59 years.^[9] The under-five mortality rate is 14 per 1,000 live births.^[9] The maternal mortality ratio is 48 per 100,000 live births (2008).^[9]

Years of life lost, distributed by cause, was 24 percent from communicable diseases, 55 percent from non-communicable diseases, and 22 percent from injuries (2008).^[9]

Life expectancy

Life expectancy in Thailand is seventy years.^[1] Life expectancy is 66 years for males and 74 for females.^[9]

Infectious diseases

Major infectious diseases in Thailand also include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis.^[11] The prevalence of tuberculosis is 189 per 100,000 population.^[9]

HIV/AIDS

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008.^[12] In 2009 the adult prevalence of HIV was 1.3%.^[13] As of 2009, Thailand had the highest prevalence of HIV in Asia.^[14]

The government has begun to improve its support to persons with HIV/AIDS and has provided funds to HIV/AIDS support groups. Public programs have begun to alter unsafe behaviour, but discrimination against those infected continues. The government has funded an antiretroviral drug program and, as of September 2006, more than 80,000 HIV/AIDS patients had received such drugs.

The American Centers for Disease Control and Prevention (CDC) conducted a study in partnership with the Thailand Ministry of Public Health to ascertain the effectiveness of providing people who inject drugs illicitly with daily doses of the anti-retroviral drug Tenofovir as a prevention measure. The results of the study were released in mid-June 2013 and revealed a 48.9 percent reduced incidence of the virus among the group of subjects who received the drug, in comparison to the control group who received a placebo. The principal investigator of the study stated in Lancet, "We now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use."^[15]

Food safety

Food safety scares are not uncommon to Thailand. Besides the ever common microbial contamination of street side food left out in the hot sun and dusty roads, as well as store food, contamination by banned or toxic pesticides and fake food products is also common.^[16]

In July 2012 consumer action groups demanded four unlisted toxic pesticides found on common vegetables at levels 100 times the EU guidelines (which are banned in developed countries) be banned. Chemical companies are requesting to add them to the Thai Dangerous Substances Act so they can continue to be used, including on exported mangoes to developed countries which have banned their use.^[16] In 2014, Khon Kaen University concluded after a study, that Thailand should ban 155 types of pesticides, with 14 listed as urgent: Carbofuran, Methyl Bromide, Dichlorvos, Lambda-cyhalothrin, Methidathion-methyl, Omethoate, Zeta Cypermethrin, Endosulfan sulfate, Aldicarb, Azinphos-methyl, Chlorpyrifos-ethyl, Methoxychlor and Paraquat.^[17]

Antibiotic abuse

A study by the health ministry and Britain's Wellcome Trust released in September 2016 found that an average of two person die every hour from multi-drug resistant bacterial infections in Thailand.^[18] That death rate is much higher than in Europe. The improper use of antibiotics for humans and livestock has led to the proliferation of drug-resistant microorganisms, creating new strains of "superbugs" that can be defeated only by "last resort" medicines with toxic side effects. In Thailand, antibiotics are freely available in pharmacies without a prescription and even in convenience stores. Unregulated use of antibiotics on livestock is also problematic. Drug-resistant bacteria spreads through direct contact between humans and farm animals, ingested meat, or the environment. Antibiotics are often used on healthy animals to prevent, rather than treat, illnesses.^[18]

In November 2016, Thailand announced its intent to halve antimicrobial-resistant (AMR) infections by 2021, joining the global battle against "superbugs". It aims to reduce the use of antibiotics in humans by 20 percent and in animals by 30 percent. The health minister said that about 88,000 patients develop AMR infections a year. The infections claim at least 38,000 lives in Thailand each year, causing 42 billion baht in economic damage. Without measures to address the issue, he said that the world would enter a "post-antibiotic era" with at least 10 million people around the world dying from AMR by 2050, 4.7 million of them in Asia.^[19]

Teenage pregnancies

In 2014, some 334 babies were born daily in Thailand to mothers aged between 15 to 19.^[20]

See also

• Birth in Thailand
• Ya ba, amphetamines

References

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