Health in Thailand

Thailand has had "a long and successful history of health development," according to the World Health Organization. Life expectancy is averaged at 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]

Infrastructure

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

Most services in Thailand are delivered by the public sector, which by 2010, included 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 that is theoretically available to all other Thai nationals. Some private hospitals are participants in the programs, but 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 reforms in 2001, 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, to 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 they 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 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

Bumrungrad International Hospital, a private hospital

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.

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 Districts

Different provinces in Thailand are arranged into different health districts by region. Each health district is responsible for about 3-6 million people living in those provinces. It aims to provide better quality medical services for citizens within that region and increased efficiency in terms of transferring patients to other hospitals if there is a lack in capability of care within that district. Health districts in Thailand are organised into the following categories, as of August 2017[10][11]:

Health Districts in Thailand
Health District Number Area of Thailand Area Code Provinces
1 Upper Northern Region Area 1 15 Chiang Mai, Mae Hong Son, Lampang, Lamphun
Upper Northern Region Area 2 16 Chiang Rai, Nan, Phayao, Phrae
2 Lower Northern Region Area 1 17 Tak, Phitsanulok, Phetchabun, Sukhothai, Uttaradit
3 Lower Northern Region Area 2 18 Kamphaeng Phet, Nakhon Sawan, Phichit, Uthai Thani
Upper Central Region Area 1 2 Chai Nat
4 Upper Central Region Area 1 1 Nonthaburi, Pathum Thani, Phra Nakhon Si Ayutthaya, Saraburi
Upper Central Region Area 2 2 Lopburi, Sing Buri, Ang Thong
Middle Central Region Area 3 Nakhon Nayok
5 Lower Central Region Area 1 4 Kanchanaburi, Nakhon Pathom, Ratchaburi, Suphan Buri
Lower Central Region Area 2 5 Prachuap Khiri Khan, Phetchaburi, Samut Songkhram, Samut Sakhon
6 Middle Central Region Area 3 Prachinburi, Sa Kaeo
Eastern Region 9 Chanthaburi, Trat, Rayong, Chonburi, Samut Prakan, Chachoengsao
7 Middle Northeastern Region Area 12 Kalasin, Khon Kaen, Maha Sarakham, Roi Et
8 Upper Northeastern Region Area 1 10 Loei, Nong Khai, Nong Bua Lamphu, Udon Thani, Bueng Kan
Upper Northeatern Region Area 2 11 Nakhon Phanom, Mukdahan, Sakon Nakhon
9 Lower Northeastern Region Area 1 13 Chaiyaphum, Nakhon Ratchasima, Buriram, Surin
10 Lower Northeastern Region Area 2 14 Yasothon, Sisaket, Amnat Charoen, Ubon Ratchathani
11 Southern Region Eastern Seaboard 6 Chumphon, Surat Thani, Nakhon Si Thammarat
Southern Region Western Seaboard 7 Ranong, Phang Nga, Phuket, Krabi
12 Southern Region Eastern Seaboard 6 Phatthalung
Southern Region Western Seaboard 7 Trang
Southern Region Border Provinces 8 Songkhla, Satun, Pattani, Yala, Narathiwat

First responders

Thailand has an unconventional approach to providing first responders in an emergency: it sends volunteers. Some 65 percent of emergency cases in Bangkok are handled by volunteers. Fully equipped ambulances with professional staff are sent only if required.[12]

There are three levels of medical emergency help in Thailand, from first responder (FR) level to basic life support (BLS) level, and advanced life support (ALS) level. Most volunteers have attained the FR level. They are affiliated with foundations and local administrative bodies.[13] Thailand's Medical Emergency Hotline centre responds to about 1.5 million medical emergencies each year. About a million involved FR teams transporting patients to medical facilities. BLS and ALS teams handled about 200,000 cases each.[13]

Two organizations, the Erawan Medical Centre and the Ruamkatanyu Foundation, are the two largest free first responders in Bangkok. They rely on private donations, but sometimes volunteers must use their own money to buy vehicles, gas, uniforms, and medical equipment. Volunteers are not allowed to accept money from hospitals or from victims. The volunteers say they do this to help people or as a way to earn karma for the next life.[12] The training level of volunteers is not high, just 24 hours. The National Institute of Emergency Medicine (NIEMS) is seeking to increase minimum training to 40 hours, a move initially opposed by the Rescue Network of Thailand, an association of voluntary first responders.[13]

Not all first responder organizations are altruistic. Significant money must be at stake as, sometimes, competition for patients between organizations leads to turf wars and even gun play.[14]

Health status

Non-communicable diseases form the major burden of 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 71 for males and 78 for females.[9]

Infectious diseases

Major infectious diseases in Thailand also include bacterial diarrhea, hepatitis, dengue fever, malaria, Japanese encephalitis, rabies, and leptospirosis.[15] 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.[16] In 2009 the adult prevalence of HIV was 1.3%.[17] As of 2009, Thailand had the highest prevalence of HIV in Asia.[18]

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."[19]

Food safety

Food safety scares are common to Thailand. Besides, common is microbial contamination of street 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.[20]

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.[20] 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.[21]

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.[22] 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.[22]

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.[23]

Teen pregnancies

In 2014, some 334 babies were born daily in Thailand to mothers aged between 15 and 19.[24]

Pollution

The World Bank estimates that deaths in Thailand attributable to air pollution has risen from 31,000 in 1990 to roughly 49,000 in 2013.[25][26]

See also

References

  1. 1 2 3 "Thailand-Country cooperation strategy: At a glance" (PDF). World Health Organization. May 2010. Retrieved 21 December 2011.
  2. 1 2 "Thailand-Country cooperation strategy: At a glance" (PDF). World Health Organization. May 2014. Retrieved 6 October 2016.
  3. 1 2 3 "Thailand: Sustaining Health Protection for All". World Bank Thailand. Retrieved 29 August 2012.
  4. ↑ World Health Organization Statistical Information System: Core Health Indicators
  5. ↑ The Universal Coverage Policy of Thailand: An Introduction Archived 2012-01-19 at the Wayback Machine.
  6. ↑ G20 Health Care: "Health Care Systems and Health Market Reform in the G20 Countries." Prepared for the World Economic Forum by Ernst & Young. January 3, 2006.
  7. ↑ Hughes D, Leethongdee S (2007). "Universal coverage in the land of smiles: lessons from Thailand's 30 baht health reforms". Health Affairs. 26 (4): 999–1008. doi:10.1377/hlthaff.26.4.999. PMID 17630443.
  8. ↑ "Thailand - Country statistics". Global Health Observatory. World Health Organization. Retrieved 21 December 2011.
  9. 1 2 3 4 5 6 7 "Thailand - Country health profile" (PDF). Global Health Observatory. World Health Organization. Retrieved 21 December 2011.
  10. ↑ "Map of Health Districts in Thailand" (PDF).
  11. ↑ "Table of health districts in Thailand" (PDF).
  12. 1 2 Calderon, Biel (2014-04-24). "In Pictures: Thailand's emergency volunteers". Al Jazeera. Retrieved 24 April 2018.
  13. 1 2 3 "Rescue workers say first responders not ready for new training rule". The Nation. 2017-12-06. Retrieved 24 April 2018.
  14. ↑ "Arrest made in bloody row between Bangkok rescue crews". The Nation. 23 April 2018. Retrieved 24 April 2018.
  15. ↑ Thailand country profile. Library of Congress Federal Research Division (July 2007). This article incorporates text from this source, which is in the public domain.
  16. ↑ Pongphon Sarnsamak (25 November 2008). "More teenaged girls getting HIV infection". The Nation. Archived from the original on 26 November 2014. Retrieved 17 June 2013.
  17. ↑ "Thailand". HIV InSite. UCSF Center for HIV Information. July 2009. Retrieved 17 June 2013.
  18. ↑ "COUNTRY COMPARISON :: HIV/AIDS - ADULT PREVALENCE RATE". The CIA World Factbook. CIA. 2013. Retrieved 17 June 2013.
  19. ↑ Emma Bourke (14 June 2013). "Preventive drug could reduce HIV transmission among injecting drug users". The Conversation Australia. The Conversation Media Group. Retrieved 17 June 2013.
  20. 1 2 Laopaisarntaksin, Pawat (2012-07-12). "Cancer-causing chemical residues found in vegetables". Bangkok Post. Retrieved 10 December 2015.
  21. ↑ http://www.biothai.org/node/302
  22. 1 2 Yee, Tan Hui (12 November 2016). "Antibiotic abuse killing thousands in Thailand". Straits Times. Retrieved 18 November 2016.
  23. ↑ "Thailand joins global 'superbug' fight". Bangkok Post. 21 November 2016. Retrieved 21 November 2016.
  24. ↑ Editor4 (1 December 2016). "Sex education strengthens sexual discrimination in Thailand". Prachatai English. Retrieved 4 December 2016.
  25. ↑ The Cost of Air Pollution: Strengthening the Economic Case for Action (PDF). Washington DC: World Bank and Institute for Health Metrics and Evaluation. 2016. p. 101. Retrieved 8 December 2016.
  26. ↑ Buakamsri, Tara (8 December 2016). "Our silent killer, taking a toll on millions" (Opinion). Bangkok Post. Retrieved 8 December 2016.
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