Despite Thailand gaining global recognition for its world-class medical and wellness facilities, lessons learned from the Covid-19 pandemic, rising health expenditure, and the surge in the aging population are putting increased pressure on future healthcare services.

Speaking at a recent seminar on “Health and Wellness Sustainability”, Assoc. Prof. Chanchai Sittipunt, dean of Chulalongkorn University’s Faculty of Medicine, said that the government must reform the healthcare system based on people-centered health services in response to the needs and expectations of its population. Other challenges to be addressed are primary care, integrated care, and patient-centered care.

Nowadays, poor health is not only caused by known illnesses but by many factors including PM2.5 pollution, emerging diseases, global warming and overflowing garbage. Non-communicable conditions as well as a fast-growing aging population also affect health and become challenges for the future health system.

Total health expenditure has been significantly increasing in recent years and now accounts for 5% of GDP. Additionally, General Government Health Expenditure (GGHE) has risen to 16-18% of General Government Expenditure (GGE). As such, health costs that are higher than the rate of economic growth has made more people question the sustainability of the healthcare system.

Assoc. Prof. Chanchai suggested that the government should integrate 3 core health insurance systems, namely the Social Security Scheme, the Universal Coverage Scheme, and the Civil Servant Medical Benefit Scheme because of redundancy. The government must reform the health insurance system to create equality, cost-effective operations, and optimize patient benefits through resource sharing and co-payment between the government and patients. Today, more than 70% of the population are covered by Universal Coverage, over 10% by Social Security, while the Civil Servant Medical Benefit takes care of the rest. However, 48 million people with Universal Coverage cards spend about 114 billion baht of the health budget compared to 66 billion baht by civil servants despite the latter’s number being 10 times lower than Universal Coverage cardholders.

In addition, the primary care system should be improved to be more effective and resilient. The emergence of Covid-19 showed that there are pain points and problems in the healthcare system including health access, inequality, and lack of surge capacity for emergency cases.

“The healthcare system must focus on needs, not wants based on patient-centered care. Though the Thai people now enjoy longer lives with an average age of almost 80, we have to extend the health span – the period of life during which a person is healthy. Therefore, the government should take a hard line on an ‘Health in All’ policy”, encouraging all parties in society to put health as the priority in any projects,” said Assoc. Prof. Chanchai.

Meanwhile, Bangkok governor Chadchart Sittipunt said that the Bangkok Metropolitan Administration (BMA) is improving its primary care system as a key to developing a healthy city while simultaneously strengthening overall healthcare. Thailand will not achieve its goal of being a global medical hub if people are unhealthy.

According to the strategic plan, the BMA is expanding the Ratchaphiphat Sandbox Model to enhance the city’s healthcare services for the general public, particularly for those in need of medical assistance. The program aims to make it easier for patients and medical staff to request and provide assistance, thereby reducing hospital crowding and workloads.

Thanks to telemedicine, Ratchaphiphat hospital will act as the Mothership linking with 69 public health centers across that city. All the centers will be transformed into area managers because the administration lacks the budget to recruit more doctors and nurses as needed. Instead, the centers will partner with community clinics and drug stores in its network allowing easy health access to community residents.

Chadchart added that health data is crucial for any health development plan. Currently, the BMA is developing digital volunteers for all communities in Bangkok. It is expected there will be one volunteer for one community to collect patient data and provide digital literacy. This project will help BMA better connect with communities and improve health access.

By Veena Thoopkrajae with additional report by Patcharee Leunguthai