Health care lessons from Thailand

Abstract

Thailand's health care system incorporates the private and public sectors. The government regulates health care through a system of capping, which protects its interests while providing a climate for competition. As a result, the private sector has developed and implemented some interesting concepts in health care as it turned to prevention, hospital care alternatives, neighbourhood-based ambulatory care and home care. The author suggests that Canada could benefit by examining some of Thailand's innovations.

PIP: The health care system of Thailand functions in an active economy and a political system in which there is a change in government about every 2 years. The governments consider infrastructure projects (e.g., health care) to be too great for the budget so they leave much of health services to the private sector. The private sector operates 50% of hospitals which receive US$ 26/year/patient from the government. The government assumes about 100,000 patients for each private hospital. The government and third party providers are developing a range of insurance plans. Private providers offer insurance plans based on public insurance plans. The private providers voluntarily work within government-regulated insurance caps. Private providers are considering delivering of services to nonpaying patients to increase revenue. Thailand scores higher than its neighbors in life expectancy and infant mortality (world ranking: male life expectancy 104 vs. 145-210, female life expectancy 123 vs. 148-209; infant mortality 120 vs. 138-210). Even though Thailand is trying to improve accessibility and its standards of practice, good private facilities are accessible to everyone and the standards of many public facilities are lower than those of private hospitals. The private sector treats more publicly funded patients than they did in the past which is improving accessibility. Some private hospitals have streamlined their operations by setting up neighborhood clinics for non-hospital-based day services, mobile clinics, an extramural hospital, and home care services. In Canada, the private sector is limited to deinsured services (e.g., in vitro fertilization) and continuing care (e.g., home care and nursing homes). Greater participation of the private sector is likely to occur in Canada. Canada lacks a clear government policy on private involvement in the delivery of health services. Thailand sets caps to protect the government's interest while allowing competition based on service.