The Thai health care system has been developed throughout the past few centuries as follows:
1. Pre-the western medicine (before 1828)
During Sukothai period, medicinal herbs were used in the treatment of illnesses. Later in the Ayutthaya period, Indian Ayurveda and Chinese traditional medicine principles were used aiming at establishing a balanced condition of four major vital elements: earth, water, wind, and fire. The role of the practitioner is to identify the personΓÇÖs mind and body type and recommend a course of treatment unique to the individual.
In the early Ratanakosin period, the medical system continued to be based on traditional herbal medicines.As there were no public hospitals. King Rama I decided to have traditional medicine formulas and methods of body stretching (ruesi dat ton) assembled and inscribed on cloister walls of a Buddhist monastery, Wat Phra Chetuphon Wimonmangklaram (Wat Pho). King Rama II had traditional medicine textbooks gathered by requesting all experts or practitioners to assemble indications of various medicines. Effective medicine formulas were selected and then recorded as a royal medical textbook. King Rama III had traditional medicine formulas inscribed at Wat Raj Orasaram and Wat Phra Chetuphon, describing causes of diseases and how to cure them. Rare medicinal herbs were planted so that the people could study and use them for self-care.
2. Introduction of Western Medicine (1828-1889)
In 1828, the fifth year of King Rama IIIΓÇÖs reign, was regarded as the first year in which Western medicine began to play a significant role in health care system in Thailand, including both curative care and preventive care of communicable diseases. However, people still depended on traditional herbal medicines as a part of their tradition, culture, and lifestyles. During the reign of King Rama V, in 1870 a sanitation law was first enacted to maintain the cleanliness of rivers and canals, and Siriraj Hospital was established in 1888. A medical school of western medicine was established at Siriraj Hospital in 1889. Among the first functions of Siriraj Hospital was to carry out vaccinations against smallpox.
3. Health Infrastructure Expansion and Health Development (1889-2002)
The Nursing Department was established under the Ministry of Education and the midwifery school was established in 1896 funded by the Queen. Smallpox vaccine and other household medicinal preparations were produced. The Government Medical Depot was set up to procure and import pharmaceutical supplies. Later on it was developed to be the Government Pharmaceutical Organization at present. During King Rama VIΓÇÖs reign, the second hospital, Chulalongkorn Hospital, was built and started operating in 1914 and in 1918 the Public Health Department was established, replacing the Nursing Department and integrating all public health programs. Then in 1942, during the reign of King Rama VIII, the Ministry of Public Health was established. There were 7 departments: Office of the Secretary to the Minister, Office of the Permanent Secretary, Medical Services, Public Welfare, Medical School, Medical Science, and Public Health Department. By 1950, a provincial hospital was established in each province.
During the present reign, King Rama IX has been very concerned about public health. While visiting his subjects or staying at upcountry residences, His Majesty will have royal doctors provide medical care to people in need. As a result, a number of units have been set up including the Royal Medical Units, the Mobile Royal Medical Project, the Mobile Royal Dental Services Unit, the Volunteer Surgeons Project of the Thai College of Surgeons, the Royal Medical Project on Ear, Throat, Nose and Allergy, and In-patient Services Unit of the QueenΓÇÖs Personal Affairs Division. Everyone in the Royal Family has been involved in medical and health care such as the Foundation for Voluntary Medical Services of the Princess Mother (Pho O So Wo), which provides medical and health services to people in remote areas. At present, this Foundation is under HRH Princess Galayani Vadhana, the KingΓÇÖs elder sister. Crown Prince Hospitals in remote areas are under the patronage of HRH Crown Prince Maha Vajiralongkorn. HRH Princess Maha Chakri Sirindhorn has been interested in, and supporting development programs on health, education, food and nutrition, as well as family planning, resulting in several projects for the benefit of children and adolescents. HRH Chulabhorn is the president of the Chulabhorn Research Institute, a collaborating centre where Thai and foreign scientists develop measures for controlling rabies, filariasis, AIDS, and cancer, in addition to implementing projects related to medicinal herbs and environmental and natural resources conservation.HRH Princess Ubolratana has recently been involved in the prevention of stimulant and narcotic drug problem in school.
Provisions of Health Care in the 1997 Constitution
In the recent 1997 Constitution, the provisions of health care are prescribed in Chapter 3, Rights and Liberties of the Thai People, Section 52, and Chapter 5, Directive Principles of Fundamental State Policies, Section 82.
Section 52 provides that ΓÇ£A person shall enjoy an equal right to receive standard public health services, and the indigent shall have the right to receive free medical treatment from public health facilities of the state, as provided by laws. The public health services by the state shall be provided thoroughly and efficiently and, for this purpose, participation by local government organizations and the private sector shall be promoted insofar as it is possible. The state shall prevent and eradicate harmful contagious disease for the public without charge, as provided by law.ΓÇ¥
Section 82 provides that ΓÇ£The state shall thoroughly provide and promote standard and efficient public health services.ΓÇ¥
Every government has given high priority to the development of public health and quality of life, emphasizing health service provision for all population groups, although each government has different focuses, depending on national health conditions during different periods.
Health Status of the Thai People
Generally, the health of the Thai people has been improving significantly. Life expectancy at birth for males and females has increased from 60 and 66 years in 1980 to 70 and 75 years respectively in 2000. The infant mortality rate decreased from 84.3 per 1000 live births in 1960 to 22 per 1000 live births in 2000. The decrease in the infant mortality rate is a result of a successful immunization program and the provision of maternal and child health services. The incidence rates of major vaccine preventable diseases have declined dramatically. However, important caused of infant deaths continue to be infectious diseases (respiratory system), congenital malformations, deformation and chromosomal abnormalities, certain conditions originating in the perinatal period, and pneumonia. The five majors causes of death among Thai people of all ages in 2000 were external cause and other accidents (death rate 66.4 per 100,000 population), neoplasms or cancers (death rate 63.9 per 100,000 population), diseases of the circulatory system (death rate 52.3 per 100,000 population), infectious and parasitic diseases (death rate 51.7 per 100,000 population), diseases of the respiratory system (death rate 34.2 per 100,000 population).
In 2000, leading causes of morbidity in Thailand were infectious/parasitic diseases, respiratory diseases, injuries and accidents, circulatory system diseases, and mental disorders.
Health Care System
The Ministry of Public Health (MOPH) is the principal agency responsible for promoting, supporting, controlling and coordinating all health services activities for the well-being of the Thai people. In addition, there are several other agencies playing significant roles in medical and health development programs such as the Ministry of Education, the Ministry of Interior, the Ministry of Defense, the Bangkok Metropolitan Administration, state enterprises and private sector. These agencies have health facilities including hospitals that provide primary, secondary and tertiary medical services. During the last decade, private hospitals and clinics have been expanding rapidly in Bangkok and other provincial cities. Public and private health care facilities in 2000 can be classified as follows:
For public health facilities in Bangkok, there are 5 medical school hospitals, 29 general hospitals, 19 specialized hospitals and institutions, 60/83 health centers/ branches.
At the regional level, there are 4 medical-school hospitals, 25 regional hospitals and 38 specialized hospitals.
At the provincial level, there are 67 general hospitals under the MOPH and 56 hospitals under the Ministry of Defense.
At the district level, there are 715 community hospitals, 2 extended OPD, and 212 municipal health centres.
At the sub-district (Tambon) level, there are 9,704 health centres, 67,472 rural and 2,470 urban primary health care centres. The last two types of health facilities are managed by village health volunteers (rural 684,788 and urban 29,284 village health volunteers) with the assistance of health workers from sub-district health centres.
The private sector also plays a key role in providing curative care for the people. In 2000, there are about 461 private hospitals (Bangkok 129, other provinces 332), 10,819 clinics, 11,094 drugstores and 2,011 traditional medicine drugstores.
The ratio of hospital beds to population in Bangkok is 1:202, while in other provinces the ratio is 1:519. The ratio of physician to population is 1:3,427 for the whole country, 1:793 for Bangkok and 1:5,161 for other provinces.
Health Care Financing
Thailand health care system reflects the entrepreneurial market-driven nature of its economy. It has a pluralistic public and private mixed system of both health care financing and in the provision of health services. Overall resources devoted to health care have markedly increased recently. The total health expenditure has increased gradually, at a faster rate than that of the gross domestic product, from 3.5 to 6.09 per cent of GDP in 1979 and 2000 respectively. The total health expenditure is covered most by the public (61%) compared to the private (39%).
The 9th National Health Development Plan (2002-2006)
The 9th National Health Development Plan is a strategic plan under the 9th National Economic and Social Development Plan. This plan emphasizes a clear vision on people-centered approach and the Philosophy of Sufficiency Economy. Due to the numerous changing trends, the formulation is based on three groups of strategies that aim to provide guiding directive for health development in response to complex and dynamic current situations and trends. The objectives are: first to strengthen and stabilize domestic economy, develop an early warning system and carry out economic restructuring in order to upgrade production efficiency and international competitiveness of the country; second is to lay out a firm foundation for national development in the long run, with greater flexibility to external changes; third is to promote governance at all levels in the Thai society; and the last objective is to alleviate poverty problem as well as increase potential and opportunities of the Thai people to become self-reliant.
The 9th National Health Development Plan aims at well being and entire health system development. The vision of this plan focuses on health security and universal health care coverage for every person in Thai society through people participation process. The objectives are as follows:
1. To foster proactive health promotion, consumer protection, food safety and food security, occupational health and environment protection, and disease prevention and control.
2. To establish health security and equal access to quality health services.
3. To build up peopleΓÇÖs capability in health promotion and in health system management.
4. To establish mechanism and measures in generating knowledge through research and development utilizing both local and international health wisdom.
Under the 9th National Health Development Plan, there are 6 strategies as follows:
Strategy 1 Expedition of Proactive Health Promotion
Strategy 2 Establishment of Universal Health Insurance
Strategy 3 Reform of Administrative Structure and Mechanisms on Health
Strategy 4 Civil Society Strengthening on health
Strategy 5 Health Knowledge and Wisdom Management
Strategy 6 Health Manpower Development Serving New Changing Health Reform
The Present Government Health Policies (2001-present)
The present government is the first administration elected under the provisions of the new Constitution, known to many Thais as the ΓÇ£PeopleΓÇÖs ConstitutionΓÇ¥. It is also the first time since the establishment of a Constitutional Government in 1932 that a single party has won a majority in the House of Representatives, capturing firm popular support across the nation. After one year of administration, political stability has been reinforced. The government has given a full potential to implementation of its campaign promises that serve as its mandate handed over from the Thai people. The government has laid a firm foundation for sustained and balanced economic growth, by first, focusing on the supply side of economic stimulation equation in order to enhance the competitiveness of the real sectors, and second, stimulating the demand side through poverty reduction, job creation and income creation at the grassroots level known as ΓÇ£One Tambon, One Product ProjectΓÇ¥. The government has embarked upon a course to improve quality of life for all segments of society in which the Ministry of Public Health plays a vital role to implement the ΓÇ£30 baht Universal Health Care PolicyΓÇ¥.
The 30 baht Universal Health Care Policy
The ΓÇ£30 baht Universal Health Care PolicyΓÇ¥ is one of the major policies of the present government. This policy is focused on creating universal health insurance coverage of the whole population. Before the implementation of this policy, there were 20% of the population uninsured by any scheme. During the first phase in April 2001, the 30 baht scheme started with 6 provinces, then the second phase in June 2001 expanded to 21 provinces, then the third phase in October 2001 when all the provinces joined the scheme except Bangkok which started the scheme in January 2002.The whole country was fully covered in April 2002. At present, there are 45 million people covered by this scheme. The rest are 10 million civil servants with spouses and parents and 8 million workers under the Civil Servant Medical Benefit Scheme and Social Security Health Insurance Scheme respectively. The health service benefit package includes inpatient/outpatient treatments at the registered primary care facility and referral secondary and tertiary care facility (except emergency case), dental care, health promotion/prevention services, and drug prescription with user fee of 30 baht per visit. After the first year of implementation, the household surveys revealed that the policy was highly supported by both the rich and the poor.
Health Promotion, Disease Prevention and Control, and Consumer Protection
The government has also set the national health agenda on ΓÇ£Health Promotion, Disease Prevention and Control, and Consumer ProtectionΓÇ¥. Health promotion is a key strategy for sustainable health development of individuals, families, communities and society. Each individual is encouraged to adopt proper health behaviors such as exercising at least 3 times/week, eating healthy and safe foods, staying away from unsafe sex and drugs.
Thailand has utilized the principles of good manufacturing practice (GMP) for drug, food and cosmetic products and recently for toxic substances. The effort has been aimed at raising the manufacturing standards to international level. At present, 85 percent of drug industries have attained the GMP certification.
Promotion of Thai Traditional & Herbal Medicine and Alternative Medicine
Policy support for the development of traditional and herbal medicine has commenced since the 4th National Economic and Development Plan in 1977 and was successively reiterated in every government policy as well as in the national drug policies. Knowledge of therapeutic usage of these herbal medicinal products has become a valuable ΓÇ£heritage of local wisdomΓÇ¥ which has been transferred from generation to generation within the family, village, society or even throughout the whole country. A lot of Thai people still believe in the efficacy of herbal remedies as well as traditional medicine practices. Usage of herbal medicinal products has remarkably been increased in accordance with the global trend of people returning to believe in the superb of efficiency natural therapy. As being a large natural resource of medicinal plants, Thailand is also alert to this global trend. Many research institutes are now turning back to the studies of herbal medicinal products or traditional medicine development. Local knowledge is recognized as a valuable inheritance. Study and research on the potential medicinal plants including extracting and purifying the active or principle components from plants to be used as medicinal products are conducted in many academic and governmental research institutions. New technology of manufacturing has been applied to produce the herbal medicinal products of higher efficacy and in more appropriate dosage forms.
The government has emphasized the promotion of traditional and herbal medicine by integrating into primary health care activities. Formally, all herbal traditional recipes were regulated as herbal or traditional medicines. Then, there have been research and development utilizing modern technology to innovate pattern of consumption. These herbal products are now classified as modern herbal medicinal products.
The period of 1994 to 2000 was designated as the ΓÇ£Decade of Thai Traditional Medicine DevelopmentΓÇ¥ focusing on the promotion of studies, research and development of health related products and health technologies, and increase of capacity in producing traditional medicines and training in Thai traditional massage.
It could be said that, for almost a century, Thai traditional medicine had been a non-formal medicine system without substantial support and development from the government. Only in the last decade did the Ministry of Public Health show endeavors to develop the whole system of indigenous medicine. In 1993, the National Institute of Thai Traditional Medicine was established and in 2002 reformed to be under the Department of the Thai Traditional Medicine and Alternative Medicine.
Supporting the Increase of CountryΓÇÖs Capability and Production of Health Related Products for Income Generation and Exports
At present, ΓÇ£One Tambon One ProductΓÇ¥ is an effective project that encourages people at the village level to produce competitive local products or to improve their local products into an export graded products. The Ministry of Public Health and the private health sector also participate in this process by encouraging the village people to produce health related products such as preserved foods, herbal products, Thai traditional medicine and massage. These also include many health resorts and spas providing traditional medical care.
Hospitals at all levels nationwide are now in the process of developing service quality to international standards for general and special health services such as dental care, elective surgery (hip or knee replacement), and plastic surgery. In 2002, Phuket was designated as a hub for tourism and also health tourism hub of Asia.
Technical Cooperation in International Health
During the past 50 years, international health cooperation has been in the form of foreign aid including expert consultations, fellowships for advanced degree study as well as study tours abroad. There are many international organizations such as WHO, UNICEF, UNFPA, UNDP, USAID that have played a significant role in health development in Thailand. It could be said that WHO is the most influential organization on the Thai health development programes. During the first few decades of cooperation, the support was focused mainly on the control of communicable diseases and the development of maternal and child health.
Later on, WHO supported the development of Thai health planning capability by providing technical support in planning expertise and also suggesting important health policy issues. The health policy transition toward WHO ΓÇ£Primary Health CareΓÇ¥ in 1978 had led Thailand to a more comprehensive health project approach which has had an impact on health policy and plan development. Thailand is fully committed to achieving WHOΓÇÖs global goal of ΓÇ£Health for All by the Year 2000.ΓÇ¥
At present, the Thai medical and health services system has been recognized by other countries with regard to the efficiency and quality of medical personnel and technology, as well as coverage and distribution, according to the international standards. Several medical and health institutes in Thailand have been internationally recognized and designated as WHO-Collaborating Centers in their respective fields such as human reproduction, radiological technology, immunology, workerΓÇÖs health, drug abuse, malaria, essential drugs and vaccine, primary health care, and environmental health.
During the present 9th National and Economic and Social Development Plan (2001-2006), international health cooperation has been expanded to various countries and international associations or groups as follows:
Countries - ASEAN countries, Japan, China, Malaysia, Australia, the United States, Sweden, the United Kingdom, and Germany.
