Healthcare reform takes centre stage in Thailand’s election campaign

Healthcare experts are scrutinising parties’ campaign pledges for the February 8 general election to assess whether they will help resolve – or further aggravate – the crisis gripping Thailand’s public healthcare system.

“Without concrete reforms, structural problems in the country’s public health system will worsen significantly over the next decade,” Dr Praphon Tangsrikiatkun, chair of a Senate committee on public health, warned recently.

He urged policymakers to urgently respond to Thailand’s rapidly ageing society by expanding their focus from immediate to long-term care. The country’s elderly population is growing quickly, bringing a bigger caseload of chronic and complex diseases, as well as rising numbers of dependent seniors, he said.

A new training and recruitment strategy is required to handle these increasing burdens on the health system, he added.

“While demand is growing, the health workforce remains limited for various reasons.”

He recommended a more holistic strategy, switching the focus from producing specialists in each field to training a strong primary-care workforce that responds to community health needs through promotion, prevention, treatment, rehabilitation, and palliative care.

System overload

Praphon said the best way to achieve this would be through long-term planning of the health workforce based on national population and disease data.

Meanwhile, funding of public hospitals and clinics would also need to be overhauled.

“We need a fair and effective remuneration system that better addresses the workloads and local context,” he said.

Dr Pawinee Iamchan, president of the Thailand Regional and General Hospital Society and director of Saraburi Hospital, said only 20% of doctors in the public healthcare system were fully committed to their jobs. However, devoted medics like these were also the first to quit public service due to the overwhelming workload, he added.

“We need to find ways to incentivise personnel, defend their quality of life, help with career advancement and protect them from burnout,” Praphon said.

He also called for more technology and innovation in the healthcare sector to curb redundancy, boost efficiency and enhance access to healthcare services, saying these must be supported by policies and laws that address data protection, privacy and patients’ rights.

Strengthening primary healthcare must go hand in hand with boosting public health awareness, giving people the tools to maintain good health and prevent long-term conditions.

“These efforts are key to reducing overcrowding at state hospitals, reducing medics’ workload and creating a sustainable healthcare system,” he said.

Setting same standards

Sureerat Treemanka, chair of the Thailand Consumers Council’s subcommittee on healthcare services, said political parties should introduce policies that reduce social gaps and provide healthcare equality.

Thailand’s public healthcare is currently separated into three systems. The much-touted universal healthcare scheme – which evolved from the 30-baht-per-visit scheme – allocates an annual budget of 3,856 baht per person to cover 47.15 million Thais.

The social security scheme has 4,900 baht per head to cover just over 12 million people. The civil servant scheme uses 18,000 baht per head for around 1.7 million people. While most medical treatments and services are covered by all three schemes, civil servants receive the most comprehensive benefits. This has led to complaints of inequality.

“The government should be spending the same amount and providing the same standard of treatment for everybody,” Sureerat said.

Apart from urging standardised health services for all Thais, she also called on policymakers to improve price control for medicines and medical services.

“The Commerce Ministry should deliver legislation that ensures fees charged for medical services, medicines and medical staff are reasonable,” she said.

She also wants the government to control drug prices by negotiating better deals with other countries and refusing to accept patents that last indefinitely.

“Otherwise, people in Thailand will be forced to continue paying a hefty price for medicines. Expensive drugs also damage the country’s public healthcare sector,” she said.

Dr Nuttanan Wichitaksorn of the Thailand Development Research Institute said that, at the very least, the three schemes should collaborate more closely.

“I also think that the social security scheme should be merged with the universal healthcare scheme,” he added.

Dr Jadej Thammatacharee, secretary-general of the National Healthcare Security Office, has said that controlling the price of medicines is crucial to sustaining the public healthcare sector.

“About half of the country’s healthcare budget goes towards medicines,” observed Jadej, whose office manages the universal healthcare scheme.

What political parties say

The People’s Party has promised to standardise public healthcare for all Thais regardless of the scheme they come under. It plans to link up the three schemes and encourage them to work together to lower the cost of medicines and supplies.

“We will also promote the domestic production of medicines,” said People’s Party list candidate Decharut Sukkumnoed.

The party has also acknowledged the severe shortage of medical personnel in some fields, particularly physiotherapy. Thailand currently has just one physical therapist for every 4,792 people – less than half the global average of one for every 2,000 people. This means long waiting times and fewer physio sessions available for patients. Meanwhile, many primary care clinics lack the space and equipment to deliver standard physio rehabilitation programs.

“We will address all these problems,” Decharut vowed.

The Pheu Thai Party, meanwhile, has promised to decentralise administration of the healthcare sector, develop medical AI, and build more healthcare facilities for rural Thais.

It was Pheu Thai’s predecessor, the Thai Rak Thai Party, that launched the 30-baht scheme just over two decades ago.

Bhumjaithai Party, which recently implemented a policy allowing cancer patients to receive treatment anywhere in the country, has now launched a campaign to hire volunteer nurses at 15,000 baht per month for four years to ease staff shortages.

By Thai PBS World’s General Desk