Political Instability: A Roadblock for Equity to Universal Health Coverage in Thailand

Thailand is under the world's scrutinizing eye in the next democratic election slated to be December 2007. Contrary to intuitive logic, candidate preference has little impact on access to healthcare for Thailand’s poor. Whether the government can return to political stability will determine the population's health future. If the health system remains the government's priority amidst a perceived increased need for defense spending, a decreasing Gross Domestic Product (GDP), and a lessening interest by foreign investors, the successes of its Universal Coverage (UC) health scheme may prevail in providing equitable universal coverage.

Thailand has been called one of South-east Asia’s most stable democracies. This title was tarnished after a military coup ousted Prime Minister Shinawatra in September 2006 validated by accusations of wide-spread corruption and abuses of power1. This political instability was unappealing to foreign investors and is thought to influence future economic development inThailand. Many investors are eagarly awaiting the outcome of the election for reassurance that democracy will again be restored2.



Thailand’s free-enterprise economy with pro-investment policies has been doing well2. The Thai economy grew 6.9% in 2003, 6.1% in 2004 and it is predicted that real GDP growth will slow to an annual average of 4.5% a year in 2008-12, down from 5.5% in 2003-07. This shift is mainly due to higher crude oil prices and lower anticipated foreign investment 3.
During the periods of economic growth, Thailand devoted a larger portion of the National Budget towards the Ministry of Public Health (MoPH) budget which enabled them to incrementally launch a successful UC scheme. For example, in 1990 of the 335, 000 million baht national budget, 4.8% (or 16, 225.1 million baht) was designated to the MoPH. In 2004, 8.1 % (or 77, 720.7 million baht) of the 1,028,000 million baht national budget was given to the MoPH 4. By 2004, the percentage of the budget spent on security versus health was 13.5% and 8.1% respectively 5.



However, with political instability and military spending on the rise, many worry that additional spending on national security, coupled with reduced foreign investment, will divert funds from the health sector. Thailand's military leaders recently awarded themselves pay increases totaling $9 million and increased the defense budget by over 30 percent. This is a $1.1 billion hike, reportedly at the cost of its health sector6. In a budget requested December of this year, the allocation for defense spending will increase to 115 billion baht (3,639,008,201 USD) or 33.8%, in comparison to the 86 billion in 20067. In December 2006, the Thai Board of Investment reported the value of investment applications from January to November had declined by 27% year-on-year2. This increased military spending has the potential to greatly impact the successes of UC in Thailand.






Thailand has been moving toward a tax-based UC scheme for all Thai citizens. The population covered by public health insurance schemes increased from 71% in 2001 to 95% in 20038. The UC scheme is funded by progressive direct taxes in which wealthier people contribute more to the system. Additional funds are to be raised from a sin tax on alcohol and tobacco9 . However, with less funding available to the national budget, making health accessible to Thailand’s population may be negatively impacted.

Although this scheme has proven to be innovative and unprecedented, many reports state a lack of health equity in under-served populations as well as a major stress on human and material resources within hospitals. Many regional hospitals have been accruing increasing debt 10. In fact, Siriaj Hospital, Thailand's oldest medical school, faces debts of approximately $13.5 million- due to earlier phases of the UC scheme 11. Under-served populations (i.e. those with Thai as a second language) have shown dramatic disparities. Nationally, 90 per cent of children are immunized against the six major preventable childhood diseases by the age of two. However, the rate drops to 81 per cent for children in these households 12. These examples demonstrate opportunity for further health sector spending to improve access to healthcare across the Thai population.



In order for Thailand to continue on a path of improved health for all, as is the goal for the Universal Coverage scheme, a continued emphasis must be placed on allocating sufficient national budget to public health expenditure. If the elections on December 23, 2007 are able to restore democracy and political stability, the stage is created for foreign investors to continue to be attracted to Thailand, the GDP will eventually begin to rise and the health sector can continue to receive the attention it needs. International and national forces should join together to ensure the upcoming election is fruitful in restoring political stability, if not for the economy, then for the health of those on the margins of Thai’s society.







WORKS CITIED

1. The Nation, "What Thaksin had done wrong", 22 November 2006


2. https://www.cia.gov/library/publications/the-world-factbook/geos/th.html


3. http://www.economist.com/countries/Thailand/profile.cfm?folder=Profile-Economic%20Data


4. Wibulpolprasert, Suwit, Thailand MDG’s and Universal Coverage of Essential Health Services. Available at http://www.wpro.who.int/NR/rdonlyres/5DB24877-DD7E-499D-A2D2-473E32AE0F10/0/15ThailandMDGsanduniversalcoverageofessentialhealthservicesSWibulpolprasert


5. Wibulpolprasert, Innovations in the Health Financing: The Thai’s Experience, presented April 20th, 2004


6. USA for Innovation website: Available at: http://www.aei.org/publications/pubID.25890/pub_detail.asp


7. Asia Defense News. Available at: http://www.asiandefense.com/news/update/12-06-2006.html


8. PRAKONGSAI, PHUSIT, et al. Assessing the Impact of the Universal Coverage Policy on Financial Risk Protection, Health Care Finance, and Benefit Incidence of Thai Households, Journal of Health Science, 2007


9. Mills, Anne, Strategies to achieve universal coverage: are there lessons from middle income countries? 30 March 2007


10. Hughes and Leethongdee. “Universal Coverage In The Land Of Smiles: Lessons From Thailand’s 30 Baht Health Reforms”. Health Affairs, 26, no. 4 (2007): 999-1008


11. Corbe, Ron. “Thailand’s Health Plan Creates Challenges for Hospitals” Available at http://www.voanews.com/english/archive/2006-05/2006-05-03-voa33.cfm


12. UNICEF-Thailand. Available at: http://www.unicef.org/thailand/reallives_3888.html