Health system of Thailand

The health system in Thailand has a centuries-old tradition and is now divided into the public health sector, which is dominated by conventional medicine, and the private sector, in which traditional Thai medicine is mainly used, e.g. B. the Thai massage . Due to its location in the tropics and subtropics , Thailand has special conditions when it comes to diseases and their prevention.

As a result of the reforms that have taken effect since the beginning of the 21st century, almost every Thai citizen is entitled to health care, 65% of which is financed by the state. The level of medical care is consistently so good that health tourism has even emerged in which travelers come to Thailand mainly or entirely for medical reasons. This also has to do with the significantly lower costs for medical care in Thailand compared to western countries.

The average life expectancy of a Thai is 70.77 years, that of a Thai woman is 75.55 years (estimated in 2009).

Problems with the health system are that most doctors work in hospitals and not in private practices - often several at the same time, so that they are not always available in one house. It is also unusual for Western patients that inpatient care is largely left to the relatives of the patient, who are also expected to spend the night with the patient. The nursing staff is largely limited to distributing the food and medication as well as routine tasks such as taking a temperature.

Health system

The Thai health system from the Thai Ministry of Health ( Ministry of Public Health, MOPH controlled). This includes a State Secretary and three departments ( task clusters ). The ministry determines health policy, directs relevant research and also takes on the administration of the country's health system, e. B. in the accreditation of hospitals. There are also numerous regional authorities, which were created in the course of the decentralization of the Thai administration at the beginning of the 21st century and which are headed by the State Secretary.

Health policy

The trend in health policy in Thailand since the beginning of the 21st century has been towards the introduction of results-oriented management ( management by objectives ), which is also intended to enable the desired increased decentralization.

Since 1961, the governments have drawn up national development plans, including a. for the country's health care, which initially ran over a period of six years and later continuously over five years. The first three planning stages concentrated on the economy, which is why they were called the "National Economic Development Plan". Later, when social factors came to the fore, the name was changed to "National Plan for Economic and Social Development". The "Health Development Plan", which focused on health policy, was integrated into these plans. Since 1961 there have been a total of nine planning stages, of which only the health-related aspects are listed here:

1. First health development plan (1961–1966)

Objectives: Expansion of the health care infrastructure, e.g. B. by establishing regional hospitals and health centers for basic medical care

Results: A number of new hospitals have been built, mainly at the provincial level; health promotion and prevention goals were met, but the problem remained with fewer medical and nursing staff.

2. Second health development plan (1967–1971)

Objectives: To accelerate the training of medical and nursing staff; Improving medical care in rural areas; Obligation for new graduates to serve in rural areas (since 1965)

Results: The successes were similar to those of the first planning phase; the number of doctors and nursing staff graduates was lower than planned; the vaccination campaigns were more successful than during the first phase; Overall, the coverage of the districts ( Amphoe ) with their own medical care increased from 42.3% to 54.9%.

3. Third health development plan (1972–1976)

The health development plan drawn up in the mid- 1970s was oriented towards the health of mothers and children, family planning , the limitation of infectious diseases and the improvement and expansion of therapeutic treatments. Pilot projects have been prepared to develop environment-related health, involving local communities; In 1975 free medical services were offered to the poor for the first time.

Results: The population growth fell from 31.5 (1971) to 26.1 (1976) per 1,000 inhabitants and the mortality rate fell at the same time from 11.6 (2nd plan) to 10.9 (3rd plan). The targets for the provision of medical personnel could not be achieved again. In 1972, doctors began to register for rural areas, so that a significant number of new doctors entered the field. Services in the health sector increased, but not as planned, at least in terms of the number of hospital beds and related services. Across all Amphoe, 70% had a first class health center and 68.5% of all tambon had a second class health center.

4. Fourth Health Development Plan (1977-1981)

Objectives: To reduce problems in the health system; Providing medical services to all population groups; In 1979, the goal of "Health for All" by the year 2000 was proclaimed, which should be achieved with basic medical care.

Results: Plague and smallpox were no longer a problem; the situation of the rural population was still inadequate due to unsanitary conditions, insufficient supply of clean water and unhealthy behavior. The medical and health centers have now been replaced by hospitals at the Amphoe level. In 1978 the most important vaccination programs were initiated. The training of village health officials and volunteers began in 1977.

5. Fifth Health Development Plan (1982–1986)

Objectives: The emphasis was on the establishment of district hospitals in all of the country's Amphoe ; all midwifery stations should be developed into health centers; Start of taking stock of the necessary medical measures (Basic Minimum Needs)

Results: District hospitals were established or renovated in 85.2% of the Amphoe; health center coverage was 97.9% of all tambon ; the goals of staff development were largely achieved: 93.6% for medical staff and 93.8% for nursing staff; with the establishment of village medicine centers, it was even possible to achieve more than twice as much as planned.

6. Sixth Health Development Plan (1987-1991)

Objectives: expansion of health facilities in all target areas; Emphasis on public participation in health development and action against HIV / AIDS ; Development of a health insurance system

Results: The overall life expectancy increased in the period from 62.8 (for men) and 64.8 years (for women) to ...; both maternal and infant mortality fell; Health facilities are offered everywhere except for the tambon level; the importance of health risks such as AIDS, accident, heart disease, cancer and mental health were recognized as emerging threats.

7. Seventh Health Development Plan (1992–1996)

Objectives: To develop the health centers as a point of contact for the "health for all" movement; Improving the quality of health facilities; Providing health security for all citizens; Improving service quality and solving the brain drain problem that caused many employees to migrate to the private health sector.

Results: The population increase decreased to 1.3% in 1996; health facilities in urban and rural areas alike have been affected by the increase in private facilities to which state-trained staff have migrated; Health insurance programs were available for approximately 45.5% of the population; 80% of the target groups received the necessary vaccines, resulting in a significant reduction in related deaths.

8. Eighth Health Development Plan (1997-2001)

Objectives: Development of human potential in the health sector, especially in healthy behavior; Improve health insurance coverage across additional populations; Health Industry Development

Results: The general health situation improved, both in terms of life expectancy and health insurance rates; 71% of the citizens had health insurance; emerging diseases such as HIV / AIDS could be brought under control; Problems of undersupply for mothers and children were reduced.

9. Ninth Health Development Plan (2002-2006)

Objectives: Development of a holistic health system for Thailand; Health insurance for all citizens; Improving the quality of health services

Results: The health centers serve as places of primary health care; around 6,000 such health centers are in use across the country; in 2004, 94.3% of the population were covered by health care; Folk medicine networks were set up with a guaranteed quality of the plant substances used.

Health care in Thailand

Vaccinations of the population

The Ministry of Health has had vaccinations carried out since 1977 . Over time, these were adapted to changing immunological conditions. Great progress has been made in this regard. 95% of those under the age of one are vaccinated against

• BCG ,
• Diphtheria , whooping cough , polio, and tetanus (the DTP vaccine in three doses)
• Hepatitis B.

In the period from 1999 to 2004 alone, this led to a considerable reduction in the number of diseases that can be prevented by vaccination, and polio has not occurred at all since 1997. The respective target groups of the vaccinations, mostly small children, are monitored regionally and their parents are asked to vaccinate if necessary in order to guarantee the highest possible vaccination rate. Although the vaccination rate is quite high at 95%, there are problems with remote settling groups, such as the hill tribes and the poor rural population, where the vaccination rate is very low. Even among the large number of immigrants, who are often not registered, there are many children who cannot be adequately cared for. Vaccinations are carried out in public or private hospitals as well as in mobile vaccination stations in order to also reach the remote groups of people in the country.

Education and prevention

Education takes place at many different levels, nationally as well as regionally and locally. One focus is the promotion of vaccination readiness through information on the prevention of diseases and the advantages of vaccinations. When it comes to prevention, the Ministry of Health primarily relies on the population's personal responsibility. For this purpose, the mass media are used through programs and commercials to spread basic knowledge about hygiene and the detection and prevention of diseases. This happens in particular for contagious diseases , but increasingly also for other diseases , such as cervical cancer , for which the target group (women between the ages of 35 and 45) is made aware of the need for a preliminary examination in the hospitals and for which the staff there is also appropriately trained . A wide range of measures has not only continuously reduced the AIDS rate since 1999, but also elephantiasis , leprosy and tuberculosis . The incidence of common diseases that are typical in Thailand , chronic diarrhea and respiratory diseases, is also on the decline. Numerous accidental deaths can be attributed to alcohol consumption. That is why the Ministry of Health is making great efforts to raise awareness of the dangers of alcohol in road traffic and to encourage the population to be more accountable. In addition, the Thai system for the rescue of accident victims (Emergency Medical Service, EMS) was improved and corresponding facilities were created or improved in the regional hospitals.

Health insurance

The Ministry of Health has made efforts to strengthen public health insurance since the late 20th century. One of the targeted programs was the so-called "30 Baht Insurance Program", which was started in April 2001. It was initially launched as a pilot in six provinces in collaboration with government health facilities that could be used by 1.3 million people. In October of the same year, it was extended to all provinces of the country and some districts of Bangkok with the participation of 1,017 public and 103 private institutions. This covered 38.8 million citizens, more than 60% of the Thai population. In April 2002, the 30 baht rule was introduced in all counties and counties in the country, giving 45 million people health insurance.

administration

The Ministry of Health in Bangkok is responsible for the administration of the Thai health system.

statistics

Thanks to the extensive measures taken since the 1980s, the population has only grown by 0.626% (2009 estimate). The birth rate is 13.88 births / 1,000 inhabitants (2009 estimated) and the death rate 7.12 / 1,000 inhabitants (2009 estimated).

The infant mortality rate is 17.48 per 1,000 live births (114th place worldwide). The fertility rate is 1.65 offspring per woman (estimated in 2009). A total of about 610,000 Thai people live with AIDS , that is 1.4% of the population (2007 estimated).

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  Doctors by region

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  Dentists by region

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  Pharmacists by region

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  MTA by region

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  Nurses by Region

History of Thai Health Care

The history of the Thai health system is mostly described in connection with the Siamese monarchy and goes back to the monarchy in Sukhothai .

For the early history of health care, see Traditional Thai Medicine .

Revival of Thai traditional medicine (1782-1851)

After the collapse of the Siamese state through the destruction of the Ayutthaya empire in 1767, national reconstruction had to be created after regaining independence. This essentially took place under the first three kings of the Chakri dynasty, which is still ruling today : Rama I (1782–1809), Rama II. (1809–1824) and Rama III. (1824-1851).

King Rama I had the Buddhist monastery Wat Pho set up as the medical center of Siam. Traditional Thai medicine formulas were written on the walls and regular physical exercise and stretching were encouraged. An authority for pharmacy was established ( krom mo rong phra osot ), as it had already existed in the Ayutthaya period. The doctors employed by the state were called royal doctors ( mo luang ), the other doctors were called private doctors ( mo ratsadohn or mo chaloei sak ).

Under King Rama II, specialist books on traditional medicine in the country were compiled by having experts and practitioners write down and collect their indications. Anyone with effective medical therapy was invited to present it to the king. The Royal Medical Board then sorted out the ineffective prescriptions and made the good ones available to the public in the book "Royal Prescriptions for Royal Pharmacy" ( tamra luang samrab rong phra osot ). In 1816 the king promulgated a "law on royal pharmacists" ( panak ngan phra osoth thawai ), which allowed them to search for medicinal plants throughout the country without anyone being able to object.

King Rama III. had Wat Ratchaorasaram renovated and wrote effective recipes in the style of Wat Pho on the pillars and on stone slabs, for everyone to know. Wat Pho also received a general overhaul and the recipes were expanded. In addition, texts on the causes of various diseases and how they can be cured were put together on marble tablets on the temple grounds. Rare medicinal herbs were grown here in order to make them available to the broad masses of the population.

From around 1828 Siam came into contact with Western medicine. The famous American doctor Dan Beach Bradley (still called Mo Bradley , Dr. Bradley, to this day ) came to Bangkok as a missionary in 1835 and carried out the first vaccinations , initially against the common smallpox . As early as 1838 the king ordered his doctors to learn this technique and use it in the population. The American doctor Dr. Samuel Reynolds House (Mo House) introduced ether as a medium for anesthesia in Siam in 1849 .

Introduction of Western medicine (1851-1917)

King Rama IV. Opened Siam to influences from the west and took over many tools and ideas from the beginning industrial age. In the course of this step-by-step modernization, the health system was also brought to a more modern level, which was developed by his successors Rama V. and Rama VI. has been adapted to the respective requirements.

Under King Rama IV (Mongkut), traditional Thai medicine continued to exist, alongside western conventional medicine, which was promoted by medically trained missionaries, among other things. Among them were Dr. Bradley, Dr. House and Dr. Lane. Dr House was known for the tinctures he used to treat cholera patients. Western medicine was initially used to a lesser extent in obstetrics and in obstetrics .

Up until the end of the 19th century, Siam only had temporary hospital wards that were set up when epidemics occurred and then disbanded after they had subsided. King Rama V (Chulalongkorn) set up a health program for the poor in 1886 and founded the hospital management committee for this purpose, which one of his brothers led. In 1888 the first hospital in Siam was opened, the Sirirat Hospital ; it is named after Prince Sirirat Kakuttaphan, who died of diphtheria at a young age . In 1889 a nursing department was added, which came under the Ministry of Education , headed by Prince Damrong Rajanubhab , and gradually replaced the hospital management committee. During this time, numerous important advances were made:

• 1889 Establishment of a medical training center at Sirirat Hospital, whose curriculum included both Western and traditional Thai medicine,
• 1895 Publication of the first textbook on medical care on the two directions of medicine in Siam
• 1896 Foundation of a school for midwives on the grounds of the Sirirat Hospital, donated by Queen Sri Patcharintara Boromarachininart
• 1905 Initiation of the first public hygiene program in Tambon Tha Chalom, Samut Songkhram Province .
• 1907 Two textbooks on medicine and pharmacy from that year are considered the first Siamese textbooks on medicine and pharmacy

Finally, a medical department was set up to take care of epidemic prevention and, in particular, to manage the smallpox vaccination outside the capital, Bangkok.

King Rama VI too. (Vajirawudh) initiated a series of health care improvements in the country. Just one year after his accession to the throne, the Chulalongkorn Hospital was built in Bangkok in 1911, partly with funds from the king himself and the Thai Red Cross . The following year the king founded the Pasteur Institute , which was given the task of preventing and combating rabies , and the Vajira hospital . Since 1914, many pharmacies were created, which were initially assigned to the Ministry of the Interior .

In 1916, Prince Rangsit Prayurasakdi , Prince of Chai Nat, had medical training reformed, which meant that traditional Thai medicine was no longer taught, but more clinical internships had to be completed. It had just become too difficult to find professional traditional medicine teachers.

1917 built King Rama VI. the first school for military doctors . Since 1918, the public medicine and hygiene programs, previously managed by the Ministry of the Interior and the Ministry of Public Affairs, have been grouped into a single department, the "Department of Public Health". The Queen Saovabha Institute was created in 1920. The International Red Cross registered the Thai Association and the Thai Red Crescent on April 8, 1920. A law from 1923 only allowed trained doctors to initiate medical measures.

Introduction of modern medical care and health care (1917–1929)

The father of the current King of Thailand, Prince Mahidol of Songkhla , was the first member of the royal family to take a serious interest in medicine and health care. Among other things, this was due to the fact that he considered the system of the time to be inadequate and barely protected people from diseases, especially infectious diseases. Therefore, he resigned from the Thai Navy and began studying medicine at Harvard University in the United States. His plan was to acquire modern technology to build an effective health system in Siam and to acquire the necessary knowledge. He received a degree in public health and a doctorate in medicine from Harvard University.

On his return, Prince Mahidol set up a medical school, hospital and nursing home from his own resources. He also gave scholarships to Siamese students who wanted to study medicine and nursing abroad. At the Sirirat Hospital he initiated the first research projects for the medical sector, and he himself worked there as a teacher and trainer as well as a doctor. Vajira Hospital became a maternity hospital and training center for nurses, midwives and doctors. Because of his services to the health of the people in Thailand, he is called the "father of modern Thai medicine". In his honor, the former University of Medicine was also renamed Mahidol University .

Era of the Thai Ministry of Health (since 1929)

Under King Rama VII (reigned 1925–1934) the interaction between traditional and modern medicine was further regulated:

• Doctors of modern medicine were those whose medical art could be found in international specialist books and who had successfully completed a regular education,
• Traditional healers were those whose healing methods had been acquired through observation and oral tradition or the old specialist books that were not scientifically founded.

In 1926 the Public Health Office was reorganized and divided into 13 departments:

1. administration
2. Financial supervision
3. Consultant
4. Publications
5. Health protection in cities
6. Engineering in Medicine
7. health
8. pharmacy
9. Drugs
10. Mental Illness Hospital
11. Promote hygiene
12. Urban sanitary doctors
13. Vajira hospital

In the meantime, the Siamese Revolution took place in 1932, which made Siam a constitutional monarchy, entrusted the military with state affairs and no longer granted the king any political rights. During the reign of Rama VIII (1934–1946), Field Marshal Phibulsongkram ordered a reorganization in 1942 and set up a commission, the so-called "Committee for Medical Restructuring". The committee recommended the creation of a health ministry, the "Law for the Reorganization of Ministries and Departments" (3rd Amendment) was brought into being in 1942 and still exists today (Ministry of Public Health, MoPH).

During the time of the Second World War , which also affected Southeast Asia from 1942 and especially 1943, there were bottlenecks in the supply of medicines. Therefore, there was an increased search for substitutes from native plants. The production of herbal medicines continued after the Second World War.

Today's King Rama IX. (Bhumibol Adulyadej) has initiated and carried out numerous projects, many of them in the field of public health. That is why he received the gold medal of the World Health Organization "Health for All" in 1992 for his tireless work . The King also received a gold medal from the Franklin and Eleanor Roosevelt Institute and the World Committee on Disabilities in recognition of the progress made in integrating the disabled into Thai society.

Establishment of the Ananda Mahidol Foundation

When it was seen that advances for the Thai welfare and health system relied on advanced technical knowledge from abroad, King Rama IX came. to the conviction that one should send more students abroad, study the modern knowledge there and apply it in the country after their return to Thailand. In 1955 a corresponding pilot project was started with the help of the Ananda Mahidol Fund. The king later ordered the name of the fund to be changed, and so on April 3, 1959, it was renamed the Ananda Mahidol Foundation. The king donated 20,000 baht in memory of his deceased brother and awarded a first scholarship to study medicine abroad as part of the foundation.

The establishment of the Rajapracha Samasai Foundation

King Rama IX gave permission in 1954 to show a film about his life in the cinema Chaloem Krung, the screening of which grossed 444,600 baht. This sum was used to build the Ananda Mahidol building at Sirirat Hospital, with the king donating more than 1.5 million baht. The inauguration took place in the presence of Rama IX. on June 9, 1957.

After the completion of the construction there was still more than 175,000 Baht in donations. At the instigation of the Ministry of Health, this sum was used to set up a training and research center for leprosy , which was created for one million baht at the Phra Pradaeng Hospital and the foundation stone of which was laid on January 16, 1958. Later this center was called "Rajapracha Samasai Institute". Again at the request of the king, a school was built for the uninfected children of the lepers, the Rajapracha Samsai School. Since leprosy no longer occurs in Thailand today, the school later went to the Department of Basic Education in the Ministry of Education as a general school.

Establishment of the Foundation for the Prince Mahidol Prize under the patronage of the King

On the occasion of the 100th birthday of the father of the current king, Prince Mahidol of Songkhla, the "Foundation for the Mahidol Prize under royal patronage" was established on January 1st, 1992. This was to honor the great contribution to the health of the people in the country. The foundation was given its current name on July 28, 1998.

Monitoring project on iodine deficiency

The iodine deficiency monitoring project in the country is considered one of the key projects in the Ministry of Health. On the initiative of the king in 1991 in Amphoe Samoeng , Province of Chiang Mai , first conducted a pilot project. Iodized salt was distributed to the population in order to combat iodine deficiency-related diseases such as goiter and developmental delays. In addition, the Chiang Mai Technical College was also investigating how small businesses could produce iodized salt cheaply. The result was a medium sized iodized salt plant that is now used across Thailand. The project is currently led by Princess Chakri Sirindhorn .

In addition to the king, Queen Sirikit also repeatedly advocates the promotion of the Thai health system. She is president of the Thai Red Cross and heads numerous associations that work to improve health, such as B. the Association of the Blind, the Foundation for the Mentally Retarded and the Deaf Foundation. Their commitment to the polio vaccination is also important, which was so successful that there are almost no cases in today's Thailand.

The work of Princess Chulabhorn , who founded the Chulabhorn Research Institute and is scientifically active there for the improvement of food hygiene, medicines and agricultural products, should also be emphasized . For this she received the Einstein Gold Medal from UNESCO .

Individual evidence

1. ↑ https://www.cia.gov/library/publications/the-world-factbook/geos/th.html CIA> PEOPLE (last accessed on May 6, 2010)
2. ↑ Archive link ( Memento of the original from June 27, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
3. ↑ https://www.cia.gov/library/publications/the-world-factbook/geos/th.html CIA Factbook> PEOPLE (last accessed on May 6, 2010)
4. ↑ Archive link ( Memento of the original from January 27, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Website of the Thai Ministry of Health on the medical history of the country (last accessed on March 26, 2010). 
5. ↑ This took place on December 27, 1918.

Web links

• Presentation of the health system in Thailand (English, last accessed on May 4, 2010)