Health4Us
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The Economics Factor
The economic situation of Thailand is a factor that impacts the problem of access to healthcare services for low income. Firstly, we can see that the economic growth is lower for Thailand than for its neighboring countries and that is slowing down over the three last years. In 2014, Thailand GDP grew only by 0.7%.
Source: The World Bank
The positive impact of this economic slow down is that the Bank of Thailand is using expansionary monetary policies in order to favor private investment and the flow of money throughout the economic system. Indeed, a lower rate reduces the cost of borrowing and thus favors investment. This might be an opportunity for private investor and this is a key point since we have pointed out that the country is lacking of infrastructures for easing access to healthcare for people in need. If we look at the current situation, the Bank of Thailand currently sets the investment rate at 1.5, which is the lowest level for the last 4 years and is more attractive than the neighboring countries and even the US, which is using aggressive expansionary monetary policies too.
GDP Growth Rate
As a result, this is probably a good thing for developing the private medical sectors such as clinics, which might represent a solid alternative to public hospital for accessing to healthcare services for people living far from major cities. However this might also slow down the government spending in the public healthcare sectors such as opening new public hospital, modernizing existing one or even rewarding the healthcare human resource. This could thus have a very negative impact on the access to health care since people under the Universal Scheme are mostly consulting in public hospitals.
In addition, while conducting several interviews, we have discovered that many low-income people do not consult their doctors in time of economic instability. Uncertainty and precarious situations lead people to skip their treatment or to buy medicine by themselves. Doctors told us that this eventually lead to complication since some people do not follow the appropriate treatment. This especially concern the bottom 10% of the Thai population, who lives with less than THB 150 per days.
Economic Data of Thailand in 2014
Source: The World Bank
If we combine these data with income repartition data provided by the World bank, we can develop a formula for estimating the daily GDP per capita for each strata of the population (daily average income):
Estimation of the daily income for each strata of the Thai population in 2014
A growing economy tends to improve the quality of life of people. However, since income repartition is very unequal amongst Thai citizen, we can legitimately wonder if a growing economy is really going to improve the quality of life of the poorest people in Thailand. Indeed, according to these figures, a growing economy is more likely to increase inequality. However, we might also say that a growing economy and a strong baht would allow Thailand to import medical equipment to modernize its medical facilities, which could ultimately improve access to healthcare to low-income people by making medical intervention more efficient, faster and cheaper.
Source: tradingeconomics.com & The Bank of thailand
Capability to Pay
One way to analyze the capability of people to pay for healthcare expenditure is to compare the incremental change of healthcare expense to incremental of income.
The above ratio is served as a way to view if the problem is arising by showing the ratio of incremental of expenditure per incremental of income. If the result is more than 1 or less than 0 then a certain group of people are haveing trouble paying for the medical treatment as their income is increased less than the healtcare expenditure.
Source: The World Bank, Official Statistics Thailand
The graph with the capability to pay ratio measures the behaviors of the patients. Based on the insight, patients tend to buy medicine from the pharmacy rather than going to clinics or hospital or used the 30-baht scheme more during the period of bad economics. There is the political unrest, which affect the economics in 2009 and 2014. This data is in parallel with what the clinics told us that they have fewer customers when the protest keeps continue. As a result, the public hospitals will become overload with patients who come to use 30-baht scheme. However, the number of doctors and resources are limited and has been maximized even without the crisis so the number of patients who has been cured will not be increasing; therefore, the government does not support more patients than usual time. The patients per private hospital will also be decreased. In the end, patients with urgency will be forced to use the private hospital and pay high price. The private hospital will excessively use resources to raise the total price due to target sales. Thus, the health expenditure for patients becomes higher.
According to the trend, the ratio keeps increasing from 0.82 in 2008 to 0.93 in 2013. Thus, it has been around the same number as GDP per capita recently. This shows that the healthcare expenditure for each person is increased more than the GDP incremental. If this trend continues, there could be a point of time when the healthcare expenditure is increased over GDP per capital as a norm. As a result, people will start to have the lifestyle problem because of healthcare expense.