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Consumer Confidence after Military Control
The foreigners outside of Thailand have shown concerned regarding the political instability in Thailand. They view the current state of Thailand as the taken control of power which reduced the thread of escalation of violence in short-term. However, the situation creates uncertainty to foreigners. The concern has affected the investment as well as the consumer confident as shown in the following graph. The graph shows the consumer's outlook of economics condition, job prospects and income expectations.
The concern affected the major healthcare corporation decision to enter Thailand. Thus, Thailand has lost a number of innovations from the other countries to entrance as a result. As healthcare has high complexity of legal process so the company has higher risk of wasting time if the political is not stable and affect the law.
Reference: Asia-Pacific Outlook: Infrastructure Focus June 2014 Cedric Chehab – Head of Asia Research
Political Involvement in 30-baht policy
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 in Thailand is lower than for its neighboring countries and that is slowing down over the three last years. In 2014, Thailand GDP grew only by 0.7%.
The positive impact of economic slow down because the Bank of Thailand uses expansionary monetary policies in order to favor private investment and stimulate the flow of money throughout the economic system. Indeed, a lower rate reduces the cost of borrowing and help 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.
Nevertheless, after the military group has taken over the control power, there are some changes to the rule. The gold card for 30 baht usually specified the exact hospital for usage which is contrast to the regulation that the patients can be cured anywhere. Thus, the new policy has been enforced to cover all the hospitals including private hospital, and the hospital could redeemed the fund equal to the amount that has been specified by the government.
The political factor is one of the most important factors of our PESTEL analysis. Indeed, government and politics can play a very important role since their decisions and actions or inactions can positively or negatively affect the problem of low-income access to health care. For instance, governments can develop and implement policies that have a strong impact for solving or contributing to resolve this issue, such as financial policies, investments plan and subsidies, reform of the educational system, etc.
Financial Policy – The Universal Coverage Scheme
The Universal Coverage Scheme (UCS), also called the 30-Baht Scheme was introduced in 2001, initiated by the former Thai government. This reform targets low to medium-low-income households and aims to ease their access to health and medical services in order to create an equitable system.
(Click here for more information on 30-baht policy)
Basically, as a patient, a Thai citizen covered under the UCS is requested to pay the medical consultation at a flat fee of 30 baht or even for free for the strata of the population that can benefit from exemption of payment (Children under 12 years old, seniors aged 60 years and over, the very poor, and volunteer health workers). In addition, the UCS covers basic medicine and further intervention. However, patients under this scheme are required to consult within their district and can eventually receive an authorization in order to follow a specialized treatment in another district when it is necessary.
This reform has increased insurance coverage to more than 99% of the population and has reduced the financial burden of accessing health care services. However, we can legitimately wonder: What are the factors that could limit the positive impact of this pro low-income policy?
Source: Ministry of Public Health & Ministry of Finance
The Health Coverage Scheme Today
Source: The World Bank
The almost totality of Thai citizen using the UCS receive health care services dispensed by public hospitals. This cloud be explained that the total health expenditure and the portion covered by the government in total health expenditure have regularly increased since the implementation of the UCS in 2001. In 2013 total health expenditure almost reaches $18 billion, the government accounts for more than 80% of this amount.
We can raise few questions to this observation:
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Can the private sector play a role to improve access to health care? Should the government encourage investment in the private sector?
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Do these increases really benefit to the improvement of access to health care services for low incomes?
The role of the government in Geographical inequalities
The government plays a major role to impact the amount and the repartition of healthcare resources throughout the kingdom. Firstly, in terms of infrastructures, the Thai government has a direct impact since it is the main healthcare service provider via its network of public hospitals, which are the place where are offered consultation under the UCS. In addition, the government can have an indirect impact via encouraging private investment in the healthcare sector. Secondly, in terms of human resources, the government can impact the production of doctors and nurses via launching more programs in public universities and providing incentives such as scholarship to encourage the Thai youth to embarrass a career in the healthcare sector.
Unequal Geographical Repartition of Resources
Source: Thailand National Statistic Office
Thailand suffers from insufficient capacity and unequal geographical repartition of health care facilities across the country, which leads to an unequal healthcare coverage of the national territory. The table above shows that Bangkok receive a disproportionally high share of healthcare resources (labor force and infrastructures) compared to its share of the Thai population. This phenomenon can however partially be explained by health tourism, which is much more developed in the capital city than in other provinces. In contrast, the Northeast province is under-served, which might result in even more difficulties to access health care services for the low-income population. Moreover, It is very difficult to find data concerning the geographical coverage within provinces. Indeed, the problem is probably even deeper. Public Hospitals are located in cities, thus the access of health care services for people living in villages might be extremely difficult and require a mean of transportation.
Ratio Healthcare Human Resources Per 1,000 People in 2010
Source: Ministry of Public Health
Thailand also suffers from a shortage and unequal geographical repartition of its healthcare human resources. This observation is even more obvious when we compare the Thai figures with other countries such as Philippines. In addition, if the health care sector is currently understaffed, another observation can raise some worries for the future. Indeed, the gap between the human resources needed and the production of human resources is increasing. As a result, it seems that this issue might get worst in the future if the government does not increase the production capacity by developing more programs and offering incentives to produce more doctors and nurses.
Healthcare Human Resources in 2015 (Unit: people)
Source: Ministry of Public Health