2. LITERATURE REVIEW 2
Abstract
The purpose of this paper is to give the reader a brief background on the history of medicine and
healthcare in both the United States and Thailand. The paper will cover how medicine came
about in both countries, the foundation of healthcare and comparisons of both systems. Some
suggested opinionated improvements will also be discussed.
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Healthcare comparison of Thailand and the United States
When comparing one thing to another it is always good to have some background on both
items in order to have a more educated understanding. Although the paper is a comparison of
healthcare between Thailand and the United States, general statistics are a good foundation to
grasp the similarities or differences of a topic.
The United States as reported by The World Health Organization, has a population of 318
million people. It has a gross national income per capita (the purchasing power parity in
international dollars) of $52,610. No information was provided for the probability of dying under
the age of 5, however information provided for the probability of dying between the ages of 15
and 60 years of age per 1000 population is 130 for males and 77 for females. Life expectancy is
76 years of age for males, females have a slightly higher life span of 81 years. Healthcare
expenditures is 17.9% of the gross domestic product. That places the United States first in the
world for spending on healthcare. (WHO, 2013)
In comparison, Thailand has a population of 67.01 million as reported by the WHO. It
has a gross national income per capita (PPP International dollar) of $9280, which is roughly 1/5
of spending by the United States. Life expectancy is 71 years of age for males and 79 years for
females. The probability of dying between the ages of 15 and 60 is higher than that of the United
States, 182 for males and 90 for females per 1000 population. Thailand has an annual total
expenditures on healthcare as a percentage of 3.9%, eight countries in the world spend less.
(WHO, 2013)
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Medicine is the foundation of healthcare. Western medicine of the US is dated back to the
same foundations as Greek medicine, circa 480 BC. It was founded by Hippocrates, the “Father
of Medicine”. Prior to 1800, medicine was considered a family responsibility, meaning the
family cared for and treated the ill with known remedies of the time. These remedies were
originally based on the four Greek humors that depended on the location of injury or illness. It
wasn’t until the 1900s when doctors started charging fees for services to their patients.
Healthcare reform was shot down by Congress when the United States entered World War I in
1917. The 1920s saw General Motors signing into an insurance contract for its employees with
Metropolitan Life. Blue Cross began to offer private coverage in the 1930s. In the 1940s,
President Harry Truman offered a national health plan. This was renounced and called a
“Communist Plot” by the American Medical Association. 1965 brought about Medicaid and
Medicare being signed into law by Congress. Federal legislation backed up Healthcare
Management Organizations or HMOs between 1970 and 1980. Between the years 1990 and
2000, Congress again denied the passage of a federal health care reform. In March of 2010,
President Obama signed the Affordable Care Act (ACA) into law by executive order.
The Affordable Care Act or ACA for short is considered the most significant piece of
legislation since the signing of Medicaid and Medicare into law. It was developed as a result of
rising health costs and lack of healthcare for uninsured and underinsured Americans. The ACA
was brought about by three events, the growth of managed care in the 1970s, the failing of
President Clinton’s managed care plan in 1993-1994 and the Massachusetts’s Health Reform of
2006.
5. LITERATURE REVIEW 5
Thailand medicine has an unknown dated foundation as it is based on religious beliefs
and culture. The founder of Buddhist medicine is Jivaka Komarabhacca. He is worshipped in
Thailand as the “Father Doctor”. Prior to the 1970s, Thailand had no healthcare services as it was
a highly impoverished nation. Villages were remote with no real access to healthcare. Between
1970 and 1980, Thai government invested huge amounts of money into highways, electrification
and school reform. This opened the door for a public health sector. In 1975, universal healthcare
began. It was known as the Civil Servant Medical Benefit Scheme or CSMBS. This was
originally created for the poor covering basics such as prescription drugs and hospitalization.
This healthcare scheme became later known as the Social Security Scheme in the 1980s. Again
in 2002 it was reformed tocover everybody and became known as the UC or Universal Coverage
Scheme. The UC covers as little as prescription drugs up to more costly items such as kidney
transplants and HIV plans. Everyone is covered under this scheme regardless of income levels. It
is directed by the Minister of Public Health.
When comparing the Universal Coverage Scheme of Thailand to the Affordable Care Act
of the United States, they both have covering their people in mind, however there are differences
of how they cover them. In Thailand, 99% of the population is covered. The one percent is
residents in unreachable remote locations or the monks who chose not to rely on coverage but
rather rely on religious healings. This coverage brought the number of impoverished households
without coverage to 1.3% in 2009. (WHO, 2013) Whereas the ACA plans to extend coverage to
32 million uninsured which will decrease the percentage to 5%. (WHO, 2013) Thailand’s UC
plans to build greater financial stability by removing the burden of health emergency financials
of lower income families where in contrast the Affordable Care Act will implement fines to not
6. LITERATURE REVIEW 6
only employers not providing coverage or not enough coverage as provided by the guidelines,
but to individuals who do not seek coverage. The ACA has extended coverage to dependents on
their parent’s plans to the age of 25. Thailand’s Universal Coverage has no boundary as to who is
covered, the plan includes internationals as long as they provide proof of income and make a
medical declaration.
Both nations are facing shortages of professional staffing such as doctors and nurses,
especially specialty practice physicians. The influx of patients now needing to be seen as a result
of coverage is a major issue. In Thailand, doctors work at numerous different polyclinics, his
leaves their patients sometimes to be seen without qualified personnel or to have to wait for a
lengthy time to be seen for something as minor as a sore throat. In the United States, there is a
vast shortage of medical professionals with the ability to meet the needs of the influx of patients
who now have coverage under the Affordable Care Act. Schools are not graduating enough
physicians to meet the demand and physicians are not reaching out to remote locations as the pay
is not favorable in their eyes. Cash payments are required to render certain services in advance in
Thailand, very similar to the high deductibles of United States plans. If these deductibles are not
met in the US, services can be denied. This creates an issue of people not going to their doctors
as they cannot simply afford to meet the requirements. Office visits can be a couple hundred or
even in the thousand dollar mark depending on if tests were ordered. Many choose to forego care
because of this.
Private sectors of both nations are very similar. If one can afford private coverage plans
and services, they render treatment. Both private sectors provide higher standards of medical
care, the difference being that the United States has no competition between the private hospitals
7. LITERATURE REVIEW 7
amongst themselves or with other nations. Thailand has private facilities that not only compete
amongst themselves for better care and patient numbers but against other nations. They strive to
have people come seek them for their medical attention. Thailand is considered to be one of
Asia’s primary locations for medical tourism.
All together both nations have great prospects for healthcare. There is a dire need for
improvement in wait times and the lack of qualified professionals. Wait times in Thailand can
exceed a month to have a procedure. Diagnostic testing in the US can be a lengthy process as
well to receive as patients must acquire approval from determination boards of the hospitals or
testing facilities. As previously mentioned the United States isn’t graduating enough trained
personnel. Rewards and incentives need to be implemented for choosing a career in the
healthcare field as well as the choice to advance. Forgiveness of loans as well as residency
rewards may entice people to seek out careers in this profession. Dropping fines in the United
States as well as lowering high deductibles would drastically increase use of services, therefore
increasing the overall health of the nation’s population. This would increase work productivity
and alas bring an improvement to the economy.
As you can see healthcare is not just something that is thought up overnight, it takes a lot
of history, as well as trial and error to accomplish a measure that suits all. Bits and pieces
throughout the ages come together and sew the fabric that is a healthcare bill. Times are ever
changing as well as a nation’s population, matters of these needs will require constant attention
and addressing. One can only hope for a change that unites the nation as a whole and contributes
to prosperity.
8. LITERATURE REVIEW 8
References
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Hippocrates The Father of Medicine - Classical Wisdom Weekly. (2013, March
12). Retrieved from http://classicalwisdom.com/hippocrates-the-father-of-medicine/
Palmer MPH, K. (1999, January 1). A Brief History: Universal Health Care
Efforts in the US. Retrieved from http://www.pnhp.org/facts/a-brief-history-universal-health-
care-efforts-in-the-us
Thailand (2014, January 1). Retrieved from http://www.who.int/countries/tha/en/
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http://www.who.int/bulletin/volumes/88/2/10-010210/en/
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