Thailand has made progress toward developing its national eHealth system but still faces challenges. The country has high adoption of health IT by providers but fragmented systems. Experts recommend prioritizing eHealth foundations like governance, standards, and privacy laws. In response, Thailand established a National Health Information Committee and is developing standards. Moving forward, partnerships, research, and capacity building will help Thailand achieve interoperable health information exchange.

1. The Road to eHealth:
Thailand’s Journey
Nawanan Theera‐Ampornpunt, M.D., Ph.D.
Faculty of Medicine Ramathibodi Hospital
Mahidol University, Thailand
Site Visit at Hong Kong Hospital Authority (Sep. 10, 2012)

2. Acknowledgments
• Parts of this presentation are reproduced or
adapted from materials made by
• Boonchai Kijsanayotin, M.D., Ph.D.
Health Systems Research Institute, Thailand
• Somsak Chunharas, M.D., M.PH.
National Health Foundation, Thailand

3. Outline
• Overview of Thailand
• Thailand’s Healthcare System
• Thailand’s eHealth Status
• Recent Progress
• The Road Forward

4. Thailand: An Overview

5. Thailand: An Overview
• Capital: Bangkok
• 76 Other provinces
• 6 Regions: N, C, NE, E, W, S
• Size: 510,890 km2
(460 times of HK)
• Population: 67+ million
(10 times of HK)
Image Source: CIA World Factbook

6. Thailand: An Overview
• Upper‐middle‐income country
• Constitutional monarchy & parliamentary
democracy
• King Bhumibol Adulyadej as Head of State
• Prime ministry as Head of Government
• Three branches of government: Legislative,
executive, judicial

7. Life Expectancy (X)
Income per person (Y)
Image Source: Gapminder.org

8. Human Development Index (X)
GDP Per Capita (Y)
Image Source: Gapminder.org

9. Thailand’s Healthcare System

10. Thailand’s Healthcare System
• Pluralistic system: both public & private
providers
• Public providers large part of healthcare system
• Financed mainly by public funds

11. Thailand’s Healthcare System
3 public healthcare schemes
• Civil Servant Medical Benefit Scheme (CSMBS)
• Non‐contributory fee‐for‐service scheme since 1980
• Covering most healthcare services (except some non‐
essential prescriptions & unnecessary services)
• Public providers (and recently, some private hospitals)
• Uncontrollably escalating costs, inequitable, pro‐rich
• Cost‐containment measures attempted

12. Thailand’s Healthcare System
• Social Security Scheme (SSS)
• Mandated tripartite contributions (employee, employer,
government)
• Capitation fee to participating public & private providers
• Successful in cost containment, but suffers from poor
quality through cream skimming, cost shifting, under‐
provision of care, ineffective regulatory oversight

13. Thailand’s Healthcare System
• Universal Coverage Scheme (UC)
• Implemented in 2001, coverage to all Thais not covered
by CSMBS or SSS, funded by taxes
• Service provided at registered community health center
or public hospital in patients’ residential area, with
referrals if necessary
• Capitation fees for outpatient & DRG for inpatients
• Effective risk pooling
• Equitable access to the poor

14. Thailand’s Healthcare System
• Distribution of public and private hospitals in Thailand
District hospitals (MOPH)
General hospitals (MOPH)
Regional hospitals (MOPH)
Other hospitals under MOPH*
Other public hospitals outside
MOPH†
Private hospitals
*Including general and specialty hospitals under other departments within the Ministry of Public Health.
†Including university hospitals, military hospitals, autonomous public hospitals, prison hospitals, hospitals of state enterprises, and public hospitals under local
governments.
MOPH = Ministry of Public Health
Source: Bureau of Policy and Strategy, Ministry of Public Health (November 2010).

15. Thailand’s eHealth Status

16. Adoption of Health IT: United States
U.S. Ambulatory Setting
100
% of Physicians
90
80
70
60
50
48.350.7
34.8 42.0
23.9 29.2
40
24.9
30
18.2 17.3 17.3 20.8 16.9 21.8
9.3 10.5 11.8
20
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year of Study
Any EHR EHR with Basic Features
Basic Features: Demographics, problem lists, clinical notes, test results, imaging results, order entry for medications
Source: National Ambulatory Medical Care Survey (NAMCS) 2001-2010

17. Adoption of Health IT: United States
U.S. Inpatient Setting
2008 2009
– Basic EHRs 7.2% 9.2%
– Comprehensive EHRs 1.5% 2.7%
– Computerized 17% 34%
Order Entry for Medications
Sources: Jha et al., 2009 & 2010

18. Thailand’s Health IT Adoption

19. Thailand’s HIS Market Share
(2004)
Pongpirul K, Sriratana S. Computerized information
system in hospitals in Thailand: a national survey. J
Health Sci. 2005 Sep-Oct;14(5):830-9. Thai.

20. Thailand’s HIS Market Share
(2011)
HoMC None 2% THIADES HIMS Abstract Other
2% 2% 1% ePHIS 7%
MedTrak/ 1%
TrakCare
H.I.M.
2%
Professional
2%
MRecord
Mit-Net 2%
SSB HOSxP
2%
4% 50%
Hospital OS
7%
Self-developed
or outsourced
16%
Theera-Ampornpunt (2011)

21. Adoption Estimates
Estimate Nationwide
(Partial or Complete Adoption)
Basic EHR, combined inpatient & 49.8%
outpatient settings
Comprehensive EHR, combined 5.3%
order entry of medications, 90.2%
combined
order entry of all orders, combined 79.4%
Theera-Ampornpunt (2011)

22. Summary on Health IT Adoption
• High IT adoption rates
• Drastic changes in adoption landscape
• Local context might play a role
– Supply Side
– Demand Side
• International Comparison

23. Thailand’s eHealth Status
Kijsanayotin B, Kasitipradith N, Pannarunothai S. eHealth in Thailand: the current status.
Stud Health Technol Inform. 2010;160(Pt 1):376‐80.

24. eHealth Development Model
• Public services
eHealth Applications • Knowledge services
• Provider services
• Citizen Protection
• Equality
Enabling Policies • Multilingualism
& Strategies • Interoperability
• Capability Building
• Governance
Foundation Policies • Policy
& Strategies • Funding
• Infrastructure
Modified from Slide by Dr. Boonchai Kijsanayotin
(Modified from WHO Global Observatory for eHealth)

25. Thailand’s eHealth Summary (2010)
• Pervasive access and use of ICT across the
country
• Diverse eHealth applications exist, but most are
scattered, fragmented, disorganized, non‐
standardized, and not interoperable
• Lack of implementation and investments in
eHealth foundations
Modified from Slide by Dr. Boonchai Kijsanayotin

26. Issues in Thailand’s eHealth
• Fragmented reporting systems
• Up to 40% of work time used for data reporting
• Lack of access to personal health data by
patients
• No national governance structure on eHealth
• Foundations needed for standards
development, privacy & security regulations,
etc.
Modified from Slide by Dr. Boonchai Kijsanayotin

27. Experts’ Recommendations
• Development of eHealth foundations is the priority
• Create a multi‐stakeholder, national‐level, eHealth
governing authority
• Incorporate eHealth strategy into ICT 2020 framework
• Enact health information security, privacy and
confidentiality laws
• Develop national health information standards
• Plan and implement systematic
mechanism for capacity building
Modified from Slide by Dr. Boonchai Kijsanayotin

28. Since That Publication in 2010...
• ICT2020 framework now includes “Smart Health”
• The National Health Information Committee was
established under the National Health Commission
• The National Health Information Standards
Subcommittee was formed
• An eHealth office was created under the Health
Systems Research Institute
• Important standards are being developed

29. National Health Commission
Chair: Prime Minister
Secretary: NHC Secretariat
National Health Information Committee
Chair: Dr. Somsak Chunharas
Secretary: Dr. Boonchai Kijsanayotin
National Health Information Standards Subcommittee
Chair: Dr. Daorirk Sinthuvanich
Secretary: Dr. Boonchai Kijsanayotin
Modified from Slide by Dr. Boonchai Kijsanayotin & Dr. Somsak Chunharas

30. Since That Publication in 2010...
• Capacity Building
– New program in biomedical and health informatics
– Healthcare CIO certificate program at Ramathibodi
– Clusters of health informatics academic activities being
formed
• Need for health information privacy & security laws
being discussed in academic forums and by the
Electronic Transactions Development Agency
(Public Organization)

31. The Road Forward

32. The Road Forward for Thailand
• Partnerships

33. The Road Forward for Thailand
• More capacity building!
• Informatics research
• Standards development & adoption
• Getting over “one country one system” and seeking
cross‐platform Health Information Exchange
• Implications of ASEAN Economic Community
• Better privacy laws

34. Where Will We Go?
Image Source: Smiletemplates.com

35. Thank You!
Q&A