HealthCare System in Thailand:Past - Present and Where is the Future ? Dr. Pradit Sintavanarong Minister of Ministry of Public Health, Thailand ริชมอนด์ 11-10-56

1. HealthCare System in Thailand:
Past - Present
and Where is the Future ?
1

2. 2
Thailand Population Census
Population of Thailand 2011 2012 2013
Total Population 63,891,000 64,413,000 64,623,000
- Male 31,445,000 31,683,000 31,438,000
- Female 32,446,000 32,730,000 33,185,000
Urban area 23,078,000 28,406,000 29,662,000
Rural area 40,813,000 36,007,000 34,961,000
Children(under 15 years) 13,010,000 12,892,000 12,123,000
Labor force (15 - 59 years) 43,091,000 43,410,000 42,983,000
Elderly(60 years and over) 7,790,000 8,111,000 9,517,000
School ages (6 - 21 years) 15,192,000 15,092,000 14,027,000
Women of reproductiveages(15 - 49 years) 17,711,000 17,712,000 17,388,000
Crude birth rate (per 1,000 population) 12.4 12 11.6
Crude death rate (per 1,000 population) 6.9 7.1 7.7
Naturalgrowth rate(percent) 0.6 0.5 0.4
Infant mortalityrate(per 1,000 livebirths) 12.3 11.8 11.2
Childmortalityrate (per 1,000 live births) 14.3 13.7 18.4
Total fertilityrate 1.5 1.5 1.6
Source: Institute for Population and Social Research, Mahidol University

3. 3
Thailand Population Census
Estimated Population of Thailand in
the Next 20 Years (2033) 65,759,000
- Male 31,633,000
- Female 34,126,000
Source: Institute for Population and Social Research, Mahidol University;
Estimated Population at Midyear 2013 (1st July)

4. 4
Health statistics

5. Coverage of Health Insurance 99.46 %
Life Expectancy at birth (2010) 74 ( Male 71 (71.1),
Female 77 (78.1) )
Crude birth rate (per 1,000) 12.4 (11.6)
Crude death rate (per 1,000) 6.5 (7.7)
IMR (per 1,000 live births) 6.6 (11.2)
MMR (per 100,000 live births) 8.9
Source: Ministry of Public Health , Public Health Statistics 2011
( ) = Institute for Population and Social Research, Mahidol University
5
Thailand Health Status

6. Aged Society
19.89 19.47 19.05
68.41 68.39 68.33
11.70 12.14 12.63
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
Year 2553 Year 2554 Year 2555
Ages 0-14
Ages15-59
Ages60 and Over
Year 2553 Year 2554 Year 2555
Age Group count percentage count percentage count percentage
Ages 0-14 12,672,935 19.89 12,496,939 19.47 12,241,023 19.05
Ages15-59 43,577,838 68.41 43,892,616 68.39 43,911,198 68.33
Ages 60 and Over 7,450,930 11.70 7,791,446 12.14 8,114,144 12.63
Total 63,701,703 64,181,001 64,266,365
Elderly = 12.63% of Total Population
Aged Society
6
Source: Bureau of Policy and Strategy, Ministry of public health

7. Source: Population Division of the Department of Economic and Social Affairs of the United
Nations Secretariat, World Population Prospects: The 2010 Revision
Japan
Korea
China
Thailand
World
7
Proportion of elderly (>65 years old)

8. Disease Year 2011 Year 2012
Infectious disease 2007.28 2044.77
Non communicable
diseases
• Circulatory diseases
• Accident
• Cancer
1881.01
712.36
700.91
467.74
1970.27
724.18
762.75
483.34
Rate per 100,000 populations
Morbidity
8Source: Bureau of Policy and Strategy, Ministry of public health

9. Disease 2007 2008 2009 2010 2011
Infectious disease 60.6 61.2 60.7 64.9 64.6
Non communicable
diseases
• Circulatory diseases
• Accident
• Cancer
208.25
55.2
68.1
84.9
209.73
56.0
66.1
87.6
209.67
55.2
66.1
88.3
215.79
61.9
62.7
91.2
227.32
68.8
63.4
95.2
Rate per 100,000 populations
Mortality
9Source: Bureau of Policy and Strategy, Ministry of public health

10. •Rate per 100,000 populations
60.6 61.2 60.7
64.9 64.6
208.25 209.73 209.67
215.79
227.32
0
50
100
150
200
250
2007 2008 2009 2010 2011
Infectious disease
Non communicable diseases
• Circulatory diseases
• Accident
• Cancer
Mortality
10Source: Bureau of Policy and Strategy, Ministry of public health

11. Source: Thailand Health Profile 2008 - 2010 11
Major Causes of Death in Thailand, 1967-2009

12. Source: IHPP, Burden of disease, Thailand, 1999, 2004, and 2009 12
DALYs attributable to risk factors in Thailand
1999, 2004, and 2009

13. 13
Evolution of health system in Thailand

14. 18881828
King Rama 3
started the
Western
medicine
Siriraj
Hospital
established
MoPH
Mandatory
rural services
HFA/
PHC
policy
UCS
NHSO
Department of
Public Health,
MoI
1918
1968
1942 2007/08/091978 20011975
Scaling up
District
Health
System
(DH + HC)
Low
Income
Scheme
1980s
CSMBS 1980
Health Card 1983
SSS 1990
1990s
1992
A decade of
health center
development
1997 Constitution
Economic crisis
NHCO
1992
HSRI
ThaiHealth
LGs
HAI
EMIT
1946
First MoPH
nursing
college
MoPH = Ministry of Public Health, HSRI = Health System Research Institute, LGs = local governments
ThaiHealth = Thai Health Promotion Foundation, NHSO = National Health Security Office,
NHCO = National Health Commission Office, EMIT = Emergency Medical Institute of Thailand,
HAI = Hospital Accreditation Institute
1999
Local
Health
Funds
2006
14
Evolution of the Thai Health System

15. Principles of organizing healthcare system in Thailand
The 1997 Constitution was adopted as principle legal framework for
moving toward welfare state by providing Universal Health Coverage,
• ‘access to needed health services is a basic right of the Thai
population’
The UHC policy in Thailand aims to enable access to needed services to
all Thai people and protecting them from catastrophic health
expenditure
• Put emphasis on ensuring access for all at an affordable cost rather
than providing the best to some
Health service delivery system has been organized as multi-level
system to ensure geographical equity while maintain efficiency of the
system.
15

16. Area
Governor
MOPH
Local
Authorities
Tumbon
health fund
Output/ Outcome/ Impact
PPP
NHCO
NHSO
ThaiHealth
EMIT
HAI
Ministry of Public Health
Emergency Medical Institute of Thailand
National Health Security Office
Health Accreditation Institute
Public Private Partnership
National Health Commission
Health System Research Institute
HSRI
Thai Health Promotion Foundation
16
Multiple Actors in Health

17. 17
Governance of the health system
MoPH had been sole actor in the health system for six decades;
however, following various reforms, there are various actors
involving in governing the health system.
• Decentralization: various public health functions have been transferred to
local governments
• Establishment of NHSO  separation of purchasing and providing functions
• ThaiHealth dealing with social determinants of health
• NHCO -> citizen empowerment in health
• EMIT  pre-hospital care system
• HAI  hospital accreditation
Following various reforms, there has been brain drain from MoPH
to those new autonomous agencies and resulted in weakening
MoPH’s role in directive the health system.

18. 18
Healthcare financing

19. Source: Thailand Data; http://data.worldbank.org/country/thailand
Note: Revenue excluding grants, GGCE = general government consumption expenditure,
GGE = General government expenditure
19
General government
Revenue and Expenditure 2003-2011

20. UHC
achieved
Source: NHA 1994-2010
Economic crisis
20
Total Health Expenditure 1994 - 2010:
↑ government spending, ↓ out-of-pocket payment, but
maintain the level of spending to GDP

21. 21

22. Source: Comptroller’s General Department, MOF
Note: direct disbursement of OP services started in 2004 for chronic conditions, 2006 extended
to pensioners, and 2009 extended to cover all CSMBS members
Per capita expense
≈ 12,000/ year
22
CSMBS expenditure, 1994 – 2012
rapid cost escalation in opposite to declining of beneficiaries

23. Source: expenses from NHA 1994-2010 excluding expense on administration
Number of beneficiaries at the end of each year from SSO
700
800
900
1100
1250
1284
1404
xxx
capitation
23
SSS expenditure 1994 – 2010
Per capita expense 2010 = 2,750 Baht

24. ที่มา : สานักงานหลักประกันสุขภาพแห่งชาติ 24
งบกองทุนหลักประกันสุขภาพแห่งชาติ
ปีงบประมาณ เป้ าหมายประชากร
สิทธิ UC (ล้านคน)
อัตราค่าเหมาจ่าย
รายหัว
(บาท/คน/ปี)
งบเหมาจ่ายรายหัว
รวมเงินเดือน
(ล้านบาท)
% เปลี่ยนแปลง
ปี 2545 45.000 1,202.40 51,407.71
ปี 2546 46.000 1,202.40 56,091.23 9.1%
ปี 2547 46.820 1,308.50 61,212.39 9.1%
ปี 2548 47.000 1,396.30 67,582.60 10.4%
ปี 2549 47.750 1,659.20 82,023.00 21.4%
ปี 2550 46.066 1,899.69 91,369.05 11.4%
ปี 2551 46.477 2,100.00 101,984.10 11.6%
ปี 2552 47.026 2,202.00 108,065.09 6.0%
ปี 2553 47.240 2,401.33 117,969.00 9.2%
ปี 2554 47.997 2,546.48 129,280.89 9.6%
ปี 2555 48.333 2,755.60 140,609.40 8.8%
ปี 2556 48.445 2,755.60 141,539.75 0.7%
ปี 2557 48.852 2,895.09 154,257.98 8.9%

25. 25

26. Data from NHSO: 78% of UCS members used benefits, OP visits increased from
2.45 to 3.37 visits/person/year, IP admissions increased from 0.94 to 1.15
admissions/person/year
26
Number of use persons, OP visits, and IP admissions
of UCS, 2003-2012

27. 27
รายงานสรุปจานวนการใช้บริการ OP ปี 2553 – 2555 สิทธิ UC
ปี จานวนคน จานวน Visit
2553 27,098,157 144,809,385
2554 29,671,976 166,184,132
2555 32,352,507 167,790,950
ที่มา : สานักงานหลักประกันสุขภาพแห่งชาติ

28. 28
รายงานสรุปจานวนการใช้บริการ OP ปี 2555 UC
Visit count group Visit count Patient count Accumulative
patient count
1 - 3 1 10,123,016 10,123,016
1 - 3 2 5,618,033 15,741,049
1 - 3 3 3,615,457 19,356,506
4 - 6 4 2,634,825 21,991,331
4 - 6 5 2,037,527 24,028,858
4 - 6 6 1,620,063 25,648,921
7 - 9 7 1,293,477 26,942,398
7 - 9 8 1,047,112 27,989,510
7 - 9 9 846,614 28,836,124
10 - 12 10 688,628 29,524,752
10 - 12 11 561,665 30,086,417
10 - 12 12 455,115 30,541,532
13 ขึ้นไป 13 ขึ้นไป 2,140,938 32,682,470
ที่มา : สานักงานหลักประกันสุขภาพแห่งชาติ

29. 29
รายงานสรุปจานวนการใช้บริการ OP ปี 2555 UC
Visit count group Visit count Patient count Accumulative
patient count
13 – 15 13 369,525 30,911,057
13 – 15 14 297,834 31,208,891
13 – 15 15 241,517 31,450,408
16 – 18 16 196,252 31,646660
16 – 18 17 160,178 31,806,838
16 – 18 18 131,145 31,937,983
19 – 21 19 108,554 32,046,537
19 – 21 20 89,594 32,136,131
19 – 21 21 73,962 32,210,093
22 – 24 22 61,340 32,271,433
22 – 24 23 51,668 32,323,101
22 – 24 24 43,466 32,366,567
25 ขึ้นไป 25 ขึ้นไป 315,903 32,682,470
ที่มา : สานักงานหลักประกันสุขภาพแห่งชาติ

30. • On average, salary of
hospital staffs increased by
6-10% per annum
• Non-salary labor cost of
district hospitals increased
sharply by 50% in 2009, and
it increased by 30-40% for
general and regional
hospitals in 2009 and 2010
• All type of hospitals had a
declined rate of expense on
drugs
Source: Health Insurance System Research Office; analysis of financial report of MoPH hospitals 30
Increase in cost of MoPH hospitals, 2009-2011

31. 31Source: Office of Insurance Commission http://www.oic.or.th/en/home/index.php
Losses incurred varied from 40-50% of collected revenues
Traffic Accident Insurance

32. Ministry of Public Health
Permanent Secretary
Technical Departments
Director-General
Ministry of Interior
Permanent Secretary
Office of the
Permanent Secretary
Province
Governor
Provincial Public Health Offices (76)
Provincial Chief Medical Officers
Regional & General
Hospital
Community Hospitals Districts
Governors
District Health Offices
Primary Care Unit
Tambol Health
Promoting Hospitals Tambol Administration Offices
Municipalities
Provincial
Administration
Offices
32
Provincial Health Administration

33. 33
Health service delivery system in Thailand
Health centers
9,768
Municipality
Medical
Centers 365
District hospitals
776
Provincial
hospitals 68
Pharmacy
11,154
Private clinics
17,671
Other
public
hospitals
120
Private
hospitals
323
Regional
hospitals 28
University
hospitals 17
Other MoPH
hospitals 55
MOPH facilities
Sub-district
District
Province
Source:
1. Thailand Health Profile 2008-2010
2. Bureau of Policy and Strategy, MoPH, http://hrm.moph.go.th/res53/res-rep2553.html

34. Private Hospital Clinics (2013)
Private Hospitals
• Bangkok 98, Other provinces 224
• Total 322
Medical clinics
• Bangkok 3,970 , Other provinces 14,533
• Total 18,503
Drugstores
• Bangkok 4,912 , Other provinces 11,780
• Total 16,692
Traditional medicine Drugstores
• Bangkok 443 , Other provinces 1,615
• Total 2,058
Private Hospital Clinics (2013)
34Source: Bureau of Policy and Strategy, Bureau of Sanatorium and Art of Healing, Food
And Drug Administration; Ministry of public health

35. Health Facilities in the Public Sector (2010)
Source : Bureau of Health Administration; Ministry of public health
Administrative Level Health facility
Bangkok • 5 medical school hospitals
• 26 general hospitals
• 13 specialized hospitals/institutions
• 68 community health care centers
Regional level • 6 medical school hospitals
• 33 regional hospitals
• 48 specialized hospitals
Provincial level • 83 general hospitals
District level • 774 community hospitals
• 284 municipal health centers
Sub-district level • 9,768 health promoting hospitals
Village level • 198 community health posts
• 48,049 rural community primary health care centers
• 3,108 urban community primary health care centers
• 1,055,000 Village Health Volunteers
Health Facilities in the Public Sector (2010)
35

36. 36
Human resources

37. 37Source: Thailand Health Profile 2008 - 2010
Population to provider ratios, 1979 - 2009

38. • There was mark reduction
in the disparities of
population to health care
provider ratios for Bangkok
and the Northeast during
2001-2009
• Population to doctor ratio
of the Northeast remained
5 time of Bangkok while the
ratios of other professions
were 1.5 – 2 times of
Bangkok
38Source: Thailand Health Profile 2008 - 2010
Disparities of population/healthcare provider ratios
for Bangkok and the Northeast, 2001 - 2009

39. 39Source: Kanchanachitr et al (2011)
Thailand has relatively low numbers of doctor and nurse to
1,000 populations compared with countries at the same level of
economy
Doctor and nurse to 1,000 population
among ASEAN countries

40. 40 40
Limited production capacity
Currently, annual production increases to 2,500 for doctor and 9,000 for nurse;
however, the production capacity remains lower than other countries.
Source: Kanchanachitr et al (2011)

41. 41
Pharmaceutical industry

42. • During the period 1992 -
2006, with a high economic
growth and new drug
marketing monopolies under
the Drug Act, the value and
proportion of imported drugs
was rising rapidly.
• The proportion of imported
drugs was rising steadily to
56.3% in 2005, 64.5% in
2009, and 68% in 2010
42
Source: Drug Control Bureau, Food and Drug Administration, MoPH
Pharmaceutical industry in Thailand

43. Percentage of prescribed items
Percentageofreimbursements
Use of drugs outside
national ED list in 31
hospitals
University hosp
MoPH hosp
Other public hosp
Data error
Bubble size represents amount
of reimbursement
Type of hospital
43

44. • In Thailand, important antibiotic resistant bacteria are
– Enterobacteriaceae (Quinolone resistance, <20% in community, 30-70% in hospital),
– Staphylococcus aureus (Penicillin resistant 1% in community, 30-70% in hospital)
– Pseudomonas aeruginosa (Carbapenam resistance 10-30%)
– Acinetobacter baumanni. (Carbapenem resistance 60-85% for hospital infection)
Antibiotic use, low / middle income countries OP penicillin use and resistance 1990-2000
Source: Werner C. (2004)
Source: report of workshop on antimicrobial drug resistance, Bangkok, 6-10 August 2012
Antimicrobial drug resistance (1)
44

45. Aim to ensure security of drug supply and to maintain price
level of necessary pharmaceutical supplies to ensure
accessibility for all Thais
• Production
• Stocking
• distribution
Trade of between national security and promoting local
pharmaceutical industry (push and pull)
• Competing with local pharmaceutical firms in producing
generic drugs
• Production of vaccines
Role of Government Pharmaceutical organization
(GPO)
45

46. Time line of Health Sector Reform
46

47. 47
Time line of Health Sector Reform
• Scaling up
district health
system
• Health
volunteer
• Community-
based health
insurance
(health card)
PHC era
• Introduction
of Universal
Health
Coverage
• Expansion to
cover high
cost services
i.e. ARV, RRT
Universal
Coverage
• Population
aging
• Increase
demand for
health care
• Increase
burden of
chronic care
• Use of original
& NED drugs
• Demand drive
by Advance
medical
technology
Increasing
health
expenditure
• Sustainability
doubted
• Control of
health care
expenditure
• Harmonization
of health
insurance
schemes
• Regional health
service plan
Health sector
reform 1
• Sustainability
• Healthcare
expenditure
• Quality and
safety
• Management
Health sector
reform 2

48. 48
Current issues of concern
Downsizing public sector policy of various governments put
pressure on public health sector
• Increased workload according to universal coverage policy
• Limited public hospital capacity in recruitment and retain
health professions, especially professional nurse
• Major incentive for working in public hospital with greater
workload and lower salary is being a civil servant
Disparities in financial compensation level for different health
professions in the public sector

49. 49
Health Sector Reform: issues for debate
Whether Thailand will move towards full welfare state,
particularly for health care
• Wealth & Health
• Balancing of revenue and expenditure; how to
generate additional revenue for health care
• Equal basic benefits to all or comprehensive benefits
• Explicit cost sharing policy to prevent unnecessary
use , especially high cost medicines
• Long-term financial sustainability

50. • Burden Of Disease and old aged dependency challenges
• Governance of the health system
– Role of MoPH and other partners and their relationship
• Government fiscal space and long term financial sustainability
• Harmonization of the three main schemes
• Health systems capacity to cope with
– Increased demand within very strained health workforces
– Decentralization context –threats and opportunities
– Public private dialogues, better trust and collaboration
50
Challenges for further reforms
1
2
3
4
5

51. ช่วงอายุ 0 – 5 ปี
• เด็กเกิดจากมารดาซึ่งมี ANC ครบถ้วนในช่วงระยะเวลาที่เหมาะสม และคลอดในห้องคลอด
• เด็กได้รับน้านมมารดาและอาหารเสริมในระยะเวลาที่เหมาะสม
• เด็กได้รับวัคซีนที่จาเป็นต่างๆครบถ้วน
• การได้รับการรักษาทางการแพทย์ที่พอเพียง
• เด็กได้รับการเตรียมตัวสาหรับการพัฒนาในช่วงวัยต่อไปอย่างเหมาะสมผ่านศูนย์ดูแลเด็กเล็ก
และโรงเรียนอนุบาล
การดูแลและพัฒนาคุณภาพชีวิตของประชาชนที่แบ่งตามช่วงวัย
51

52. ช่วงอายุ 6 – 19 ปี
การดูแลและพัฒนาคุณภาพชีวิตของประชาชนที่แบ่งตามช่วงวัย
52
• การบริการทางการแพทย์ที่พอเพียง
• เด็กและเยาวชนได้รับวัคซีนที่จาเป็น และวัคซีนกระตุ้นครบถ้วน
• เด็กและเยาวชนได้รับการพัฒนาทักษะเพื่อการเข้าสู่ช่วงวัยทางานต่อไปอย่างเหมาะสมกับ
สถานการณ์และปัญหาด้านสาธารณสุข เช่น
• ยาเสพติด สุรา บุหรี่
• การตั้งครรภ์ไม่พร้อม
• โรคติดต่อทางเพศสัมพันธ์ รวมทั้ง HIV/AIDS
• ปัญหาอุบัติเหตุ
• ปัญหาทางการโภชนาการ โดยเฉพาะ โรคอ้วน
• การออกกาลังกาย
• ปัญหาการติดการพนันและเกมส์
• การมี E.Q. ที่เหมาะสม
• ความรับผิดชอบต่อสังคม

53. ช่วงอายุ 20 – 59 ปี
การดูแลและพัฒนาคุณภาพชีวิตของประชาชนที่แบ่งตามช่วงวัย
53
• ได้รับการดูแลส่งเสริมสุขภาพและการคัดกรอง โดยมีการกระตุ้นเตือนให้ความรู้ผ่านช่องทาง
ต่างๆอย่างเหมาะสม
• ได้รับบริการด้านสุขภาพที่พอเพียงในกรณีที่เจ็บป่วย
• ได้รับการเตรียมตัวที่จะเข้าสู่ช่วงอายุวัยชราต่อไป
ช่วงอายุ > 60 ปี
• ได้รับการซ่อมแซมสุขภาพในกรณีที่จาเป็น
• ได้รับการส่งเสริมให้มีสุขภาพที่แข็งแรงจนถึงช่วงสุดท้ายของวัย
• ได้รับการดูแลจากลูกหลานและชุมชนอย่างอบอุ่น

54. 54
Reform direction

55. 1. Restructuring health sector
55
Reform direction
Separation regulatory role and service provision role in the MoPH
Strengthening MoPH functions as National Health Authority
• Policy, direction, and guidelines on financing
• Policy on human resources
• Regulation and supervision
• Monitoring and evaluation
• Implementing cost accounting system in hospitals
Reorganize relationships between MoPH and various main actors

56. 2. Regional health service commissioning
56
Reform direction
Decentralize administration of service provision to 12
regional MoPH areas (service plan)
• Improve efficiency of resources use by sharing
resources
• Improve capacity of service provision within the regions
• Better referral system
• Greater accountability by setting KPIs
Greater cooperation between purchaser and providers in
planning, purchasing, and service provision

57. 3. Financing reform
57
Reform direction
Expansion of health protection coverage by compulsory
contributory insurance
• Migrant workers and dependents
• Foreign visitors
• Foreign residents
Reform Traffic Accident Insurance to improve effectiveness and
efficiency of the system
Pharmaceutical cost control of CSMBS and reform payment
system for better cost control
Reform payment system to support MoPH service plan
57

58. 4. Harmonization of current health insurance schemes
58
Reform direction
National Clearing House
National Information center
Harmonization of benefit package and payment system
• Accident and Emergency services
• Anti-Retro Viral Therapy
• Cancer

59. Provider
National Health
Authority
PurchaserRegulator Supplement / Agent
- สปสช.
- สวรส.
- สช.
- สพฉ.
โครงสร้างการทางานระบบสาธารณสุขประเทศไทย
59

60. • MOPH hospitals at border areas provide unpaid care around 250
million Baht a year
Walk in across border for medical visit
• Illegal migrants & dependents, both registered and non-
registered ≈ 3 mil.
• Legal skilled migrants & dependents ≈ 1 mil. (attracted by 2 mm
public project on infrastructure)
Immigrant workers
• ≈ 800,000/year, not much affected by AEC
Medical Hub
Increase demand for health care
60

61. • Illegal migrant workers &
dependents ≈ 3 m, share
15-20% of OP visits and
20-35% of IP admissions in
provinces with high
density of migrant
workers.
• Non-Thais patients shared
≈ 30% of OP services and
35-50% of IP services in
hospitals at west-border of
Thailand
• There are ≈ 1 million
foreign patients under the
medical hub
1,363,295
695,779
935,035 942,107
-
500,000
1,000,000
1,500,000
2008 2009 2010 2011
Number of Medical hub services
Health services use by non-Thais
61

62. Policies response to increase demand for healthcare of
Non-Thais
At the border;
• Supporting capacity building of health facilities in nearby
countries at border areas
• Supporting governments of neighborhood countries in
moving towards UHC
Providing health protection to Non-Thais and generate
additional source of finance by compulsory contributory
insurance
• Migrant workers and dependents
• Foreign visitors
62

63. 63

64. 64

65. Policies response to increase demand for healthcare of
Non-Thais (2)
Medical hub (academic training and conference,
medical care, dental care, spa and Thai traditional
medicine)
• Promoting Thailand as center of medical education, academic
training, and conferences)
• Loosening professional barrier in importing foreign
professions
• Reduce income gap between public and private sector in
order to prevent brain drain
65

66. Inspiration
66

67. ชายคนแรกตอบ
“ผมกำลังทำงำนหำเงินเพื่อเลี้ยงชีพอยู่”
คนที่สองตอบว่า
“ผมกำลังฝึกหัดเพื่อเป็นนักแกะสลักหินชั้นยอด”
ชายคนที่สามตอบ
“ผมกำลังสร้ำงวิหำรอยู่ครับ เป็นวิหำรที่จะอยู่เป็นร้อยๆ
ปีและเป็นแรงบันดำลดลใจให้คนรุ่นหลังอีกหลำยชั่วอำยุ
คนหลังจำกผมตำยไปแล้ว”
67

68. Bamboo seeding ( water for 4 yrs )
After off from land : grow 60 fts in 9 m
68

69. Bamboo seeding
( water for 4 yrs )
After off from land
grow 60 fts in 9 m
69

70. A journey of a thousand miles begins with a
single step.
Chinese proverb
70

71. ระยะทางจากโลกถึงดวงจันทร์ 1/4 ล้าน ไมล์
ระยะทาง 3 กม. แรก ใช้พลังงานไป 50 % ของทั้งหมด 71

72. Attitude is a little thing
that
makes a big difference
Winston Churchill
72

73. 73