Abstract:
Health care reform movements in Thailand have occurred during three main overlapping periods.
The first wave of health care reform focused on increasing the geographical coverage of the health care
infrastructure, while the second wave focused on reforming health care financing mechanisms. The third
wave shifted its focus to strengthening primary care. This paper is aimed at exploring the third wave of
health care reform in Thailand using literature and document review. It was found that, among five areas
of reform initiatives to strengthen primary care, there was an imbalance of investment in the primary care
infrastructure and capacity building of health staff. An insufficient number of health centre staff, along
with their limited capacity, is a major constraint affecting the ability to improve health centre performance.
The development of a referral system has been neglected and could reduce confidence of the
people in primary care. Although health care financing reform has improved financial status of the health
centres, it still needs continuous development in order to promote the responsibility and productivity of
health centre staff toward its registered population. Finally, there is a need to develop and adapt the
concept and practice of family medicine to fit with the country-specific context and to promote it to be
well recognized by the general public as well as by physicians. New challenges for the development of
primary care in Thailand include its governance system, in the context of health care devolution, and the
provision of health services for chronically ill patients and the elderly.
