Abstract
The results from conducting the third phase of National Health Accounts (NHA III) shown the estimation of a Total health expenditure (THE) of Thailand in 2001 of 170,203 million baht at current price including capital formation. The total health expenditure of Thailand had gradually increased during 1994-2001 with average of 1.2 percent of annual growth rate at constant price, though, there was a recession due to the economic crisis during 1997-1999. Whereas the average of annual growth rate of Gross Domestic Product (GDP) during the same period was 0.9 percent at constant price. Ratio of THE to GDP at constant price was 3.2 percent in 1994 and reached to 3.9 percent in 1997, the year which Thailand faced the economic crisis, after that period the ratios of THE to GDP had decreased continuously to 3.2 percent in the year 2001. The THE per capita accounted for 2,560 baht at constant price in 2001 which increased from 2,477 baht in 1994. The share of public sector was 45 percent of THE in 1994. However, it dominated the greater part which was equivalent to 56 percent of THE in 2001. It was due to high average annual growth rate of 7.7 percent which was greater than that of non public sector which expanded only 0.7 percent per year. The major sources of healthcare finance in 1997 came from central government and household sector which accounted for 30.5 and 44.5 percent of THE respectively. Nevertheless, the share of these two main sources had become nearly one third of the whole health expenditure each in 2001. It was due to the high average growth rate of central government expenditure which was 5.5 percent per annum while that of the household was 0.1 percent per annum. During 1994-2001, three third of THE of the Thai health system was personal healthcare consumption. Prevention and public health services had its rather stable share of 7-8 percent, though the country had encountered the difficulty during this period. While the ratio of expense on health administration and health insurance was 4 percent during 1994-1996 and sharply increased to 7-8 percent in the year 1997 on ward. The investment on health sector reflected the impact of the economic crisis apparently, its ratios were about 14-18 percent of THE before the crisis and had declined to be 15.9 percent in 1998 and rapidly decreased to 5-6 percent during 1999-2001. The average growth rate of recurrent healthcare expenditure was 5.6 percent per annum during 1994-2001. Public hospitals earned the highest share of growth of recurrent healthcare expenditure which was 64.8 percent of total amount or average 7.5 percent per year. Private hospitals, though occupied the second large of share, their average growth rate was only 0.3 percent per annum during this period. Private clinics and retail sale of medical goods distributors which shared some extent of important role in the Thai health system showed the average growth 2.5 and 3.4 percent respectively. Pattern of personal health care expenditure in 2001 had been changed when compared to that of 1994. In 1994, non-government sector occupied the highest ratio of personal health care expenditures, which was 63.7 percent. Of which 51.7 percent contributed by private households mainly for ambulatory care (32.9 percent), in public hospitals 12.3 percent, in private hospitals10.3 percent, in private clinics 8.8 percent; for in patient care in private hospitals 5.8 percent, in public hospitals 4.5 percent. In addition, private households paid for over the counter medicines 8.5 percent. The government sector earned the rest of share, 36.3 percent. Of which 19.1 percent paid by central government for ambulatory care in public hospitals (10 percent), and public in-patient care (7.8 percent), the rest 1.2 percent was for provision in health centers. In 2001, non-government ratio declined to 51 percent due to the decrease of private households whose expense decreased to 40.8 percent from 51.7 percent in 1994. However, the main service consumed by private households was for ambulatory care (23.2 percent) in public hospitals 8.9 percent, in private hospitals 6.1 percent, in private clinics 7.4 percent. On the other hand, the private household utilization for in-patient care in private hospitals was increased to 6.1 percent whereas that in public hospitals decreased to 3.7 percent. The share of self prescribed medicine declined to 7.6 percent, though its portion was still high. For the government side, its share increased to be 49.1 percent, of which 24.1 percent was contributed by central government for public in-patient and ambulatory care which equivalent to 12 and 10.8 percent respectively, the rest 1.3 percent was for provision in health centers. Compared with NESDB’s SNA, the amount of the1994 NHA’s recurrent expenditures, which accounted for 110,167 million baht and increased to 161,752 million baht in 2001, less than that of NESDB which estimated for 168,244 and 277,051 million baht in the year 1994 and 2001 respectively. The discrepancy rates were 38-71 percent during that period, the discrepancy rates increased sharply especially in the last two years. It was the main reflection of the increase in non-government sector. The ratios of the NHA’s recurrent expenditures to GDP were approximately 3 percent during 1994-2001, while those of the SNA’s health care consumption to GDP were approximately 4-5 percent during the same period.
