Abstract
This was an initiative by local researchers, with an emphasis on putting the NHA system in place. Two work steps were involved; first, tracking the flow of funds from ultimate sources of finance to financing agencies and second, analyzing the use of funds by financing agencies. Five ultimate finance sources and twelve financing agencies (7 public and 5 private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. The results from NHA1 in 1994 estimated a total health expenditure of 128,305.11 million baht; 84.07% represented consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% represented purchasing care from public providers, 32.35% from private providers, 5.93% on administration and 9.65% on all other public health programs. Public sources of finance were responsible for 48.79% and private sources of finance for 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.57% of GDP (consumption expenditure 3.00% of GDP, capital formation 0.57% of GDP). However, NESDB estimated 1994 consumption expenditure to be 180,516 million baht or 5.01% of GDP, of which private sources were dominant (82.17%) and the public source played a minor role (17.83%). The discrepancy of consumption expenditure figures between the two estimates is 2.01% of GDP. In addition , there is a big gap in the public and private proportion of consumption expenses; 46:54 in NHA1 and 18:82 in NESDB. From this NHA2 study, the researchers estimated that health care expenditure in 1996 was increasing when compared to the GDP in that year. But in 1998, health expenditure was decreasing when compared to the GDP in that year. This was due to the economic crisis in Thailand. The main decline in health care expenditure was experience by the private sector with a 21% decline., but the expenditure from the government side was still increasing by 10%. This showed that the government played a big role in protecting people’s health during the economic crisis. Another finding indicated that individuals tended to spend less on services from both public and private health providers. They went by themselves to pharmacies and bought medicines to treat themselves. Although the government increased health care expenditure in general, it decreased its own spending on health prevention and promotion because, due to the economic crisis, the government needed to put more emphasis on treatment and curative services than preventive ones. In conclusion, a sustainable NHA and utilization of NHA for planning and policy development is a major national objective. Having a strong NHA structure will enhance the demonstration of how the country’s health resource were spent, what services were provided and who paid for them and will further facilitate international comparison, especially with members of the OECD countries.
