Abstract
After Universal Health Coverage policy was implemented in 2002, accessibility to
health services of Thai citizens have been increased especially catastrophic treatment.
Health outcomes have been improved. Nevertheless, there is constrained in the supply side
of the health care, shortage and inappropriate distribution of health facilities and human
resources in health. Public-private mixed in Thailand is also not efficient.
Thailand will be changing dramatically in the next 20 years from rapid progress of
technology, changing of socioeconomic situation and environmental changes. Thailand will
be aged society within next 20 years. Chronic disease and diseases of inappropriate lifestyle
will be a major burden of diseases.
This study used both qualitative technique and quantitative techniques. Researchers
developed 4 scenarios of health care. SC-0 is the situation that Thai social health protection
is fragmented. Harmonization is not success. SC-1 is the situation that Thai social health
protection is harmonized. However, Health literacy of people is low. Health care is provided
using passive approach. Health care facilities and health care personnel are inadequate and
distributed inappropriately. SC-2 is the situation that Thai social health protection is
harmonized. Health literacy of people is low. Health care facilities and health care personnel
are adequate. Morbidity expands from the increasing number of elderly with chronic
diseases. SC3 is the situation that Thai social health protection is harmonized. Health literacy
of people is good. People have appropriate lifestyle. Health care is provided using active
approach. Health care facilities and health care personnel are adequate. Morbidity is
compressed. Regarding the macroeconomic situation in the next 20 years, there are 3
scenarios. Potential economic growth scenario used previous trend to project Real GDP
growth. Prolonged Middle Income Trap scenario is the situation that Thailand has
institutional weakness. And Overcoming middle income trap scenario is the situation that
Thailand can reform institutions.
According to Potential economic growth scenario, SC3 need more money in the
initial period. However in the long run, the impact of people who are in better health status
will reduce health care expenditure to 3.03% of GDP. In contrast, if management of health
service system is inefficient and people still are low level of health literacy as in SC2, healthcare expenditure will increase to 3.5% of GDP. If the social health protection schemes
are harmonized alone without adequate supply side, health care expenditure in the long
run will increase to 3.08% of GDP in 2031, which is higher than the SC3.
Financial sustainability (Public debt less than 60% of GDP) of the social health
protection schemes depends mainly on economic growth. There is no financial sustainability
problem under Potential economic growth scenario and Prolonged Overcoming middle
income trap scenario. However, the problem of fiscal sustainability will be occurred in the
Middle Income Trap scenario. If policy makers would not like to decrease other public
spending, while maintain the level of health care expenditure. Reform of tax policy is
inevitable.
