Abstract
This future research study aimed to: 1) examine current situations and trends of factors influencing the health system, 2) explore plausible future scenarios of Thailand’s health system over the next
decade, and 3) synthesize policy recommendations suitable for future Thai contexts. The study was
conducted in three phases. Phase 1 examined trends and factors affecting the health system through
a systematic literature review and expert opinions, employing the ethnographic Delphi futures research
(EDFR) method. This involved in-depth interviews and questionnaires with 25 experts in health policy,
health systems, society, economy, and environment. Phase 2 involved developing four future health
system scenarios through two rounds of brainstorming workshops with 48 public health executives and 38
multidisciplinary experts from both public and private sectors. Phase 3 formulate policy recommendations
based on results from phases 1 and 2 to promote desirable future outcomes and mitigate undesirable
scenarios. Qualitative data were analyzed using content analysis, while quantitative data were analyzed
using descriptive statistics.
The study found that: 1) the influencing factors on health system could be categorized into
two main groups; 1.1) individual factors such as gender, age, marital status, income, education, health
experiences, health beliefs and behaviors, health literacy, and mental well-being; and 1.2) external
factors including environmental condition, social support, health workforce, health information systems,
communication channels, medical technology and innovation, health system accessibility, political
governance, and economic context. Uncertainty analysis identified 33 critical factors across six dimensions:
political and legal (6 factors), economic (6 factors), social (6 factors), technological (4 factors), environmental (5 factors), and health service systems (6 factors). The highest uncertainties were pandemics and
economic volatility. Based on these, four future scenarios were formulated: 1) Rapid economic growth
hindered by recurring pandemics, 2) Dual crisis of economy and public health, 3) Economic instability
without pandemics, and 4) Prosperous nation with a resilient health system.
The recommendations on health systems and policy were organized into seven areas: (a) Policy
– continuously advocate long-term health policy and the “Health in All Policies”; (b) Economy – encourage investment in clean technology, bio-circular-green (BCG) economy, medical innovation and health
development (medical hub) economy; (c) Society – improve elderly welfare, promote community
participation, mitigate household debt, and develop lifelong learning health curricula; (d) Health
technology and education – enhance the integration of healthcare technology and medical education;
(e) Environment – build healthy cities and environmental health surveillance systems; (f) Legal – revise
laws to safeguard patient rights, ensure access to digital health services, and improve environmental
health legislation; and (g) Health service systems – strengthen health service efficiency, decentralize
primary care, promote community-based services, integrate digital health data systems, reform employment models, and optimize healthcare financing for equity and sustainability.
