บทคัดย่อ
Thailand’s National Health Security System resembles
the system of the United Kingdom (UK) in three respects.
First, it is entirely financed by tax revenue.
Second, it sets co-payment rates in a similar manner. In
the UK, services initially were provided completely free of
charge. Four years later, in 1952, when Winston Churchill was
re-elected as prime minister, a prescription charge of five pence
(£0.05) was introduced for obtaining medicines. Subsequently,
policies, criteria, and the fee schedule were revised on multiple
occasions for various reasons. In Thailand, by contrast, a co-pay
of 30 baht is charged per visit when receiving services.
Third, the UK began its system by nationalizing hospitals,
with the public accessing care initially through general practitioners (GP), who remained privately owned. In Thailand,
the public is required to register with primary care units, most
of which are publicly operated, with only a small number of
private hospitals participating.
Despite these similarities, there are several important
differences between the UK and Thai universal coverage
schemes, particularly with regard to drugstores. In the UK, the
drugstore (pharmacy) system is separate from GP services:
Physicians prescribe medicines on a prescription, and patients
obtain their medicines from drugstores, where pharmacists
dispense them. In contrast, Thailand’s primary care facilities—
whether they are part of regional hospitals, general hospitals,
community hospitals, or health stations (now upgraded to
Subdistrict Health Promoting Hospitals)—have their own
dispensaries or pharmacy departments within the healthcare
facilities themselves.
There have been continuous and long-standing efforts
to integrate drugstores into Thailand’s National Health
Security System, led by both the National Health Security
Office (NHSO) and the Pharmacy Council, through pilot projects
as well as policy advocacy. These efforts came to fruition
toward the end of fiscal year (FY) 2019, and were formally
launched at the beginning of FY 2020, on 1 October 2019.
Subsequently, during the Covid-19 epidemic, additional
initiatives were introduced to enable drugstores to provide
services under the National Health Security System, initially
allowing treatment for 16 minor (common) illnesses, later
expanding to 32 conditions. Drugstores were also engaged to
deliver health promotion and disease prevention services,
areas in which service utilization had been relatively low.
This volume is a product of the effort to distill lessons
learned from the implementation of these three programs.
The discussion begins by laying the groundwork with the background of the universal health coverage system, the Gold
Card Scheme, drugstores in Thailand, and the relationship
between drugstores and the National Health Security
System. This is followed by a summary of the implementation
outcomes of all three programs and a review of related
researches. The volume concludes with reflections from
representatives of drugstores participating in the programs,
and a final summary.
This resource is intended to provide stakeholders—
including policymakers, service providers, service users, and
the general public—with a comprehensive overview, so as to
offer information that enables meaningful participation in
system development and implementation. It is hoped that
this will contribute to good governance of the National
Health Security System, thereby genuinely enhancing the
well-being of the Thai population and the nation at large.
