Abstract
In the contemporary development of the Thai national framework for health system development,
this report has drawn the experience of Brazil, the United States of America, and the United Kingdom for
lessons to be learned for Thailand. The study was conducted using document analysis carried out during
August to December 2007, by searching available information from the Internet. Data sources were from
published literature, the media and the websites of several organizations.
The study found that histories, political changes and reform initiatives have influenced the route of
health system development of different countries in different ways. Brazil, which had been under military
dictatorship for a long time during the period 1964-1985, has established a supporting mechanism for
people’s participation in health reform agenda-setting and health policy formulation. Widened participation
successfully pushed the concept of human rights in health care to be adopted in the 1988 Thai Constitution.
Since then universal access to health care has been established and financed with taxes. Every
new reform direction which has been adopted in the national health conference was incorporated to revisions
of the 1988 Constitution. The USA case presents a model of decentralization in health system development.
The federal government supported states in extending the coverage of health-care access. A
collaborative project involving academics and state governments called “Turning Point Initiative” formulated
a model of the overarching public health framework and formulated the “Model State Public Health
Act” which provides initiative ideas for the states to develop their own laws and development plans with
a collaboration from for all stakeholders in the state. The UK case presents long experience with centralized
management for controlling universal access, achieved since after the World War II. Several reforms
were introduced to tackle with the cost escalation and system irresponsiveness (long queues for elective
surgery, for example). Current issues include a balance of the centralized policy and decentralized management.
Thailand passed the National Health Act in January 2007 with the aim of establishing national health
governance which promotes the role of individuals and civil societies in participating in health policy
development and system monitoring and evaluation. Brazil’s experience in the supporting mechanism
for people’s participation is useful for Thailand for comparison with the Thai national health assembly
and for gaining knowledge for strengthening the role of civil societies in health policy development. The
experience of the USA in collaborative work among academics, state officials, and the private sector would
seem to be fruitful in the promotion of the deliberative policy process of health system development. An
experiment in a different context, such as in Thailand, should be practical. The UK’s experience shows the
transitions from the state’s responsibilities in people’s health to the community’s and individual’s choices
in health care. This reflects the direction of sharing responsibilities in society which Thailand has pursued
in this era of health system reform. This study suggested that, in the Asian context, Thailand could adapt,
but not adopt, some good concepts and procedures in health system development from these three countries
in order to establish a reform mechanism and an overarching health system framework with a particular
characteristic based on the wisdom of Thais.
