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Health Policy and Planning Advance Access originally published online on May 25, 2006
Health Policy and Planning 2006 21(4):310-318; doi:10.1093/heapol/czl017
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© The Author 2006. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.

Incoherent policies on universal coverage of health insurance and promotion of international trade in health services in Thailand

Cha-aim Pachanee and Suwit Wibulpolprasert

Ministry of Public Health, Nonthaburi, Thailand

Correspondence: Ms Cha-aim Pachanee, International Health Office, Bureau of Policy and strategy, Office of Permanent Secretary, Ministry of Public Health, Tiwanond Road, Nonthaburi 11000, Thailand. Tel: +61 2 6125 5611; Fax: +61 2 6125 0740; E-mail: chaaim{at}health.moph.go.th and Chaaim.pachanee{at}anu.edu.au.

The Thai government has implemented universal coverage of health insurance since October 2001. Universal access to antiretroviral (ARV) drugs has also been included since October 2003. These two policies have greatly increased the demand for health services and human resources for health, particularly among public health care providers.

After the 1997 economic crisis, private health care providers, with the support of the government, embarked on new marketing strategies targeted at attracting foreign patients. Consequently, increasing numbers of foreign patients are visiting Thailand to seek medical care. In addition, the economic recovery since 2001 has greatly increased the demand for private health services among the Thai population.

The increasing demand and much higher financial incentives from urban private providers have attracted health personnel, particularly medical doctors, from rural public health care facilities. Responding to this increasing demand and internal brain drain, in mid-2004 the Thai government approved the increased production of medical doctors by 10 678 in the following 15 years. Many additional financial incentives have also been applied. However, the immediate shortage of human resources needs to be addressed competently and urgently.

Equity in health care access under this situation of competing demands from dual track policies is a challenge to policy makers and analysts. This paper summarizes the situation and trends as well as the responses by the Thai government. Both supply and demand side responses are described, and some solutions to restore equity in health care access are proposed.

Key Words: universal access, health insurance, private health providers, trade in health services, human resources for health, brain drain, health care equity

1The career for Thai civil servants starts from PC level 1 rising to PC level 11. PC level 9 is the level for Deputy Director General of a Central Department or the deputy governor.


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Home page
 Global Social PolicyHome page
S. Wibulpolprasert and C.-A. Pachanee
Addressing the Internal Brain Drain of Medical Doctors in Thailand: The Story and Lesson Learned
Global Social Policy, April 1, 2008; 8(1): 12 - 15.
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